Any experences with Watchman Implant for A-Fib?

Posted by Tresjur @tresjur, Oct 5, 2017

I've been living with A-Fib for close to 20 years now. I took warfarin for 14 of those years and then switched to Pradaxa. After being on Pradaxa for 8 months, I started having GI bleeds and over the course of 14 months I had 8 blood transfusions. After ending up with a hemogloblin count of 5 and
an INR of 9, I ended up in ICU. After my release, and lengthy discussions with my cardiologist, we decided that my body could no longer tolerate the
blood thinners. For three years I went without any A-fib treatment and a year ago I started taking a full dose aspirin daily.

Early this summer I saw the TV ads for the Watchman, for people who cannot take blood thinners. It's an jellyfish looking implant that is inserted in the
left atrial appendage of the heart. After implantation, heart tissue will grow over the device and provide blockage of clots that could travel to the brain.
I had the implantation done on September 13th, which requires an overnight stay in the hospital, and will be on Eliquis and an aspirin for about 45 days, then I will just take an aspirin daily for the rest of my life.

From reading the pros and cons of this device, it is my understanding that it does not work any better than blood thinners, but is an option for those who
cannot take the thinners. My first visit with the electrophysiologist is 2 weeks from today and at the end of October, I will undergo another TEE to determine
if all is working well.

I lived the 3 plus years not being on blood thinners with the though of stroke in the back of my mind. Even though I realize that nothing is 100% guaranteed or successful, I do have some relief now that I am again under treatment.

I'm posting this experience and wondering if anyone else has undergone this procedure and may be further along in their journey. It has been only 22 days
since my implant. I'm doing well so far and have not had a problem with the Eliquis so far.

Regards,
Mary

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@bergordon

Hi Mary,
Just wanted you to know I had the Watchman Device implanted this past Monday. Like with you, the stitches were removed the same day and I did stay overnight. I had no problems whatsoever with the procedure. My plan is to stay on Eliquis for 45 days, have a TEE on March 22 to determine if the opening is totally closed, then to get off of Eliquis and be on Plavix and baby aspirin for 6 months. If everything is fine during that period, I will quit taking the Plavix and only take the baby aspirin. Sounds like a pretty good plan. This week (since the Implant on Feb 5th) has been good - no problems at all! I’m hoping this is the start of an improvement stage!!
How are things going with you?

Take care!
Billie

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Thank you for the information. I have been wrestling with this decision for about 5 months. My afib was controlled well with Flecainide and Eliquis as my blood thinner for 4 years but I had an episode of gastrointestinal bleeding early this year requiring a blood transfusion. I just had my 2nd opinion by an electrophysiologist from Cleveland Clinic. It looks like the procedure is in my future but it's nice to hear firsthand from someone who has been through it. I appreciate your sharing this. I still get anxious when I think about inserting something within my heart though.

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Mary, I had a Watchman implant nearly 2 years ago in December 2021. The procedure was straight forward and did involve 1 night in the hospital. The worst part for me was the need to lie still on my back for 6 hours after the procedure while the entry point in my groin closed and began clotting. Followup TEE’s have showed the Watchman to be in place and functioning as planned. To me, it has been invisible as I have no sensation that it is there. I do take a daily 325 mg aspirin, as directed, and have handled that as well. Having the Watchman gives me peace of mind about not having blood clots and an associated stroke. While I am not immune from blood clots forming and traveling to my brain, the risk of this happening has been reduced by having the Watchman. Before my procedure, I shared your concerns about having something inserted into my heart. I suggest reading as much as you can about it. Also, I found an animation of the procedure somewhere on line that helped me visualize exactly what was going to be done, which was helpful to me. Having been through it now, I feel that it was a safe, mostly painless procedure that yields great benefits and I would not hesitate to encourage you to go forward with it, if that is your wish. Best of luck to you!

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Why bother to render an opinion when we have data from two studies (the "PROTECT" & "PREVAIL" studies) & a rigorous assessment of LAAO & implantation of the Watchman from one of America's preeminent electrophysiologists (cardiologist & clinical researcher), John Mandrola, M.D.?

Quoting the major points against LAAO & implantation of the Watchman--& the URL to Dr. Mandrola's review (in his role as the cardiology editor for Medscape) in his Medscape article: See: https://johnmandrola.substack.com/p/the-case-against-watchman-for-stroke:

"Six major points form the case against this procedure:

* Data from the two pivotal regulatory trials (Watchman vs Warfarin) do not convince me. There were higher rates of ischemic stroke in the Watchman arm.

* PROTECT and PREVAIL (studies of LAAO & the implantation of the Watchman) found no difference in major bleeding (if you count bleeding surrounding the procedure).

* Percutaneous closure requires anti-platelet therapy and at least two studies find bleeding rates on anti-platelets are not much different from anticoagulants.

* A foreign body in the heart can act as a nidus for clot formation. Device-related thrombus has been reported—and can occur many months after implant.

* The procedure to implant this device has a major complication rate ranging from 3-9%. So even if there were future benefits (there aren’t), patients start the gamble with a significant upfront risk of harm.

* There is dubious pathophysiological basis for this procedure. Recall that stroke is a systemic disease and LAA appendage closure is a focal solution."

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