Published:
February 6, 2023
If you have atrial fibrillation, or A-Fib, chances are you probably take a blood thinner. Your cardiologist prescribed this medication (also called an anticoagulant) to help prevent blood clots from forming in your heart. A blood clot could break lose and cause a stroke. While blood thinners are a good therapy for most patients, they can also be related to an increased risk for bleeding issues – some of which can be very serious.
For some patients, the WATCHMAN device is an alternative to taking life-long blood thinners. The WATCHMAN is implanted into a specific area of the heart where clots are known to form, and by blocking off this area, has been proven to prevent strokes as effectively as blood thinners.
What is A-Fib and Why Can it Cause a Stroke?
Let’s start by taking a quick look at A-Fib itself. Atrial fibrillation is a type of irregular heartbeat, or arrhythmia. It is a problem with the heart’s electrical system that causes its two upper chambers (the atria) to quiver or fibrillate. When this happens, blood can collect in a pouch called the left atrial appendage (LAA) where it has a greater chance of forming blood clots. This can then be dangerous because clots can travel to the brain, block blood flow, and cause a stroke. Someone with A-Fib is about five times more likely to have a stroke than someone with a normal heart rhythm.
A variety of health problems that damage the heart and its electrical system can cause A-Fib, including:
- High blood pressure
- Coronary heart disease
- Heart failure
- Heart surgery
- Lung disease
- Overactive thyroid gland
While some people don’t have symptoms of A-Fib, others may feel dizzy, tired, short of breath, or notice a fluttering, racing or pounding in their chest. If you are experiencing these symptoms, your doctor will likely do a physical exam and order an electrocardiogram (EKG) to look for problems with your heart’s electrical pattern.
Is the WATCHMAN Procedure Right for You?
After being diagnosed with A-Fib, your cardiologist will determine the treatment that is right for you. In many cases, this will be taking a blood thinner. The FDA-approved WATCHMAN device may be an option for people with A-Fib not related to a heart valve problem. This one-time minimally-invasive procedure doesn’t require open heart surgery and may reduce your risk of stroke for a lifetime.
Your cardiologist may recommend the WATCHMAN procedure if:
- You are at increased risk of stroke
- You have non-valvular A-Fib (A-Fib not caused by a heart valve problem)
- You have a history of bleeding or a job or lifestyle that puts you at risk for bleeding
- There is a reason for treating your A-Fib with a method that doesn’t involve taking blood thinners for the rest of your life
How the WATCHMAN Device Works
The WATCHMAN is a mesh-covered device about the size of a quarter. The device is inserted by a cardiac electrophysiologist—a heart doctor who specializes in treating heart rhythm problems. Electrophysiologists with The Heart Group of Lancaster General Health were some of the first in the region to offer this advanced procedure which closes off the left atrial appendage (LAA) where blood clots often form, reducing the chance of stroke.
The WATCHMAN Procedure
Before the actual procedure, you will likely have some tests to make sure you are a good candidate for the WATCHMAN. Your doctor will answer any questions you may have and provide instructions on how to prepare.
The approximately one-hour, minimally-invasive procedure is done in a hospital under general anesthesia. Doctors insert a large IV in a vein in your groin area. They then insert a catheter (small tube) through this vein and advance the closed WATCHMAN to the opening of the left atrial appendage. The WATCHMAN device is then pushed out of the catheter into the LAA where it opens, similar to small umbrella to permanently seal off the LAA. Over the next several weeks to months, your own heart tissue grows over the WATCHMAN to form a barrier against blood clots.
Patients with a WATCHMAN device remain on blood thinners for a short period of time—usually a few weeks or months—while the device heals over and becomes part of the heart. During this time, the medications are sometimes changed, but with the ultimate goal/plan of discontinuing the blood thinner. Eventually, most patients continue on only a baby Aspirin.
You usually leave the hospital the same day as the procedure. You may have some bruising where the catheter was inserted and will need to limit your activity for about a week. Your doctor will explain what you need to do to help assure a successful recovery.
So, if you have A-Fib and would like to consider permanently reducing your risk of stroke without the worries that can come with taking life-long blood thinners, talk to your cardiologist. Your doctor will carefully review all of your options to help you make the choice that is best for you.