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stroke risk with watchman

Posted by redalfa1961 
stroke risk with watchman
September 08, 2017 02:16PM
Since the major concern with afib is prevention of stroke, I was wondering if there are any studies comparing subsequent overall stroke risk in patients who have a Watchman device vs. pts who do not have a Watchman device but are 100% compliant taking their NOAC post ablation (as I am). This would assume the remainder of the heart is completely structurally normal (as is mine) other than a mild to mod decreased LAA velocity 8 months post ablation. ( mine is 0.4 I am told)
Thanks in advance for reading and replying
Re: stroke risk with watchman
September 09, 2017 07:20PM
What is NOAC? Something anticoagulation? Why would the left atrial appendage velocity be decreased 8 months post ablation?
Re: stroke risk with watchman
September 10, 2017 06:33PM
Libby NOAC is an acronym for 'Novel Oral Anti-Coagulant' and includes all the newer OAC drugs like Eliquis, Xeralto, Savaysa (Edoxaban), and Pradaxa (Dabigatran) ... in short, all the non-Vitamin-K antagonist with warfarin being the main Vitamin K Antagonist OAC drug.

LAA velocity typically is only decreased at the 6 month TEE scan that is required for those whose ablation included an LAA isolation as part of the ablation process. And LAA velocity is only delayed significantly 6 months post ablation in approximately 58% of those Afibber's who had full LAA isolation. Meaning that 42% retain enough LAA mechanical function to at least be considered for stopping all OAC drugs long term .. and only assuming their CHADS-VASc score is less than 2.

People who remain in unaddressed and poorly controlled persistent and LSPAF, their LAA function is almost always significantly impaired as it is, and thus almost always will require long term OAC therapy so long as durable NSR has not been restored, regardless of their CHADS-VASc. As such, for those folks with either advanced paroxysmal AFIB, with frequent and typically lengthy symptomatic episodes as well as persistent and LSPAF cases, in a practical sense the only way such folks are realistically going to be able to stop OAC drugs is with successfully re-gaining durable NSR from a successful LAA isolation as part of a complete expert ablation process, but 58% of those causes will still either have to stay on a NOAC or Warfarin .... OR... qualify for and undergo a successful LAA Closure procedure such as Watchman, Amulet, Atriclip or LARIAT PLUS procedure.

By undergoing the later LAA Closure an even larger percentage of LAA isolation patients can often qualify for stopping OAC drugs long term. In any event, this is an individual decision to discuss and decide between the patient and a highly-experienced EP who performed the LAA isolation and who possibly will perform the LAA Closure procedure as well.


Edited 1 time(s). Last edit at 09/13/2017 12:13PM by Shannon.
Re: stroke risk with watchman
September 10, 2017 08:01PM
Thanks Shannon!
I'm an echo tech, but didn't know about isolation of the appendage in EP. Why is the velocity lower? Does the appendage contract?
We are doing Watchman procedures and I have been involved in the pre-procedure TEE's, but not part of the team doing the actual procedure. Learn something new every day!
Re: stroke risk with watchman
September 11, 2017 08:23AM
Re: stroke risk with watchman
September 11, 2017 10:10PM
I'm an echo tech, but didn't know about isolation of the appendage in EP. Why is the velocity lower? Does the appendage contract?

Re: stroke risk with watchman
September 13, 2017 12:16PM
Thanks George! We are on the same wavelength as usual ... I was looking up that same editorial by Drs. DiBiase and Natale on LAA Closure after LAA Isolation when I noticed you had beat me to the punch! 👍

Re: stroke risk with watchman
September 14, 2017 08:43PM
Here's some information from the Zurich LAA meeting just a couple weeks ago:


This details the surgical and catheter options for LAA closure and the current state of the art regarding said procedures. I'm sure Shannon could enlighten us. Bottom line to my unscientific mind is that the next year or two should bring the very best options into clearer focus.

I linked to this PDF from their landing page at:

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