Watchman

I just heard back from my Afib nurse that my EP is recommending ablating my atrial appendage due to continued arrhythmia after my second ablation and installing a watchman. This is just not what I had in my mind. I am a 55 year old, very active female. I think I am too young for this. Will it decrease my cardiac output and my way of life? Is there any long-term cautions about this or is it too new? Help!

In July I had my LAA ablated as it was one source of my arrhythmia. When speaking with my EP the following day I discussed the possibility of the watchman device. He said that for me it was not yet an option for 2 reasons. First and foremost Wass the fact that there may need to be more work done on the LAA. Secondly at my age ,52, insurance would not want to pay for it.

From what I’ve read here you shouldn’t be concerned about reduced cardiac output plus the Watchman device has been around for a while now and has just been replaced/is about to be replaced by a new revised version.

Shannon and Carey will doubtless soon be along to give you all the proper info plus I’m sure no small dregree of reassurance that you haven’t got much if anything to be worried about.

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rocketritch
In July I had my LAA ablated as it was one source of my arrhythmia. When speaking with my EP the following day I discussed the possibility of the watchman device. He said that for me it was not yet an option for 2 reasons. First and foremost Wass the fact that there may need to be more work done on the LAA. Secondly at my age ,52, insurance would not want to pay for it.

Forgive my ignorance here, but what’s the deal with your age insurance-wise? Given that you’re still quite young it can’t be because you’re too old so must be because you’re too young?! I would have thought that at your age it’s not great to have to stay on an AC for the next 30-40 years?

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MissSunshine
I just heard back from my Afib nurse that my EP is recommending ablating my atrial appendage due to continued arrhythmia after my second ablation and installing a watchman. This is just not what I had in my mind. I am a 55 year old, very active female. I think I am too young for this. Will it decrease my cardiac output and my way of life? Is there any long-term cautions about this or is it too new? Help!

It has no effect on cardiac output. My LAA was isolated in August 2017 and I had a Watchman implanted six weeks ago. I'm an avid cyclist so I would definitely recognize any reduction in cardiac output. I noticed none from either the LAA isolation or the Watchman.

As others have mentioned, the problem is going to be convincing your insurance company to pay for it. Currently, the policy of Medicare and virtually all insurance companies is to only cover a Watchman if you can't tolerate anticoagulants and you're CHADS-Vasc score is 2 or higher. They haven't recognized the fact that an isolated LAA raises your stroke risk significantly if afterwards you don't have adequate blood flow through the LAA, and about 65% of patients won't. In that case, you must remain on on anticoagulant continuously and indefinitely. They have seen strokes in people after missing only a dose or two, so obviously that justifies a Watchman following LAA isolation, but insurance companies just haven't come around to accepting that yet. I think they will in the next few years as more and more LAA isolations occur and the inevitable increase in strokes start costing them money. So you might have to remain on anticoagulant for a couple of years before they'll approve it.

To anyone who has had their LAA isolated during an ablation and hasn't had their flow velocity measured or didn't meet the minimums, I would say be utterly religious about taking your anticoagulant. Do not miss a single dose EVER. And do not follow instructions from other doctors to stop your anticoagulant for any reason. If you need a procedure that requires stopping it, there are protocols for bridging you with heparin that your EP can provide.

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mwcf

In July I had my LAA ablated as it was one source of my arrhythmia. When speaking with my EP the following day I discussed the possibility of the watchman device. He said that for me it was not yet an option for 2 reasons. First and foremost Wass the fact that there may need to be more work done on the LAA. Secondly at my age ,52, insurance would not want to pay for it.

Forgive my ignorance here, but what’s the deal with your age insurance-wise? Given that you’re still quite young it can’t be because you’re too old so must be because you’re too young?! I would have thought that at your age it’s not great to have to stay on an AC for the next 30-40 years?

Not sure. That is just what Dr. Natale said. Who knows how insurance works. I think the bigger issue is with the LAA and the fact that ablating it is not easy, even fior elite EP’s. Which leaves the possibility for touch up work. Dr. Natale ablated around my LAA twice during my procedure and did not rule out having to address it again.



Edited 2 time(s). Last edit at 09/19/2018 07:23PM by rocketritch.

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rocketritch


In July I had my LAA ablated as it was one source of my arrhythmia. When speaking with my EP the following day I discussed the possibility of the watchman device. He said that for me it was not yet an option for 2 reasons. First and foremost Wass the fact that there may need to be more work done on the LAA. Secondly at my age ,52, insurance would not want to pay for it.

Forgive my ignorance here, but what’s the deal with your age insurance-wise? Given that you’re still quite young it can’t be because you’re too old so must be because you’re too young?! I would have thought that at your age it’s not great to have to stay on an AC for the next 30-40 years?

Not sure. That is just what Dr. Natale said. Who knows how insurance works. I think the bigger issue is with the LAA and the fact that ablating it is not easy, even fior elite EP’s. Which leaves the possibility for touch up work. Dr. Natale ablated around my LAA twice during my procedure and did not rule out having to address it again.

Even with a Watchman, and I have one (mine’s about an hour older than Carey’s), Natale said he still can do more work in the area should it be needed.

Carey and AB Page - what was your determining factor in going for the Watchman? Could you no longer tolerate ACs? How have you been feeling? Did you deal with Pericarditis? Did your EP ablate before he installed the watchman? Thank you for your insight. You have no idea how grateful I am for all of you.

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MissSunshine
Carey and AB Page - what was your determining factor in going for the Watchman? Could you no longer tolerate ACs? How have you been feeling? Did you deal with Pericarditis? Did your EP ablate before he installed the watchman? Thank you for your insight. You have no idea how grateful I am for all of you.

I tolerate anticoagulants just fine. No pericarditis or anything like that. I feel great!

I went for the Watchman because my last ablation that finally solved my afib and flutter problem required isolating my LAA. And when they did a TEE six months later they found that I did not have adequate flow through my LAA to come off anticoagulants. So that meant anticoagulants for life despite being completely free of arrhythmias. And with an isolated LAA it also meant I couldn't risk missing even a dose or two. What are the odds that's not going to happen in the next 20-30 years I might expect to live? Right. Zero.

So when the opportunity to get into the Watchman FLX trial came along, I jumped on it.

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MissSunshine
Carey and AB Page - what was your determining factor in going for the Watchman? Could you no longer tolerate ACs? How have you been feeling? Did you deal with Pericarditis? Did your EP ablate before he installed the watchman? Thank you for your insight. You have no idea how grateful I am for all of you.

My determining factor was a strong desire to be free of AC, though I tolerate Eliquis fine. And the reasons Carey mentioned, especially with an isolated LAA, even though my TEE numbers were fairly good. I don't like the stroke possibility with an iso LAA and I don't like the long-term bleed risk on AC. I've felt great from the time I came out of anesthesia. The procedure is trivial in regards to recovery, if not potential risk. I had my 2nd ablation (1st by Natale) 14 months prior, which is when my LAA was isolated. NSR since. I'm now off the Eliquis and taking clopidogrel/aspirin and tolerating it well. I expect and hope to be clear of the clopidogrel in February.



Edited 1 time(s). Last edit at 09/20/2018 04:51PM by AB Page.