Watchman

After having two strokes involving the cerebellum, I may be getting a Watchman. What questions should I be asking? For those with a Watchman, what is your experience? What is recovery like? Thanks.

I have one. Implanted Sept 2018, so two years now.

The only question you need to be asking your doctor is how many they've done? You don't want to be their early learning experience.

As for my experience, no problems whatsoever. I'm completely unaware of its existence and have been since the moment I woke up after the procedure, which only took about 20 minutes. Since there's an insertion site you have to lie flat for 2 hours after the procedure (6 hrs if they don't use collagen plugs), but after that I was up, walking around, having dinner, etc. It's a nothing procedure since you're only under anesthesia for minutes, there's only one insertion site, and especially since there's no burning going on. Assuming all goes well, you'll never even be aware it's in you. (And neither will TSA -- airport scanners don't detect it.) I've met a dozen or so people who've received a Watchman and they all report the same experience.

With your stroke history, I would leap at the chance if I were you.

Do they have to do a transceptal puncture to install it ?

Thanks, Carey. That was very reassuring to hear. After lurking on this site I learned to go to a high volume EP center. Dr. Natale did my original ablation 7 years ago. Except for Takosubo cardiomyopathy 4 yrs ago, I’ve been in NSR. A ZIO patch last month allowed TCA to tell me I could stop low dose Eliquis and take baby ASA. I didn’t tell them I had been having some benign vertigo. Four days later I had a stroke to my cerebellum. Dr. Natale put me on high dose Eliquis. Tuesday, 11/24 Dr. Natale will do another ablation and Watchman.

After the initial ablation 7 yr ago I felt like I had been run over by a truck for a couple weeks but was fine after a month. Expect this touch-up ablation will be easier. This Watchman is new to me but I understand Dr. Natale has put in many. I intend to ask him about that.

Thanks for the info about airport travel. Glad I won’t be setting off the alarms for TSA!

Betty

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NotLyingAboutMyAfib
Do they have to do a transceptal puncture to install it ?

Yes.

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bstevens
After the initial ablation 7 yr ago I felt like I had been run over by a truck for a couple weeks but was fine after a month. Expect this touch-up ablation will be easier. This Watchman is new to me but I understand Dr. Natale has put in many. I intend to ask him about that.

Touch ups typically are much easier since there's far less burning going on. And since he'll already be in the left atrium for the touch up, that means installing the Watchman won't require any additional invasive procedures. It will just add an extra 5-10 minutes to the procedure.

In 2018 Natale had done several hundred Watchman devices, so I would imagine he's done well over 1000 at this point. You're in good hands.

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bstevens
After having two strokes involving the cerebellum, I may be getting a Watchman. What questions should I be asking? For those with a Watchman, what is your experience? What is recovery like? Thanks.

I had a Watchman FLX installed, like Cary, in 9/18. I'd echo Carey's advice and confirm his experience. I simply don't notice it. Recovery pretty easy. I'm pretty sure that Natale will be giving you the newer FLX version, but you might want to confirm.

Thanks for the good information. It is reassuring to hear from others who have had the same. How long did you take off from work? How long after getting the Watchman did you remain on Eliquis or blood thinner? Do the Watchmans come in different sizes and is it more difficult to put one in a woman than a man? Is the complication rate different?
Betty

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bstevens
Thanks for the good information. It is reassuring to hear from others who have had the same. How long did you take off from work? How long after getting the Watchman did you remain on Eliquis or blood thinner? Do the Watchmans come in different sizes and is it more difficult to put one in a woman than a man? Is the complication rate different?
Betty

I only needed to be off work for 2 days (day of procedure and the next day), but I had to travel to Austin so there were a couple extra days for travel. If you have a job that requires lifting, you would need to take a week off since you have to avoid lifting more than 10 lbs for a week to allow the insertion site to heal.

You'll be on an anticoagulant and aspirin (or clopidogrel) for 6 weeks. After 6 weeks you'll undergo a TEE to make sure the device is properly seated and has no leaks. If everything looks good with the TEE, you can stop the anticoagulant. At this point it becomes a choice for you and your doctor to make. The FDA protocol is a full-strength aspirin for life at this point, but not all doctors agree that's the best choice. Your choices will be: 1) take nothing (the usual procedure in Europe), 2) take an aspirin per day for life (the FDA recommendation), or 3) take a half-dose Eliquis for life. In my case, Natale thought that the half-dose Eliquis was the best choice. It has a lower bleed risk than aspirin and doesn't cause ulcers, and has added benefits similar to taking a daily baby aspirin but with fewer side effects. My PCP and local EP agreed that half-dose Eliquis was the best choice, so that's what I'm doing. (It helps a lot that my insurance covers Eliquis at 100%.) If I were a CHADS 0 or 1, I'd probably be taking nothing, but I'm a CHADS 2 so the Eliquis has attractive benefits. Between the Eliquis and the Watchman, my risks of stroke, DVT, PE, etc. are extremely low. And if I need to stop the Eliquis for some sort of procedure, that's no problem. I just stop for as long as necessary with no significant risk because the Watchman is still there doing its job.

Carey- you make so much sense getting a watchman. I hope one day soon they develop one without nickel. My np had the watchman’s rep check it out and it does contain a nickel alloy. What a shame. I’m waiting for my 6 month post LAA ablation to get a TEE. Hopefully I can finally get my gallbladder out (major surgery-no laparoscopic). I would love not to worry about bridging. But obviously the odds are not the greatest that the TEE will show my LAA isolation will allow me to discontinue

You'll be on an anticoagulant and aspirin

Carey - just noticed this after posting a new topic - [www.afibbers.org]

How much aspirin in this situation? Thanks.

Low dose or "baby" aspirin. Once you get above 100 mg the antiplatelet activity of aspirin doesn't increase, so there's no point in taking more. Generally, the only reason to ever take more than low-dose aspirin is if you're looking for pain relief.

Go it - thanks !

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bstevens
Do the Watchmans come in different sizes and is it more difficult to put one in a woman than a man? Is the complication rate different?Betty

Betty,

The Watchman certainly does come in different sizes. Different people (whether male or female) have left atrial appendages (LAAs) of different sizes and various odd shapes.That's why they give you a TEE (transesophageal echocardiogram) before a Watchman procedure, either on the same day or several days before.They need to see and measure the size and shape of the LAA.

I can't speak authoritatively about whether women or men have more complications.I haven't heard of it.

All best,

Lance

To my knowledge there's no difference in complication rates between men and women. Can't imagine why there would be.

And these days, complications are extraordinarily rare with an experienced operator. If you look up complication rates you'll probably find a study that had some alarming numbers, but that study was done when the Watchman was a brand new device and EPs had zero experience with it. Turns out experience matters and over the years they've gotten it down pat. Major complications in the highest-risk patients are about 1.5% and that's across all EPs. But experienced operators like Natale probably have complication rates well under 1%.

Great to hear your procedure went so well and you're off aspirin. It's rather amazing how treatment has evolved. While I still prefer warfarin over eloquis (ha ha), looks like we're all doing well!

Dr Natale did my touch-up ablation and Watchman three days ago. They said he seats Watchmans on Tuesdays and I was the 4th one that day. The touch-up ablation wasn’t much cause he had already ablated most everything 7 yrs ago. No need for a TEE cause he decides about the LAA and Watchman using ICE. The first FLX Watchman he tried leaked so he went for a bigger size to close the LAA which he said was no problem. Collagen patches to the puncture sites mean only 2 hrs bed rest then I was up walking. No foley cath. Yeah!! No post op pain. I’m on Eliquis 2.5 and life is good.

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bstevens
I’m on Eliquis 2.5 and life is good.

Glad to hear things went so well for you. No aspirin or clopidogrel?

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bstevens
The first FLX Watchman he tried leaked so he went for a bigger size to close the LAA which he said was no problem. . . . No post op pain. I’m on Eliquis 2.5 and life is good.

Good news! Happy for you.

Someone asked earlier in this tread about different sizes. Here's confirmation, and also of the fact that, as I understand it, one advantage of the new FLX version is that if one doesn't quite fit, the operator can pop it out and try again with another. I believe this was much more difficult with the earlier Watchman version.

Best, Lance

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Carey

I’m on Eliquis 2.5 and life is good.

Glad to hear things went so well for you. No aspirin or clopidogrel?

No aspirin or clopidogrel. He said he may leave me on Eliquis cause I’ve had thrombus to cerebellum x2 recently.
Thanks,
Betty

If you have to stay on a blood thinner, then why get a Watchman? I had always thought that one of the reasons to get a Watchman was to get off bloodthinners.

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Elizabeth
If you have to stay on a blood thinner, then why get a Watchman? I had always thought that one of the reasons to get a Watchman was to get off bloodthinners.

See Carey's message above..

Elizabeth,
I had a stroke taking Eliquis 2.5 mg twice a day. Dr. Natale increased the Eliquis to 5 mg twice a day and put in a Watchman. The purpose of the Watchman is to prevent strokes. Now that the Watchman is seated, the Eliquis has been decreased to low dose again. I would rather have both the Watchman and Eliquis than to have strokes.
Betty

Betty:

You were on Eliquis when you had the strokes?

L

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Elizabeth
Betty:

You were on Eliquis when you had the strokes?

L

2.5mg probably ineffective without the Watchman

Regarding the Watchman and anticoagulants, one needs to keep in mind that the LAA isn't the only source of emboli that can causes strokes, and your CHADS-Vasc score still matters. What a Watchman does is completely eliminate the LAA as a source of emboli, which means it eliminates 90% of the risk of strokes due to afib. That means it reduces your stroke risk to the same level as someone who has never had afib and who has the same CHADS-Vasc score as you do. But it has no effect on other sources, such as ruptured arterial plaques, and that's where your CHADS-Vasc score comes in. If you're a CHADS 1 or less, you can safely stop taking an anticoagulant after a Watchman, but if you're a 3 or higher, you would be foolish not to remain on at least a low dose of an anticoagulant, Watchman or not. (Probably Betty's situation given the prior strokes.)

A Watchman also has no effect on clots within the venous circulation, such as DVTs that can cause pulmonary embolisms, which can be just as deadly as strokes.

Does your heart function normally when in AF didn't think it did, but i may be wrong. i am in persistent AF i am able to do everything that i did before being persistent expect i do tire easier and get a little short of breath when walking a distance. i don't believe that a person's heart is functioning normally when in AF like this Doc. O'Connor says, am i wrong?


The following is from the doctor of a person you all know;
His doctor now describes the atrial fibrillation as 'persistent.' O'Connor cited a list of tests that show the candidate's heart is functioning normally and his only needed care is a blood thinner to prevent the most worrisome risk, blood clots or stroke.

Elizabeth,

Afib is an abnormal heart rhythm. That means It is not normal. If untreated it can lead to serious complications. Untreated Afib is associated with blood clots, cognitive impairment, heart attack, heart failure, stroke, and sudden cardiac arrest. Otherwise it is harmless.

Betty

Great to hear Betty!

So glad you got the WatchmanFLX done plus a quick minor touch up by Dr N in the same visit.

Best wishes to you Betty, keep us posted going forward and enjoy!

Cheers!
Shannon

Thank Shannon!

I appreciate your support and guidance over the years. Hope this finds you and your family doing well.
Will keep you posted.

Be safe and well,

Betty

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bstevens
Elizabeth,

Afib is an abnormal heart rhythm. That means It is not normal. If untreated it can lead to serious complications. Untreated Afib is associated with blood clots, cognitive impairment, heart attack, heart failure, stroke, and sudden cardiac arrest. Otherwise it is harmless.

Betty

b stevens:

And how do you treat Af? i am now in persistent AF after being in Proximal AF for about 20 years, and I am now just on a blood thinner for it. Apparently from what I have read about the person of whom I was speaking of, is that he is only on a blood thinner as well and i am sure he has the best doctors in the world.