Are EP’s routinely offering Watchman as an alternative to thinners?

I am curious if there has been a move to routinely offer Watchman at the time of ablation as an alternative to long term thinners. It seems that this may become more the standard. The Penn Medicine website says that they routinely offer Watchman to most of their patients with afib. Medicare now has a new code for when a Watchman is placed at time of ablation and this may encourage the combined approach. Traditionally I think Watchman was only offered as an option if you had experienced a complication with thinners but that may be changing.

The winds have definitely changed. Watchman and similar LAA closure devices were once reserved for patients who couldn't tolerate any anticoagulant, so it was definitely a niche item. But insurers have seen the benefits of a large one-time cost vs. years or even decades of expensive meds. Plus there are no patient compliance issues with a Watchman. People are terrible taking anticoagulants regularly because they don't do anything the patient can see or feel. So stroke and heart attack risks should fall as the Watchman becomes more commonplace.

I haven't seen any numbers on how many centers are offering a Watchman with ablation, but I know it's becoming more common. It makes perfect sense to do one procedure instead of two. However, there is a catch. The people who need a Watchman the most are people who've had their LAA isolated, and unfortunately a Watchman can't be placed in those patients until after the ablation. There's concern with swelling around the LAA that could cause the device to not implant and seal correctly.

My sister was a nurse and knew two males who had the Watchman procedure, developed complications and died. I was in the hospital earlier in January 2025 for Fludder and Afib and they gave me one tablet of Eloquest and I dumped a large amount of blood in my stool. I had not had that for years with my UC. After that they gave me no more and the bleeding went away. I have been taking Nattokanase 100 mg morn and night for years before that with no side effects.

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Kenai
My sister was a nurse and knew two males who had the Watchman procedure, developed complications and died.

To add a little perspective here, two anecdotal deaths is meaningless. There is no invasive medical procedure with a zero death rate, not even filling dental cavities. That said, the complication rates for the Watchman are extremely low and deaths are vanishingly uncommon. In the Watchman FLX trials, 0.45% of patients had a key safety endpoint, with a 0.81% all-cause death rate at 45 days. And keep in mind that an all-cause death rate means causes unrelated to the Watchman are included.

If the same surgeon, same facility, same team, were having repeatedly high mortality rates in Watchman installations, we could probably all worry, but only about those same parameters...not about the 'Watchman' itself, or about its utility. Instead, two patients died, and may have been due to die anyway, or they were just coincidental, linked only by their familiarity to the nurse in question. Natale installs Watchman devices all the time, probably once or twice a day, and doesn't appear to be looking at it askance these days.

I was at work today and assisted with two cardioversions for patients in atrial fibrillation . I was saddened to hear the active patient who does farming/ranching/etc. Ask the doctor if he would always have to be on meds. The doctor said yes. This is a patient who is first time in Afib, first time Cardio version, has not yet met with an EP or had an ablation and the doctor told him he will have to be on Eliquis forever and probably Metoprolol forever. Why would he say that? I asked about the Watchman, and he said it just wasn't as consistent in preventing strokes and just wasn't a viable option. I was disappointed to hear that said to a new Afib patient at the beginning of his journey from a fairly new Cardiologist.

Yeah, that was pretty disappointing because the ED doctor was flat wrong and speaking from a position of ignorance. He should have just told the guy he needed to find an EP and ask them.

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Kenai
My sister was a nurse and knew two males who had the Watchman procedure, developed complications and died. I was in the hospital earlier in January 2025 for Fludder and Afib and they gave me one tablet of Eloquest and I dumped a large amount of blood in my stool. I had not had that for years with my UC. After that they gave me no more and the bleeding went away. I have been taking Nattokanase 100 mg morn and night for years before that with no side effects.

It was the result of an inexperience EP I speculate. I remember being a patient at the hospital for uncontrollable tachycardia and I was seen by an on call EP. He was pushing a watchman. I asked him if had any iatrogenic problems and he replied honestly. He said he tore 5 patient’s hearts. Why he was allowed to still practice is a mystery. I also personally know of an EP who butchered cyro ablations and was kicked off the trials.

Not all EPs are experienced and have manual dexterity. I always asked during my pre-op appointments if the surgeon considers himself an artist with a knife. To get into a dental technology program, my entrance test was getting a bar of soap and given a knife and told to create something. My dentist had to take the soap test, I wonder if EPs are required.

As Carey mentioned, your sister heard 2 isolated cases that doesn’t represent the watchman population of patients who had procedures. I, myself, am the beta tester of what can go wrong does go wrong. However out of my 21 surgeries and ablations, my watchman was successful with minimal affects except for the usual hematoma one gets at the site. I was walking around after two hours and discharged 4 hours after my watchman.

I would ask your sister if the two who died had the same EP.

Had my ablation and Watchman last week-7 days ago exactly. Nary a palpitation post procedure. Went for my first run yesterday (4.5 miles) and felt great. My EP was fine with that as long as the groin was healing well which it was. Have ok to get back to the gym as well.