Getting a Watchman next week and feeling unsure...and scared

After speaking with Shannon not long ago, I decided I would take the opportunity to get the Watchman while Dr. Natale was visiting here in New York. Then Omicron hit and I backed out, and thought I would just catch him when he's back in town.
It seems that Dr Natale doesn't know when he'll be back in town and it may not be for awhile....so I should get on his schedule again. I am now scheduled for the morning of January 11th (my birthday, btw!), and am feeling hesitant...and second guessing myself.

I had a LAA isolation ablation back in September of 2013, and then a "touch up" in June 2014, both by Dr. Natale. I have been Afib free ever since...for 7 1/2 years. I will be turning 69 (yikes) next week, and would love to get off or at least go to the lower dose of Eliquis, and also not have to worry about forgetting a dose, and all the other worries with a blood thinner.

I still am not clear as to why anything more is needed, as I had successful ablations and no longer have Afib. It's been over 7 years and all is well. Why am I still at risk for a stroke? Is it really necessary to get a Watchman, and are they over rated? I read an article saying they have been heavily marketed and that the blood thinners were better (safer?) . I would rather not be going into a hospital during a surge in Covid, but I am triple vaccinated and of course, will mask up too (I hope they mask me up when they roll me into the recovery room, elevator, etc).

Who's had a Watchman put in and what are your thoughts? I am looking for reassurance and if there are any strong reasons to just WAIT, I'd like to hear that too.

Thanks in advance ~ Barb

Barb- I was n95 masked in late 2020 and April of this year while being prepped for the ablations and while being wheeled to the Cath lab. Natale’s team let me keep my mask on until anesthesia and laid it down on a sterile sheet on a table and showed me where my mask will be once they started the ablation. Once the procedure was done, they promised they would put the mask back on me…and they did both times. I woke up with my mask.

All you have to do is ask. I went one step further and while admitted, the nurses allowed a sign in my door that said “keep this door shut and no housekeeping”. Everyone had their own room so I felt safer.

Regarding elevators. I don’t share since the pandemic to get my social distance.

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tobherd
I still am not clear as to why anything more is needed, as I had successful ablations and no longer have Afib. It's been over 7 years and all is well. Why am I still at risk for a stroke?

Because you don't have an LAA that pumps adequately. Once your LAA was isolated, it no longer pumps normally and consequently blood can stagnate in it and form clots. Without constant anticoagulation you would be at very high risk of stroke.

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Is it really necessary to get a Watchman, and are they over rated? I read an article saying they have been heavily marketed and that the blood thinners were better (safer?) .

No, a Watchman isn't necessary; you could remain on full-dose Eliquis for life instead, being careful never to miss a single dose. I don't know what being overrated means in this context. That makes no sense. I've also not seen data showing that anticoagulants are safer, but I have seen evidence showing quite the opposite.

I looked at the Watchman carefully before I got one, and I looked only at actual research data, not marketing. The data is convincing and very credible. I have a suspicion I know what article you saw, and if I'm right, the author actually knows very little about the Watchman and LAA isolation in general. He fancies himself a crusader and writes contrarian articles for the lay public that stir up fear, uncertainty and doubt among patients. He is not taken seriously in the EP community.

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Who's had a Watchman put in and what are your thoughts? I am looking for reassurance and if there are any strong reasons to just WAIT, I'd like to hear that too.

My thoughts are if I were in your shoes I would be booking my flights right now. Ask yourself this: How are you going to live the rest of your life never missing a single dose of anticoagulant? How will you do colonoscopies or surgeries? Are you sure the time will never come that you will be unable to take them for any reason whatsoever? (Lose them, traveling, illness, injury, surgery, just plain forget, etc etc) That was one of my primary reasons. I think the odds of me living out my entire life taking 2 pills a day, every single day without fail, are approximately zero. Remember, that LAA of yours is a clot factory without an anticoagulant. A Watchman turns it into a harmless appendage, and you'll be getting it from one of the most experienced Watchman operators in the world.

I can't think of any reason to wait, not even weak ones, and definitely not strong ones.

I would also point out that it's a breeze of a procedure. It takes about 20-30 minutes of actual procedure time, and then you're awake again and should be feeling perfectly fine since there's no trauma involved as with an ablation. I had to lay flat for 2 hours to let the single insertion site seal, and then I was walking the halls, ordering dinner, and feeling like nothing whatsoever had happened.

Thank you Susan and Carey for your replies. I do feel better after reading them. I had worried about how the mask thing would be handled, and feel better hearing your experience, Susan. I think they are planning to have me leave the same day, so there won't be any overnight, unless of course, something needs to be watched more.

And Carey, I am lucky in that this doesn't require a flight - my daughter is going to drop me off at my son's apt (not far from the hospital),the night before, and my son will bring me to the hospital the morning of the procedure. That's the main reason I decided to do this now - Dr. Natale will be about an hour away from me versus traveling from NY to Texas will all of the expenses, etc.
As for forgetting a dose, I didn't realize that just missing one dose was a big deal - I have already done that a number of times....so I do agree, it's hard to always remember every single dose. I have also worried about any possible surgeries, etc. that might be needed and having to get off of Eliquis then. So you are right - I guess I didn't realize what having a LAA ablation really meant in terms of the risks afterwards.

I think I have to stop Googling the Watchman, as I read about the many possible side effects or things that could go wrong...and the author of the article I saw saying it was heavily marketed was David Becker, a cardiologist. Is that who you were thinking of, Carey?

I was instructed to “bridge” (substitute Eliquis for a shorter half life blood thinners) prior surgery to be protected when temporarily off Eliquis.

I religiously take my Eliquis at 8/8. I set my iPhone to give me a very loud annoying ringtone that is very long until I take it. I can hear the ringtone from across the house and my IWatch just keeps vibrating. It cuts down on forgetting to dose.

Unfortunately due to frequent admissions, I fight like heck for the RNs to dispense it on time. I speculate caregivers or hospital personnel are not as compliant as I am…and that is my risk concern once dosing is out of my control.

I do wonder if I would ever be allowed (ER protocol) another ecv, if needed, after the watchman once I cut down Eliquis or stop and substitute a baby aspirin? One of the first ER questions was always “are you still taking your Eliquis?” I don’t know if all ER doctors will be willing (malpractice check box) to ecv with a watchman instead of a full dose of Eliquis twice a day.



Edited 1 time(s). Last edit at 01/04/2022 03:03PM by susan.d.

Carey has always said that he has had a watchman but he is still on a blood thinner. I don't know about others on this board that have had a watchman if they are also on a blood thinner, it is said to take aspirin if you have a watchman.

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Elizabeth
Carey has always said that he has had a watchman but he is still on a blood thinner. I don't know about others on this board that have had a watchman if they are also on a blood thinner, it is said to take aspirin if you have a watchman.

I am saving Carey from retyping :-)

[www.afibbers.org]

[www.afibbers.org]



Edited 1 time(s). Last edit at 01/04/2022 11:23PM by susan.d.

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tobherd
I think I have to stop Googling the Watchman, as I read about the many possible side effects or things that could go wrong...and the author of the article I saw saying it was heavily marketed was David Becker, a cardiologist. Is that who you were thinking of, Carey?

Google any invasive procedure you can think of -- even dental procedures -- and you'll find scary stuff. So it's best not to even google stuff like that unless you're prepared to read and understand the actual published science because you'll probably find opinion pieces written by people with a bias who selectively highlight negatives, or the opposite, people who selectively highlight positives. Becker isn't who I was thinking of but I think I did see what he wrote and wasn't impressed. Like most of the critics he fell back on old data.

Most of the problems with Watchman was early in its development and centered around complications due to operator inexperience rather than the device itself. As more and more EPs became experienced at implanting it, the complications dropped swiftly to the point where they're extremely low today, and negligible in the hands of experienced operators. So what that means is you want the most experienced operator you can find. You'd be hard pressed to find an EP with more Watchman implants than Natale, and if you did it would probably be his coworker Rodney Horton. (Natale did mine in 2018 with Horton assisting.)

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susan.d
I am saving Carey from retyping :-)

Thank you!

Carey, you are a CHAD 2, what advice for a CHAD 4-5-6?

Would a half dose Eliquis be enough and would temporarily stopping Eliquis and avoid bridging (advantage of the watchman) during surgery be safe after a successful watchman when compared to someone with a CHAD2?

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susan.d
Carey, you are a CHAD 2, what advice for a CHAD 4-5-6?

Would a half dose Eliquis be enough and would temporarily stopping Eliquis and avoid bridging (advantage of the watchman) during surgery be safe after a successful watchman when compared to someone with a CHAD2?

Well, it's probably going to depend on why the person is a CHADS 4-6 and what other issues they have. For example, someone with a history of clots from other sources (DVTs, for example) would probably want to stay on a full dose even with a Watchman. For that person the Watchman is adding protection from LAA clots but it can't do anything about clots in your legs.

But assuming they're a CHADS 4 because of, say, age + gender + hypertension, I would think a Watchman plus half dose would be fine.