Watchman vs NOAC safety against clots

[www.inquirer.com]

“The downside: expense, potential complications, and spiraling use as the device begins to be implanted for questionable indications. There have already been well more than 50,000 placed worldwide. Questions have been raised about validity of studies, many of which have been sponsored by the device manufacturer.

Boston Scientific, the manufacturer, charges a hospital an upfront fee to start a program to put in the devices. The hospital even gets a discount if it puts in more devices, a potential incentive.

In an analysis by researchers at the University of Alabama-Birmingham, almost 60,000 patients treated for atrial fibrillation were compared, and it was found that medications were safer than the Watchman device. Apixaban (Eliquis) was the safest, followed by edoxaban (Savaysa), dabigatran (Pradaxa), warfarin (Coumadin) and then rivaroxaban (Xarelto); the Watchman device ranked last.”

analysis:
[journals.plos.org]



[www.heartrhythmjournal.com]
[a-fib.com]
Closure of the LAA



Edited 1 time(s). Last edit at 02/06/2022 02:25AM by susan.d.

Everything that article cites is years old and no longer accurate. And citing Mandrola first does nothing to enhance his credibility. No one considering a Watchman should use this article as guidance.



Edited 1 time(s). Last edit at 02/07/2022 10:06AM by Carey.

I didn’t cite Mandrola. That was another thread. I gave more than one link above.

This one is more recognized:
[www.ncbi.nlm.nih.gov]

It comes down to skill of the EP but I don’t know how many patients fall into the below group and are just plain unlucky. If even a just a few, its not 100% flawless for those who can tolerate the NOAC and opt for the watchman that comes with some slight potential risks they are unaware about.


“Disadvantages of the percutaneous transcatheter closure of the LAA are as follows: In general, guiding catheters, stiff wires manipulation, the Watchman device itself, and transseptal puncture procedure can cause pericardial effusions/tamponade during occlusion of the LAA.6,21,22) Air embolism and device embolization are also procedural complications related to transseptal puncture and device implantation. Five out of 449 patients who had Watchman device implantation, as reported by Holmes et al.21) had periprocedural stroke secondary to air embolism, and about 0.2% of cases had device embolization. Other possible outcomes of the procedure can be cardiac arrest, stroke, hypotension, acute coronary ischemia, and death.“



Edited 2 time(s). Last edit at 02/06/2022 12:47PM by susan.d.

Ive decided that since my Watchman is scheduled 2/16 in Austin im going skydiving this afternoon
I think that ea of those risks are identical to pre ablation

Can I come with Tom? I’ll bring my sotalol. I have a fear of heights.

It’s on my bucket list. I conquered my fear of drowning (almost drowned at 5-sunk to the bottom of the lake) by taking a catamaran snorkeling trip not knowing how to swim. I just paid a random crew worker $20 to jump in if I drowned. I dove in and conquered that fear. The next day I returned during a real bad Puerto Rico rain storm with rocky huge waves. That time the same guy really earned his second $20 by sending out a rescue search.

Just think: you me and Jay all in Austin within the same few days!
And i trust we ll all have a positive outcome. We ll all at a minimum be better!

This may be a more balanced view of the procedure:

[www.medtechdive.com]

Thank you Joy! My gosh!

I don’t mind Eliquis at all and am 100% compliant. I took a poll at the ER and was told if I am on full strength Eliquis, I have the green light for any potential ecv but not with the watchman. I was told they would treat me as a clot risk. I would remain on full dose afterwards. I can’t take aspirin. I only considered the watchman for future surgeries, colonoscopies and pacemaker battery swaps. I had a huge orange fruit size hematoma from my pacemaker that lasted 6 painful weeks. A major surgery would present its own bleeding problems after pre surgery bridging and Eliquis right afterwards.



Edited 1 time(s). Last edit at 02/06/2022 08:15PM by susan.d.

Quote
susan.d
I didn’t cite Mandrola.

No, but the author of the article you linked did. He seemed to pretty much base his entire viewpoint on it.

Is everyone here aware that Shannon Dickson, the editor of this site, wrote an article for Medscape rebutting Mandrola's opinions on this subject? It's rather old now but it's still accurate and worth reading. It demonstrates why I don't put much credence in Mandrola's opinions on this subject.

And seriously, on the subject of LAA isolation and occlusion, it's an emerging field that has been advancing rapidly, so we need to pay attention to publication dates. Articles older than a couple of years may be very misleading.

More hogwash. Do you really think Dr Natale s accident rate is 6.3 and 3.9 for Watchman?? Lol. Seriously
Look : we re all in a type of checkmate. We have to make a move. Every move has some risk and thats it
No one forces us to do anything. The internet is a Godsend its also a poison

In reply to [www.afibbers.org]

Quote
Carey

I didn’t cite Mandrola.

No, but the author of the article you linked did. He seemed to pretty much base his entire viewpoint on it.
.

I included four links..not solely on one author that you and Shannon disagree upon.

One was a-fib.com link above. Shannon has submitted articles there. I value this link the most because of Dr Jais’s comments. Many here has their successful ablations from this excellent EP. In the words of Dr. Pierre Jais of the Bordeaux Group at the 2020 AF Symposium, “We have ablated too much…Those patients when they have the (Left Atrial) Appendage taken out, they have very poor residual LA (Left Atrium) function. I don’t want that to happen anymore. If we can avoid it, I think we should.” Dr. Jais later added, “Sinus rhythm is by definition superior to persistent A-Fib. But the best ablation strategy is the one that restores sinus rhythm at the least tissue cost, thereby preserving as much as possible the LA function.”

I wonder if there is a similarity to a watchman’s affects of closing (scar tissue after 45 days) to Dr Jais comment on LAA functionality when the LAA is surgically removed or modified.

There was a fourth heart rhythm journal link where I did linked Dr. Mandrola along with other cardiologists authors, but I value healthy rhythm journal because both doctors Natale and Horton have excellent articles published plus the many excellent citations this journal article listed. There is no reason to discount the other authors of the article or the excellent sources they listed because Mandrola poisoned the well.

Regarding articles older than two years may be outdated, you reference Shannon’s rebuttal, while a quite a gem to read, also falls in the same older published date category.

I look at it this way. My LAA was a mess when Dr. N. did my first ablation and at the post touch up TEE in '17 because the flow out of the LAA was so poor he warned me that if things didn't go well a Watchman, then second gen, might be in my future. I got five very good years of bicycle riding and many thousands of miles on my motorcycle when things went sort of south back in Oct. At my pre-procedure telemedicine call last week he said, "we'll fix everything and implant the Watchman." I said, "fine with me." When you aren't on fire and aren't getting shot at life's pretty darn good. We'll get 'er done next week and I'll go on a long motorcycle tour to Yellowstone this fall.



Edited 1 time(s). Last edit at 02/08/2022 08:39AM by JayBros.

I need an iv hooked up from Jay to me and get some of his DNA, Blood etc
So its right back to the mind - body concept which is growing in so many areas of health
No your mind cant cure afib or broken bones or cancer but! It can absolutely expedite healing and
Better outcomes. For anyone interested : Nicole Sachs podcasts and YouTube, Dan at Pain Free You on youtube
Dr John Sarno books. Dr Howard Schubiner books and YouTube. Some dont need it most do. FEAR in the sub concious the primary driver
Sounds quackery. Its not. Your mind can make water come from your eyes. Your mind can make your heart beat faster
Your mind can cause headaches. Those are the obvious

Tom

I remember many years back hearing about a physician who gave a lecture on how the mind and thought processes can affect one's health and wellbeing

He was addressing a very skeptical audience so he asked them to bear with him while he read an excerpt from a book.
The book in question was a very erotic novel.
As he read on, there was a lot of fidgeting and movement from his audience and some muted coughs and giggles.

He then put the book down and asked if anyone had felt a physical or mental reaction while he was reading.
The majority of the audience agreed, yes.

The physician replied, if reading a page or two from a book can alter the way you feel and think, how do you think long-term worry and negativity will affect a person's wellbeing?



Edited 1 time(s). Last edit at 02/10/2022 06:58PM by JoyWin.