Possible to have an ablation and watchmen at the same time?

I recently spoke with my EP at Sutter Health in San Francisco, Dr Hao, and he indicated that he does not perform a second ablation and the watchmen at the same time. He indicated that when a Watchman device or other similar types of devices are inserted into a patient it limits the amount of future ablation work that I can occur at that spot. Is that correct? I think I've heard some other opinions on the topic before.

Thank you

Yes, it's possible. I know a couple of people on this forum who've had both done in a single procedure and another on another forum who will be having it done soon. I don't understand his reasoning unless he thinks your LAA will need to be isolated in your next procedure. But if he gets in there and doesn't find any arrhythmias originating in the LAA, I don't understand why he couldn't go ahead and do the Watchman. There are EPs who will do that, including Dr. Natale who practices in CA once a month.

I am interested in this question too as I'm being evaluated by Dr. Natale for a 1st ablation and if he finds it necessary to isolate the LAA, it would seem easiest to put in a Watchman at the same time. Does anyone know if it would be "routine" for Dr. Natale to do this if the patient has requested it, or whether there are some special circumstances necessary for him to do both at the same time?

And, if the LAA doesn't need to be isolated, would there be an advantage to placing a Watchman just as a further precaution against clots?

Carey, yes he wants to keep the option open of isolating the LAA in the next procedure. He said he would wait for a period of time to see if I needed another ablation. If not, then a watchman could be inserted.

All the best

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Daisy
I am interested in this question too as I'm being evaluated by Dr. Natale for a 1st ablation and if he finds it necessary to isolate the LAA, it would seem easiest to put in a Watchman at the same time. Does anyone know if it would be "routine" for Dr. Natale to do this if the patient has requested it, or whether there are some special circumstances necessary for him to do both at the same time?

And, if the LAA doesn't need to be isolated, would there be an advantage to placing a Watchman just as a further precaution against clots?

I don't think it's routine, but I also don't think he'll hesitate if it's appropriate for the patient. I'm unaware of any special circumstances other than both procedures being medically justifiable.

And that last part is why nobody will put a Watchman in just as a further precaution. They won't because the insurance company won't approve it. They've loosened up a lot since I got mine in 2018, but they still insist on there at least being a high clot risk. Having an isolated LAA would be an example of such high risk. But in 2018, that wouldn't have been sufficient and I would have been denied.

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Edited 1 time(s). Last edit at 05/15/2022 11:31AM by Mac.

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Mac
Sure it can be done.
I’d be careful about it, though. As you’ve noted, once it’s in place the LAA can’t be ablated from the inside anymore.
So you want to be really confident that you won’t need an LAA ablation in the future
My LAA was ablated several different times over the years . . .so you never really know.
I had a touch up ablation and Watchman done at the same time a couple months ago.
But that was my fifth ablation, so I’m pretty much at the end of that road.

Thanks, but I'm going to ask for clarification: is there a difference between ablating the LAA and isolating it? I had been under the impression that isolating the LAA was a 'once and done."

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Daisy
Thanks, but I'm going to ask for clarification: is there a difference between ablating the LAA and isolating it? I had been under the impression that isolating the LAA was a 'once and done."

No, there isn't. I'm probably guilty of using the term "ablating" when I should have said "isolating" but the two terms are synonymous.

It should be and normally is a "one and done." I've never heard of more than one LAA isolation being performed, so Mac's story is surprising to me. I'd love to hear more details on how that happened.

Hi Carey,
I went back and looked at my procedure reports online.
Although I could only see them going back to 2019, they did not reference my LAA being ablated more than once.
So I think I am wrong.
I did have ablations before 2019, but I’m not sure exactly what areas were ablated, so I don’t want to guess and possibly put erroneous info out there.
Sorry about that! Please ignore my post.

Spoke to Natale's NP at Los Robles today, watchmans are put in after the the LAA procedure in case they need to go back and do more on the LAA.

There are exceptions. Natale and other EPs have done combined procedures. I'm still waiting on answers to my questions about this from Natale but he's a busy guy and this is a particularly busy time for him. But he knows there's wide interest in this question so he will respond soon.