Last time I wrote the device was relatively new (long term data wasn’t yet available), and based on my research it didn’t seem like a great choice. Ashley Festa is a Greenville, S.C.-based freelance writer and editor who has been writing professionally for nearly two decades. I’m 56 years old and can not take blood thinners, my doctor thinks I’m a good candidate for the watchman. This was the main reason for having the device implanted. Age itself is not a contraindication. If you want to stay local maybe start with your electrophysiologist. She recently had a stroke and was airlifted to Sunrise Hospital in Las Vegas. As things stand, the decision is made based on risk of bleeding and risk of stroke. This time it was the sutchers that were bleeding. Is there another dye or such that could be used? Even at 87 there may be significant benefit, and the procedure can be done safely in the right hands. Typically after 45 days the blood thinner Coumadin can be stopped. In people with atrial fibrillation, this sac quivers constantly, the blood in the sac becomes stagnant as a result, and clots can form in it known as left atrial appendage clots. They told us her bleeding was due to Pradaxa and they have now put her on Eliquis. Please discuss with the treating team and involve them in any discussions regarding stopping any blood thinner prematurely. In the US, as things stand, Coumadin for 45 days after the procedure then after that switch to aspirin and plavix until 6 months then aspirin alone is the typical protocol. Disclaimer: The comment response is opinion and in no way affiliated with my employer. plse It shouldn’t lead to alteration in afib characteristics. My Dad recently received a Watchman. Switch the Watchman on and off. Most medical procedures have risks. As things stand, the evidence is there only for patients that don’t tolerate blood thinner. Regardless, when it comes to stroke prevention strategy, it is an approved method and widely offered and hopefully over the next few years the data becomes more clear. Minor dementia after prolonged hospitalization. I don’t have a relationship with Boston Watchman as things stand nor do i seek one. The device seals the LAA and prevents the … Will have consult re watchman. Again I strongly recommend clarifying this with the treating team. about a month. so the surgery was very high risk but was completed successfully. Almost half of patients with atrial fibrillation cannot tolerate the blood thinner. Regardless successful use of the Watchman Device has been described in all these circumstances. What type of questions and do you know what I need to do. Recovery typically takes twenty-four hours. He has had endoscopy, colonoscopy, and various other tests to find where blood loss is. Friend was scheduled for watchman but it couldn’t be done because of large clot blocking access – friend also has dementia and doesn’t understand what dr said – thus far, unable to gain access to dr…, Would they have removed the clot, dissolved it or ignored it – I don’t know where the clot was/is – I’m extremely concerned and unable to get answers – help please. The chicken wing can sometimes be straightforward and sometimes more difficult. Arizona Heart Rhythm Center. She has had 3 ablations & loop monitor placement due to complaints of SOB & chest discomfort. She is upset that she has to continue taking these as this is one of the biggest reasons for her having the procedure. Dr Ahmed, so glad I came across your site. The whole goal of the Watchman Procedure is to close off the left atrial appendage. The WATCHMAN device does not cure nonvalvular atrial fibrillation, but you may be able to stop taking blood thinners like warfarin if the LAA seals properly. After watchman procedure about two months my heart beat sounds like an old clock and is The procedure lasts on average about one hour and patients usually spend the next 24 hours in the hospital. 3. And what can be done about it? These healthy foods taste great, help you manage your blood sugar levels, and lower your risk of heart disease, too. What can be done about a leaking watchman i had it put in 6-27-18 & on 8-29-18 my tee showed leaking after 60 plus days & I’m still taking Warfarin is there any procedure to be done to stop this leakage from around the device. In such patients, the Watchman Device is felt to be a good alternative to reduce stroke risk. My father had a Watchman put in about 10 months ago. I am in Afib often and have had two strokes and a number of TIA’s. Specifically, it is a parachute-shaped, self-expanding device that is placed in the opening of the LAA. In our center, safety and success rates of the watchman has been excellent. You might be a maze procedure candidate if you have atrial fibrillation (afib) that is not well controlled by medication and you need heart surgery. Another physician in his group discharged me, and I excitedly showed him my lower blood pressure readings They typically form in a small sac called the left atrial appendage. Implanting the Watchman Device in to the left atrial appendage basically closes off the appendage and prevents any clots forming inside. What do you think of this procedure for somebody almost 87? As things stand, the blood thinning medication Coumadin needs to be taken for 45 days after the procedure. Are at increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores and are recommended for anticoagulation therapy; 2. Prepare for next appointment. The factors that determine the need to stay on anticoagulation are whether there is leak around the device and whether there is any evidence of clot seen at follow up. Would depend on the risk to benefit ratio of stopping the anticoagulation. Im not familiar with the lasso procedure, do you mean the lariat? As per the current watchman protocol most patients will need to be able to take coumadin after the procedure for 45 days. Even in those patients who have already fulfilled the above criteria, the Watchman Device should not be used in the following groups of patients. My grandmother had the watchman a couple of months ago. After that his counts came up!! I believe the “trauma” that caused the hematomas was very aggressive head bouncing, shaking, and bumping by my hair salon while shampooing my hair! What’s your thoughts? You can reduce your risk of complications by: Informing your healthcare providers if you are allergic to anesthetics or have had complications from anesthesia in the past, Lying flat for several hours after the procedure to prevent bleeding at the catheter insertion site, Taking care to research the cardiac electrophysiologist carefully, considering his or her experience implanting the WATCHMAN device, Notifying your doctor immediately of any concerns, such as bleeding or pain. I’ve been told to stop blood thinners after approximately 6 months due to a bunch of otherwise mysterious bleeds including painful internal hemorrhage in calf with walking painful after several weeks. After the procedure, heart tissue will grow over the implant within about 45 days. Just with the little i know from your very nicely worded question, unless you are sure its something you want for sure it may well be best avoided particularly if there is a wish to avoid anesthesia, and given his advanced co-morbidities. Firstly, access to the leg vessel is obtained through a small needle and a wire. I am a 74 year old female with persistent AFib, am scheduled for an ablation procedure in 3 weeks, with a Wachman to be implanted a week later. Examples would be patients who have had a bleed or are at high risk for bleed for various reasons. He can only walk a few steps with a walker and just sits all day due to back problems that docs think is secondary to his prostate cancer. Thanks, This is an entirely independent piece without compensation of any sort with the intent to educate. A Cardiologist friend of mine mentioned to also look at the Lasso procedure. How does Watchman work with a pacemaker? This cord is removed by gently unscrewing the cord until the device is detached. Congestive heart failure                   – a history of heart failure is             1 point, Hypertension                                     – a history of high BP is                     1 point, Age ≥ 75                                              – age ≥ 75 is                                          1 point, Diabetes                                             – a history of diabetes is                     1 point, Stroke                                                 – stroke or TIA history is                   2 points. Depends on the local team, no real reason for a significant delay. The WATCHMAN Implant is a quarter-sized device used to help prevent blood clots formed in the LAA from breaking loose and causing a stroke in patients with non-valvular AFib. The battery model required is: VARTA CR2430, and they are avaliable locally from good photographic shops or chemists or can be … Do you know of anyone doing a ‘gene’ study that is studying/following patients with afib and failed control by ‘blood thinners’. If you have an increased risk for stroke and have nonvalvular afib, but you aren’t able to take blood thinners because of side effects, compliance, or bleeding problems, your doctor may recommend mechanical LAA closure. To help the procedure go as smoothly as possible: Don’t eat or drink after midnight the night before your procedure. It is extremely lightweight. This usually takes about 6 weeks. I was currently on eliguis and baby asprin. The watchman has been around for several years and experienced teams have performed this with excellent safety profile. He has had 3 TIAs during this time. The blood thinners, all of them cause me back pain…mostly due to kidney intolerance to the drugs…the worse was Warfarin. Always consult a medical provider for diagnosis and treatment. To implant WATCHMAN, your doctor makes a small cut in your upper leg and inserts a narrow tube, as done in a standard stent procedure. His left atrium is 48. There have been instances described of placement of further devices in significant leaks although evidence for such a strategy is lacking. I am waiting on the EP who did her Watchman to call). Effects of Anesthesia. Has been on Xarelto 15 mg. for a couple of years due to afib (possibly due to previous alcohol abuse). If she ultimately has the watchman then contrast would be required and premedication given prior to the procedure. My mother is 63 yrs old and has had 2 major bleeds recently and the 2nd one was so bad the doctors basically said she almost bleed to death. When she was taken off the Warfarin earlier this year for abdominal surgery (off for 10 days total) by day 11 she had her first stroke. So, if we had a patient that is 75 years old (1 point), and has a history of high blood pressure (1 point) and diabetes (1 point), this gives us 3 points and therefore a CHADS2 score of 3. I have an unruptured basilar tip brain aneurysm which has been coiled 3 times. I cannot take blood thinners so this is my alternative. My very healthy 84 yr old Mom had a Watchman. Its critical that the patient understand what is going on and you shouldn’t hesitate to have them and the family discuss with the treating team. After ending […] The clot may have been in the leg, or in the heart in the appendage. It is being controlled by medication. An irregular heartbeat can result in slower blood flow in the heart, which can cause blood clots to form. Post-FDA Approval, Initial US Clinical Experience with Watchman Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation, Low Heart Rate – Bradycardia Explained by a Heart Doctor. Would you recommend the procedure with such an allergy? I have been on Eliquis for the past three years. Reasons may include inability to use a TEE probe for imaging, the presence of active bleeding or infection, anatomy that does not allow catheters to be used appropriately, the patient has a hypersensitivity to the components of the device, etc. To highlight a very small detail of the depth of information I am talking about…if there are 5 different sizes of the Watchman, how does the doctor determine the correct size, or during the procedure, at what step does the doctor perform the “tug test” and does this tug test procedure mean the same for all doctors? Living with heart failure requires careful management of your symptoms and lifestyle. There are small anchors in the device that keep it in place also. She has been on Coumadin for her Afib for several years but in the last few months her INR has been quite erratic. Last week based on an electrocardiogram Cardiologist determined need for an angiogram since I unable to complete stress test and results of chemical test not clear. The watchman can technically be performed in most people however in terms of stroke reduction there will not be a lot known regarding the situation you have described. They did a cardioversion with flecainide and her BP droped dangerously. Time to Cost-Effectiveness Following Stroke Reduction Strategies in AF. I was put on Eliquis over coumadin as my favorite vegetables are spinach, broccoli, and sprouts, also I live in the boonies and going for blood tests was difficult after surgeries (at that time I was scheduled for hip and knee replacements). Now he is afraid that the afib may have made the watchman move out of place because of the rapid heart rate. The device is advanced to the appendage through the tube. In general management of these depends on the size of the leak, if it is less than 5 mm it is felt to be non significant, if greater than this the treating team may choose to place you on blood thinner for an extended time or perform closer follow up or such. The Watchman does not treat the atrial fibrillation itself but is rather a procedure that reduces the risk of stroke due to atrial fibrillation, Nguyen stressed. My 86 yr. old mother has had two bleeds in her eye twice within the last 6 months. Do you think the procedure was done badly or is it just a complication of the watchmen that caused this? In general watchman is reserved for those that are not good candidates for anticoagulation. This certainly needs to be discussed at length with the implanting team. The watchman is certainly more well known and performed. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider. I also said what are true statistics as to how many have you installed and tracked had to stay on blood thinners as I would not want to go thru and still take the meds. I am yet to see a clot on the device or a significant leak and have therefore been able to take everyone off the anticoagulation. If the insertion site bleeds, lie down and apply pressure to the area for several minutes. Your doctor may prescribe another blood thinner for a few months … Can this be a pleasant side affect of my watchman? I have genetic issues of being a non expressor of all anticoagulnts including plavix nd warfarin xarelto and eliquis. How long have WATCHMAN implant procedures been performed? I have a friend who has had a successful Watchman proceedure done in Texas and I may get names from her. I have a dear friend who has no close family and for whom I am the health surrogate. She cannot take blood thinners due to bleeding risks in lungs. He has intermittent afib. This causes her to bleed occasionally when she coughs. Its important to be fully comfortable prior to agreeing to the procedure as there is always a risk with any invasive procedure. Left atrial appendage closure (LAAC) with the Watchman device is an alternative to warfarin in patients with atrial fibrillation (AF) at moderate to high risk for stroke and are not optimal candidates for long-term anticoagulation. This allows you to easily monitor the oil levels in your tank and prevent run outs. After TAVR, it’s especially important to focus on heart-healthy eating. Would I be a candidate for a Watchman even though I have had a fairly successful oblation? This needs to be determined by the treating team. My husband went in to have it done after having a TEE done and when they got in there they said the opening was larger than the largest size of watchman they had and they couldn’t do it. After reading all this good information I am scared to death. I am not an MD but am pretty knowledgeable but I have no idea what to tell her to ask her cardiodoc. The Watchman device is used to close off the left atrial appendage. Also, anesthesia in the past caused memory problems. He told me to stop giving my husband Heparin injections and justvstart baby aspirin, a thing the hospital staff had mentioned for his future. my heart doctor He has had intense left-chest pains for five days now. After doing a video endoscopy they discovered the leak in his small intestine. In your opinion Dr Ahmed, what would you do if the watchmans devise didn’t sit right ? In my circumstances would it be reasonable to wait till then? Less than a week later she started having symptomatic episodes of Afib and is extremely tired. I was in the NeuroICU of our local hospital for a few days and was sent home after 3 CAT scans, the final one upon discharge showed gradual decrease in the hematomas. My hands bruise terribly with big red mark just from touching something. The watchman seals it. Historically patients with atrial fibrillation that were considered to be of a high stroke risk were treated with blood thinning medications such as Coumadin / Warfarin to reduce stroke risk. Heart beat ticks like an old clock and is noisy after Watchman procedure. Are You a Candidate for the Maze Procedure? In terms of activity you may be told to take it easy for a day or so to prevent bleeding issues from the vessels of the leg the device was placed through. I cannot decide if this is absolutely necessary and I am also terrified of anesthesia. U.S. Food and Drug Administration. Etc. The content on Healthgrades does not provide medical advice. Firstly lets look at the official guidelines then we can discuss this in a little more detail in a way that patients can understand. The watchman was suggested an an alternative to blood thinner in a patient that is not a good candidate for long term use of blood thinner due to the risk of hemorrhagic stroke. A fib only noted after segmentectomy of lung last year. Get important maze procedure facts and information you might not know, including the difference between a full maze and mini-maze procedure, and how they compare to catheter ablation for afib. Dr’s said he was totally unresponsive and wanted to remove ventilator and let him die. Thank you. This come about after As with any invasive procedure there are risks associated. In order to be a candidate for the Watchman Device, the following criteria need all to be fulfilled. You can follow our twitter at @MustafaAhmedMD. About this time, you will follow up with your doctor to make sure the device has sealed off the LAA and to discuss discontinuing blood thinner medications. She is past the 45 day window for being on blood thinners. Atrial Fibrillation: What is Your Heart Trying to Tell You? 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