WATCHMAN™ Device for the Heart: Atrial Fibrillation (Afib) Treatment

Atrial fibrillation (AFib) is a type of abnormal heart rhythm, or arrhythmia. Those with AFib are often at high risk for stroke. It’s important to look at the horizon for years to come, even if the current risk of stroke may seem small.

Many with personal experience know that AFib treatment often includes blood thinners. They’re also aware to proceed with caution because of the associated risks of bleeding. The WATCHMAN™ Left Atrial Appendage Closure Implant offers a new treatment option that can eliminate the need for blood thinners.

The WATCHMAN device is a one-time, permanent implant that reduces the risk of stroke in patients with AFib, eliminating the need for and long-term risk of bleeding caused by blood thinners such as warfarin.

The procedure takes about an hour. We implant the WATCHMAN device similar to a stent, in which a narrow tube is inserted through a small opening in the upper part of your leg. We’ll then carefully place the WATCHMAN device into the appropriate location in your heart. You’ll be under general anesthesia and likely stay in the hospital overnight.

Many patients who have received atrial fibrillation treatment have a strong aversion to the idea of taking blood thinners due to the worry around risks of bleeding in other places. The ideal solution has been to find a way to prevent stroke without the need for blood-thinning therapy. The WATCHMAN device is FDA approved and an effective alternative for patients who can’t be on adequate stroke protection.

Those with AFib not caused by heart valve problems who would like to explore an alternative to blood thinners may be eligible for WATCHMAN. If you have a history of bleeding along with your AFib, or if your lifestyle puts you at risk for bleeding, discuss the procedure with your doctor.

We most likely won’t recommend the WATCHMAN device to you if:

• You can’t take warfarin, aspirin or clopidogrel.
• You can’t undergo heart catheterization procedures.
• You’re allergic or sensitive to nitinol (nickel and titanium) or anything else the WATCHMAN Implant is made of.
• Your left atrial appendage is too large or too small to fit WATCHMAN.

Overall, the decision to implant WATCHMAN doesn't come without its challenges. It's a balance of protect against stroke and appropriately manage the related risks.

If you're an eligible Medicare patient who meets certain criteria, WATCHMAN will most likely be covered. An increasing number of commercial insurance companies are also beginning to cover the procedure.

Patients are generally receptive to it and express an overall interest. It strikes conversation because of the common worry around blood thinners. First and foremost, the common denominator with all patients is risk of stroke, which can be a scary reality. It’s important to look at the horizon for five years, even if the current risk of stroke may seem small.

We also closely look at where our patients are in life. Some of them fall frequently, have ulcers and/ or are very active. Lifelong skiers don’t want to stop, so we can’t advocate blood thinners for those with high risk of impact. The decision is challenging. We want to protect against stroke on one hand, and then on the other hand, appropriately manage the related risks.

We’d like to see WATCHMAN be positioned as more of a choice. Right now, we’re not at the point to establish it as a stand-in for medication. The good news is there’s a large amount of trial data right now. We follow every one of our patients for several years. Between technology evolving and allowing us to get a better sense of how patients can improve over the long term, we’ll eventually be likely to pose the question: “Would you prefer to go on blood thinners for AFib treatment or would you consider this one-time, permanent procedure?”

Everyone is different. If and when we get to this juncture, it would be nice to offer patients something tailored to their own desires.