If someone says Watchman, if you’re a comic book fan you may think he or she is talking about the DC Comics superheroes. But if you have atrial fibrillation, there’s another Watchman you need to know about — the Watchman Implant.
Dr. Smith implants the Watchman device into the left atria of the heart of patients with a-fib to help prevent blood clots causing stroke.
What is Watchman?
The Watchman is a one-time implantation procedure that reduces the risk of strokes originating in the left atrial appendage (LAA). The LAA is an area of the heart where blood clots can form when a person has atrial fibrillation. The Watchman is implanted into the left atrial and it blocks off the atrial appendage.
What is the benefit of having a Watchman implanted?
The sole purpose of Dr. Smith implanting a Watchman into your heart is to prevent the formation of blood clots in the LAA. Over 90 percent of blood clots in people with a-fib form in the LAA. If a blood clot forms here during a period of irregular heart rate, that clot can move up toward the brain. There it can block blood flow, and that is a stroke.
Who is a candidate for a Watchman?
Candidates for the Watchman procedure have a higher risk for stroke, but have trouble with anticoagulation. Appropriate candidates have one or more of the following characteristics:
- A history of major bleeding when taking therapeutic anticoagulation therapy
- Inability to maintain a stable therapeutic International Normalized Ratio (INR) and unavailability of an approved alternative anticoagulation agent
- A medical condition, occupation, or lifestyle that puts the patient at high risk of major bleeding due to trauma
How Dr. Smith implants the Watchman
Dr. Smith performs this procedure with the patient under general anesthesia. First, Dr. Smith performs a transesophageal echocardiogram to measure the left atrial appendage to find what size implant is needed.
He then inserts an access sheath into the patient’s femoral vein. This is advanced using fluoroscopic guidance up to the heart. The catheter then crosses the inter-atrial septum into the left atrium, and it is advanced into the left atrial appendage. When in place, Dr. Smith then deploys and releases the Watchman device, which opens and blocks the LAA. Over time, the device endothelializes to seal off the LAA.
Within a couple months, 92 percent of patients are able to stop taking Warfarin, and that number increases to 99 percent by one year.