18 January 2023
Atrial Fibrillation or A-Fib is an irregular heartbeat, usually rapid. The upper chambers of the heart are out of sync with the lower chambers. A-Fib is not always constant but can come and go. This arrhythmia or irregularity can cause blood clots, which, in turn, cause stroke or other cardiac events. It can be part of other cardiac conditions or solo. As people age, there is a greater risk of A-Fib with up to 20% to 30% of individuals over 75.
To prevent these clots, medication like Eliquis or Warfarin, are often prescribed. Compliance can be spotty because of the price of the drug to the patient, frequent monitoring, and the risk of increased bleeding. So, for patients who are prone to ulcers or at risk for falls, another option should be considered.
One alternative is an implanted device called Watchman. It does not control or change A-Fib but it does prevent blood clots from moving into the bloodstream. This is a piece of mesh-covered metal around the size of a quarter that looks much like a parachute.
Before the procedure is scheduled, the individual will undergo some tests and consult with two separate doctors, one who performs the implant and another who will not be involved in the surgery. It is likely that the patient will need to wear a cardiac monitor for a period of time to determine how often he or she is in A-Fib. This can be internal or external and will record the data for transmission to the physicians. Probably a transesophageal echocardiogram (TEE) and a CT scan will be involved. These latter two tests allow the doctors to get a clear picture of the heart, including the valves, and how they are functioning.
If found to be an appropriate candidate, the procedure will happen in a hospital. Medical personnel will place the device using cardiac catheterization, which is inserting it starting from a blood vessel in either the arm or groin through only a tiny slit. It only takes about an hour. Once the Watchman is in place, it will open like an umbrella. Expect to stay at the hospital for several hours or overnight so that you can be monitored for bleeding or other issues. In about a month and a half, the heart tissue will grow over the implant.
After the implant is placed, there will be some physical restrictions for a week or so. That includes heavy lifting, climbing stairs, strenuous exercise like cycling or running or heavy duty housework, and, sadly, sexual activities. Because you were under anesthesia, no driving for at least 24 hours after discharge from the facility. You may notice some bruising at the incision site. If there is bleeding, lie down and apply pressure for up to 20 minutes, when the bleeding should stop.
With any medical procedure there are risks that come from an adverse reaction to anesthetic, infection, a clot forming during the operation, or other issues. These risks are reduced when you are fully honest with your doctors and other medical personnel and answer all the questions completely, as well as following their instructions before and after the procedure.
The Watchman has been used since 2009 and is available for use in 75 countries around the world. It has a success rate just under 95% which are pretty good odds. If you have concerns or questions, speak with your primary care provider.
