Watchman Left Atrial Appendage (LAA) closure is a procedure performed to
reduce the risk of stroke in patients with atrial fibrillation who are
not a good candidate for long term blood thinners. Dr. Raney received
expert training in the Watchman procedure at the prestigious Scripps Clinic
in San Diego and performs Watchman procedures at St. Joseph Hospital.
St. Joseph was one of the original trial sites for the Watchman device
and is now the highest volume Watchman program in Orange County.
What is the connection between atrial fibrillation and stroke?
When patients are in atrial fibrillation, a clot can form in the atrium
(upper chamber of the heart), which can then travel to the brain and cause
a stroke. Most of the clots form in an area called the left atrial appendage.
The majority of patients with atrial fibrillation are treated with blood
thinners to prevent blood clots from forming in this area.
Why are patients referred for Watchman?
Blood thinners are the main treatment to prevent stroke in patients with
atrial fibrillation, but some patients cannot take long term blood thinners.
The most common reason is excessive bleeding while taking blood thinners.
The Watchman is recommended for patients with atrial fibrillation at risk
for stroke who are not candidates for blood thinners.
What are the steps prior to the procedure?
Prior to Watchman, all patients will have a Transesophageal Echocardiogram
(TEE). This is a specialized ultrasound procedure used to evaluate the
atrium of the heart. During TEE, a small ultrasound probe is inserted
into the esophagus where very clear pictures of the atrial are obtained.
An anesthesiologist is present to administer deep sedation, ensuring that
patients are comfortable during the exam. The procedure takes around 30
minutes, and patients can go home after waking up from sedation.
How is the procedure performed?
General anesthesia is used in all cases to ensure the patient is comfortable
during the procedure. A small catheter (tube) is inserted into the femoral
vein, which is a blood vessel near the hip. The Watchman device is then
advanced through the femoral vein and up into the patient’s heart.
The device is carefully advanced and positioned in the left atrial appendage.
The device is then deployed in the left atrial appendage, which blocks
off the appendage from the heart. After 2-3 months, a skin-like layer
forms over the device, preventing clots from forming in this area.
After the procedure, patients are monitored for one night in the hospital.
Most patients are discharged the following day. Two months after the procedure
a final TEE is performed to confirm the device has sealed the left atrial
appendage; blood thinners can then be stopped and anti-platelet medication
(aspirin) is started.
What is the recovery from a Watchman procedure?
After the procedure, patients lie flat for 4-5 hours, and can then can
sit upright in a chair. The majority of our patients are discharged after
a one night observation in the hospital.
After discharge, patients can resume everyday activity, including walking.
We recommend no heavy lifting for at least one week to give the artery
time to heal. Bruising around the femoral artery is normal, as a small
amount of blood may leak out into the soft tissue. This blood will be
totally recycled, but it may take 3-4 weeks for the discoloration from
bruising to resolve. It is ok to shower, but we recommend avoiding a bath
until the puncture site has healed.