Watchman

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.

Our Providers

Our Provider

Aidan R. Raney, MD
Cardiology, Interventional Cardiology
City:  Orange
4.9 out of 5

Meet Our Physician

Dr. Aidan Raney, MD, FACC, is a board certified cardiologist specializing in advanced interventional cardiology procedures. Dr. Raney received internal medicine and cardiology fellowship training at UC Irvine, followed by a two year fellowship in interventional cardiology at the prestigious Scripps Clinic.

As the director for Structural Heart Disease for St. Joseph Health System in Orange County, Dr. Raney has a special focus on complex coronary interventions and structural heart disease. Dr. Raney started the TAVR and Mitraclip programs at St. Joseph Hospital, which are now the highest volume programs in Orange County. Dr. Raney performs over 150 TAVR and 50 Mitraclip procedures per year, in addition to a high volume of complex coronary procedures.

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