The WATCHMAN Device and Procedure to Reduce Stroke Risk

After experiencing atrial fibrillation (AFib), patients are often prescribed blood thinners to reduce their risk of stroke.

“One of the major concerns for anyone with atrial fibrillation is stroke caused by a blood clot, which increases after being in AFib for 24-48 hours,” according to Dr. Amir Lotfi, MD, FRCPC FSCAI, Chief, Cardiology Division Baystate Health, Associate Professor of Medicine, U-Mass School of Medicine.

While blood thinners can reduce the risk of a stroke caused by a blood clot, they can also limit a patient’s activities. There is an alternative called the WATCHMAN device, which decreases stroke in AFfib patients. That means they can come off blood thinners—which reduces the risk of bleeding—and worry less about the risk of stroke.

“A patient comes in with AFib and needs to go on a blood thinner, but they have other bleeding problems, like gastro or they take frequent falls,” Dr. Lotfi explains. “This is an alternative so we don’t have to worry about that, but also don’t have to worry about stroke. Many of our patients are active – they like to ski or ride horses – but they get an AFib diagnosis and hear they have to be on blood thinners and they are fearful of falling [so they] stop doing what they’ve been doing.”

The WATCHMAN device is a good alternative for some, reducing the risk of stroke. The Federal Drug Administration approved the device in 2015. Baystate Health has since performed 300+ WATCHMAN procedures, with Dr. Lofti performing 100+ of those.

What does the WATCHMAN Device Do?

Dr. Lotfi says the WATCHMAN device, also known as the left appendage closure, is implanted in a pouch located in the top left chamber of the heart, the left atrial appendage, where 90 percent of clots form.

“The device is designed to seal off that pouch so a clot can’t form,” he says. “If all goes well, people come off their blood thinners within months of the procedure.”

The WATCHMAN is not meant to treat the arrhythmia or make them feel better from it, but to reduce the risk of stroke.

The device is about the size of a quarter, and is implanted during a minimally invasive surgery. Once implanted, it lowers your lifetime risk for stroke, without blood thinners.

Who is a good candidate for the WATCHMAN device?

Dr. Lotfi says before considering left atrial appendage closure using the WATCHMAN device, providers will look at the patient’s heartrate and rhythm control, managing precipitation factors, assess stroke risk, assess heart rate and assess symptoms.

“When deciding on what treatment a patient will receive, including the WATCHMAN, we look at how the benefits outweigh the risks,” he says.

Patients that have AFib not caused by a heart valve problem, might be a good candidate for the WATCHMAN device and procedure if they also:

• Have a history of serious bleeding while taking blood thinners.
• Have a lifestyle, occupation, or condition that puts you at risk for serious bleeding.
• Are having trouble with your warfarin treatment plan and a different type of blood thinner is not an option.

What to expect from the WATCHMAN Procedure

After a patient sees their primary care provider and they discuss what they think is the best course of treatment. If it is decided to explore the WATCHMAN, the patient meets, either in person or via telehealth, with Dr. Lotfi or someone else on the team.

“The procedure is done under general anesthesia, though we’re trying to move away from that with all of our advancements,” he explains. “We go in through a vein in the groin and using ultrasound and X-ray, move our way to the left side of the heart, where we inject dye. We do a four-step procedure to make sure it won’t come loose, and if it’s good, we remove the tubes.”

If the patient is one of the first of the day, they might be able to go home that day, otherwise, they will be discharged the next day.

“Typically, they might be sore in the groin area or have some residual effects from the anesthesia,” he says. “Otherwise, they pretty much go back to their baseline.”

Forty-five days after the procedure, they have an ultrasound and if the device looks good and skin has grown over it and there is no sign of clotting or leakage around the device, they continue for six months when they come off all blood thinners except aspirin.

“After that six months, they are back to their primary care provider and cardiologist and we are out of the picture unless they need us,” he says.

WATCHMAN device implants at Baystate Health

The procedure is done at Baystate Health in Springfield. The hospital has done over 300 implants since it started four years ago. Dr. Lotfi has done about 100 of those.

“We don’t look at our patients as patients having this procedure done, but as humans who are looking for a better quality of life,” he says. “We make sure it’s right for each of them. We minimize the safety issues and give each person the greatest advantage. Baystate is committed to providing leading-edge technology to our communities.”