Keeping watch
Watchman procedure helps prevent strokes in people who can’t use blood thinners
Key takeaways:
- Atrial fibrillation in the heart leads to an increased stroke risk. Blood thinners help with AFib, but not everyone can use them.
- The Watchman implant is an alternative. The minimally-invasive procedure is usually just a one night stay in the hospital.
- Know the signs of AFib: irregular heartbeat and sudden fatigue. See a health care provider if you have these symptoms.
September is Atrial Fibrillation Awareness Month. It’s a time to bring awareness to what Abraham Kocheril, MD, calls the most common heart rhythm disorder that requires treatment.
Atrial fibrillation, or AFib, is when the heart’s rhythm is irregular. Electricity in the heart’s atrium (the right upper chamber) is also disorganized, preventing the atrium from properly contracting, says Dr. Kocheril, the director of cardiac electrophysiology at OSF HealthCare Cardiovascular Institute in Urbana, Illinois. All of this brings a big increase in the risk of suffering a stroke. In fact, Dr. Kocheril says AFib can cause up to one-third of strokes.
“The atrium, instead of pumping blood, is sitting there quivering,” he explains. “So, blood flows slowly. It can form clots. Clots go wherever blood flows. The worst place would be out the aorta and up to the brain.
“This is serious business,” he adds.
So, managing AFib and reducing stroke go hand-in-hand. For many, Dr. Kocheril says a blood-thinning medication will do the trick long-term. But blood thinners aren’t for everyone.
“There are some people who get on a blood thinner and start bleeding. They have to be taken off it,” Dr. Kocheril says. “There are other people who, because of a bleeding history, never get started on a blood thinner. There are others who, because of lifestyle or other reasons, shouldn’t be on a blood thinner.”
But medicine has found an answer to this problem by way of a Watchman implant.
Dr. Kocheril says within the heart’s atrium, over 90% of clots form in a pouch called the left atrial appendage. A cardiologist can implant a Watchman device to close the area off.
“The stroke risk goes down tremendously,” Dr. Kocheril says.
Approved by the FDA in 2015, Watchman has been studied and refined by medical professionals, Dr. Kocheril says.
The Watchman procedure
Hollywood has ways to describe the complicated parts of medicine, but Dr. Kocheril sums up Watchman by saying there’s a lot involved with the procedure.
It begins with a process known as shared decision making.
“The person has to be sent to an appointment with a cardiologist who is not part of the implantation team. Someone who has no stake in whether the person says yes or no,” Dr. Kocheril explains. “The doctor goes through the risks and benefits of having a Watchman in. They give the person time to ask questions.”
Before procedure day, a cardiologist will also perform some imaging on the person’s heart to see how big of a device is needed.
Dr. Kocheril says a cardiologist will get access to the heart and deploy the Watchman through the femoral vein. It starts with a small incision near the groin. A heart surgeon and blood supply are on standby for complications. The person typically spends the night in the hospital to be monitored.
Other heart procedures like a valve replacement aim for improved quality of life fairly quickly, like easier breathing. The Watchman procedure is all about prevention.
“There’s very little to recover from in the atrium because we’re not doing any cutting. It’s just a plug going into the appendage,” Dr. Kocheril says. “But there is a healing process there. Your body grows tissue over the device. The idea is as that tissue grows, the Watchman is completely sealed. It’s as if there’s no pouch there at all.”
Follow-up imaging will confirm things have healed properly. The person typically takes low dose aspirin for the rest of their life to help prevent clots.
Learn more
Talk to your primary care provider or cardiologist to see if Watchman is right for you and which OSF hospital near you offers it. Read more about Watchman on the OSF HealthCare website.
During AFib Awareness Month, Dr. Kocheril says you should know the signs of AFib. If you feel your heartbeat is irregular or if you have sudden fatigue, see a health care provider. Your smart watch may also track heart rhythm, although Dr. Kocheril cautions not to rely on that alone.
Another test: Can you do everything this year that you did last year? You walked a mile last year with no problem. This year, you get halfway done and are spent. That’s a sign to see a doctor.