Atrial fibrillation (AF) is an irregular rhythm that usually originates from the left atrium. It is one of the most common arrhythmias we treat and is on the rise among our population, In fact, over five million patients are currently being treated for AF in the United States, and this number is expected to keep growing. AF presents many serious risks to patients: the irregular nature of the rhythm can result in heart rates that are too fast, too slow, or a combination of both. It can also exacerbate underlying congestive heart failure due to the heart beating too fast and because of the lack of synchrony between the atria and ventricles. The irregular and disorganized activity of the left atrium in AF can also result in the formation a blood clot, most commonly in the left atrial appendage. If that clot were to be pumped out of the heart, it could potentially cause a stroke. Even worse, the embolic strokes related to AF tend to be large and debilitating strokes associated with significant morbidity and mortality.
A proven alternative for AF patients
Unfortunately, approximately 30% of nonvalvular atrial fibrillation patients are unable to tolerate the prescribed blood thinners to try to prevent AF related stroke. However, thanks to a relatively new and percutaneous procedure known as the WATCHMAN™ implant procedure, at-risk patients have an alternative option for stroke risk reduction. Backed by a decade of clinical studies and trials, and with FDA approval since 2015, the WATCHMAN™ device has proven itself to be a safe and effective procedure with minimal recovery time. Prisma Health affiliated hospitals have performed more than 450 WATCHMAN™ procedures since 2017.
"Stroke is the most feared complication of atrial fibrillation for patients; however, a large number of them remain at a high stroke risk because they are unable to tolerate long-term blood thinners, says Chetan A. Patel, MD, of Carolina Cardiology Consultants in South Carolina. “Watchman is an alternative that is the best of both worlds by offering these patients a much needed therapy for stroke risk reduction while avoiding the complications and lifestyle restrictions associated with long-term blood thinners.”
When the newer WATCHMAN FLX™ device received FDA approval in 2020, once again, Prisma Health became one of the first healthcare systems in the Carolinas to begin using it. The improved version is considered safer, easier and more efficient. It is also manufactured in a wider variety of sizes, making it available for a broader group of patients. Like its predecessor, the new device offers stroke protection to those who cannot tolerate the side effects of blood-thinning medications.
“I used to sweat during implantation of the Watchman first generation device, “ says Sultan M. Siddique, MD, of Prisma Health Cardiology in South Carolina. “The second generation Watchman Flex device, however, has been a game changer. It is easy to deploy at the os of the appendage or to manipulate within the appendage with precision without the added risk of perforation. We should have a lower threshold to implant this low-risk device in our patients.”
Safe, fast procedure with comprehensive follow-up
To perform the WATCHMAN™ procedure, one of our interventional cardiologists or electrophysiologists inserts a large IV in the right femoral vein. The device is advanced to the heart from the venous access point and positioned in the left atrial appendage, where more than 90 percent of clots are formed in nonvalvular atrial fibrillation patients. With time, the heart cells encase the device in tissue, effectively closing the area and preventing clot embolization. This one-time procedure has been proven to significantly reduce the risk of stroke.
At Prisma Health, the typical WATCHMAN™ implant surgery averages less than an hour under general anesthesia with transesophageal echocardiography or conscious sedation with intracardiac echo guidance. After approximately four additional hours of bed rest, patients are up and walking. Some patients are kept overnight for observation and released the following day with minimal discomfort. Some patients could even be discharged home the same day if their procedure is completed in the morning. Patients are asked to avoid heavy lifting or exertion for a week. Following the procedure, patients typically take oral anticoagulation and aspirin for 45 days or until follow-up imaging shows there is an adequate seal. After discontinuing oral anticoagulation, patients take a P2Y12 Inhibitor (clopidogrel) and aspirin until they are six months post-implant, followed by only aspirin therapy.
Prisma Health has a comprehensive follow-up program in which a care coordinator collaborates with referring physicians to adjust medications and quickly address any questions or issues.
Ideal candidates for the WATCHMAN™ procedure have atrial fibrillation not caused by a heart valve problem, are at high risk of stroke and have not been able to tolerate blood thinners well or are considered too high risk for blood thinners. Atrial fibrillation patients actively using blood thinners may also wish to switch because they fear the increased risk of falling or being injured while taking this medication. The WATCHMAN™ procedure offers the opportunity for both better health and peace of mind.