Watchman (Left Atrial Appendage Closure)

Watchman is a one-time, minimally invasive, catheter-based procedure that offers an alternative to long-term blood thinners for selected patients with atrial fibrillation. It is performed at Saint Francis Hospital through the Trinity Health Of New England Structural Heart Program. Depending on the operator and clinical setup, the Watchman procedure may be performed in either the cardiac catheterization laboratory or the electrophysiology (EP) laboratory.

What is atrial fibrillation, and why is the left atrial appendage important?

Atrial fibrillation (AFib) is the most common irregular heart rhythm. In AFib, the upper chambers of the heart beat irregularly and inefficiently, which allows blood to pool and form clots. The most common place for these clots to form is in a small pouch off the left atrium called the left atrial appendage. If a clot forms there and travels to the brain, it can cause a stroke.

To reduce stroke risk, most patients with AFib are prescribed long-term oral blood thinners (anticoagulants). However, some patients cannot tolerate blood thinners or face significant bleeding risks. For these patients, closing off the left atrial appendage with the Watchman device offers a long-term alternative.

How does the Watchman procedure work?

The procedure is typically performed under general anesthesia and is guided by X-ray and transesophageal echocardiogram (a specialized ultrasound of the heart). A catheter is inserted into a vein in the groin and advanced to the heart. The Watchman device, which resembles a small parachute, is delivered through the catheter and placed at the opening of the left atrial appendage, sealing it off. Over the following weeks, the body’s own tissue grows over the device, permanently closing the appendage. Most patients go home the day after the procedure.

Who is a candidate for Watchman?

Watchman is generally considered for patients with non-valvular atrial fibrillation who are at increased risk of stroke and have a clinical reason to seek a non-drug alternative to long-term blood thinners. Candidacy is determined by the Heart Team after a complete evaluation, including review of stroke and bleeding risk, prior bleeding events, and lifestyle factors. After the procedure, most patients are able to stop their long-term blood thinner over the following months under their cardiologist’s guidance.

To learn more about the Watchman procedure at Saint Francis Hospital, call 860-714-1265.