Watchman Implant Procedure: Everything You Need to Know

Watchman implant procedure (also called left atrial appendage closure) is a surgery in which a small device is implanted into the heart to close the left atrial appendage (LAA). It is done to reduce the risk of stroke in people with non-valvular atrial fibrillation (Afib) and is an alternative to long term blood thinners.

A glowing red x-ray image of the chest cavity and heart

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What Is Watchman Procedure?


Watchman is a device that is about the size of a quarter. The device is implanted into the left atrial appendage (LAA) of the heart in people with non-valvular Afib in order to keep blood clots from escaping and causing a stroke.

The procedure is done by a cardiologist, who makes a small incision in the upper leg, inserts a narrow tube, and guides the implant into the LAA of the heart. The Watchman is a minimally-invasive, permanent, one-time procedure that lasts a lifetime.

Watchman procedure is done under general anesthesia and usually requires an overnight hospital stay. While the procedure is done so that people can stop taking warfarin (blood thinners), the drug will need to continue to be taken for about 45 days after the surgery or until the LAA is permanently closed off. During that time, heart tissue will grow over the implant to provide a barrier against blood clots.

Contraindications

Watchman is minimally-invasive in that it does not require open-heart surgery to place the implant in the heart. While effective, it may not be right for everyone. The decision to implant the device is made on a case-by-case basis between you and your cardiologist and based on the review of the benefits and risks of the treatment.

Watchman is contraindicated in those who currently have a blood clot in the heart, those who have had prior surgery to repair atrial septal defect, or those who have a patent foramen ovale repair or closure device present.

Some people’s anatomy will not accommodate the Watchman, and the device should not be used on those with a known allergy or sensitivity to nickel or other materials in the device. People who cannot take blood thinners are not candidates for Watchman.

Risks

In addition to the general risks associated with any surgery, Watchman procedure presents its own risks and concerns. Although the procedure is minimally-invasive and effective, some people may experience complications during or following the procedure.

Risks and complications associated with Watchman procedure include:

Purpose of Watchman Procedure

People with non-valvular Afib, especially those who want to avoid long-term blood thinners, may warrant Watchman procedure. One study showed that 96% of people who had the Watchman device implanted were able to stop taking blood thinning medications after 45 days and more than 92% were able to discontinue blood thinning medications one year after the procedure.

Watchman may be appropriate in the following circumstances:

  • When Afib is not caused by a heart valve problem
  • In people who can take warfarin but have a history of bleeding or risk factors for bleeding 

To determine whether Watchman is appropriate, candidates’ medical history and stroke risk will be evaluated. In addition, they will undergo a physical exam and a transesophageal echocardiogram (TEE).

The images from the TEE will show whether there are any existing clots and if the LAA is compatible with the size and shape of the Watchman. If clots are discovered, they may be treated with blood thinners before proceeding.

How to Prepare

Watchman is a minimally invasive procedure, but does require preparation. Watchman is covered for eligible Medicare patients. Other insurers may require pre-approval or pre-authorization. Your doctor’s office can assist you in communicating with them.

Location

Watchman procedure is performed as an in-patient surgery in a hospital. The procedure is done under general anesthesia, which means you will be asleep for the entire procedure. Watchman procedure takes about an hour and patients stay one night in the hospital following the procedure.

What to Wear

Prior to your surgery, you will be asked to change into a hospital gown and to remove any hairpieces, eyewear, dentures, hearing aids, and tongue or lip piercings. For your hospital stay, you may wish to bring things like toiletries, medications, a comfortable robe and slippers, your cell phone and charger, and socks and underwear. Leave valuables at home.

Food and Drink

Your doctor will advise you about dietary restrictions, but you should expect to stop eating at midnight the night before your surgery. On the day of the surgery, you may be allowed a few sips of water to take your morning medication, if necessary.

Medications

It is important to talk to your doctor about any medications and supplements you are taking in order to avoid any complications. Following the surgery, warfarin, a blood thinning medication will be prescribed for about 45 days or until the LAA is permanently closed off and heart tissue has grown over the implant to provide a barrier against blood clots.

To avoid complications, inform your doctor about any medications, supplements, or herbal remedies you are taking.

What to Bring

You will want to bring a driver’s license or another form of government ID for registration and your health insurance card. You may want to call in advance to see if any up-front payment is required and to verify which forms of payment the hospital accepts.

Watchman is an inpatient procedure. You may want to ask someone to remain at the hospital with you prior to and after your surgery. You will need someone to drive you home after the procedure.

What to Expect the Day of Surgery

On the morning of the surgery, wash with an antiseptic wash provided by your doctor. Avoid deodorant, powder, lotions, makeup, nail polish, and fragrances. 

Before the Procedure

You will be asked to change into a hospital gown, a cap, and paper slippers and will be given a hospital ID bracelet for your wrist. A nurse will check your blood pressure, heart rate, and oxygen levels. An IV tube, called a catheter, will be inserted into a vein in your arm to deliver fluids and anesthesia. 

During the Procedure

Anesthesia will be administered via the IV inserted into the vein in your arm and will be monitored throughout the procedure. The surgeon will numb the groin area with an anesthetic and then insert a catheter into a blood vessel in the upper leg. The surgeon will then guide the catheter to the heart and into the LAA.

A TEE imaging test may be performed before placing the implant to be sure that it is in the appropriate location. Once in place, the surgeon will push the Watchman out of the catheter, where it will open like an umbrella.

The procedure generally takes one hour and is done under general anesthesia, which means you will be asleep and will not feel any pain during the procedure. 

After the Procedure

After the procedure, you will be moved to a recovery room, where you will be monitored as the anesthesia wears off. How long you stay in recovery depends on how long it takes you to wake up. 

Watchman procedure is an inpatient procedure and people generally stay one night in the hospital following the procedure. Once in your hospital room, a nurse will monitor your vitals and pain levels.

Recovery


Your doctor will prescribe warfarin, a blood thinner, for about 45 days, the time it usually takes for the LAA to permanently close off and for heart tissue to grow over the implant to provide a barrier against blood clots. Your doctor may also prescribe pain medication for any discomfort you might feel from the surgery.


Prepare to have someone drive you home after you are discharged. You should not drive for 24 hours after having the procedure. Consult with your doctor to determine when it is appropriate to resume normal activity. Follow up with your doctor, as scheduled, usually around 45 days following the procedure.

Healing

Although Watchman procedure is minimally invasive, your body will still need time to heal. Follow these precautions:

  • It is normal for there to be some bruising and possibly some bleeding around the groin area where the catheter was inserted. Tell your doctor about any unusual or significant bleeding.
  • You may be advised to abstain from heavy lifting while you heal. Talk to your doctor about when you can expect to resume normal activity. 
  • Contact your doctor if you experience increased pain, are nauseous, vomiting, or have redness or pus at the incision site. 

Long-Term Care

Watchman procedure is an alternative to long term blood-thinning medication. After your LAA permanently closes, usually around 45 days after the procedure, you will be able to discontinue taking warfarin. It is important to continue taking warfarin until your doctor advises you that it is safe for you to discontinue the medication.

Watchman is a one-time procedure and does not require future surgery.

A Word From Verywell

Watchman procedure is an alternative to long-term blood-thinning medication for people with non-valvular atrial fibrillation (Afib), but it is not right for everyone. If you have a known sensitivity to nickel or other components in the device, or if you are unable to take blood-thinning medication, Watchman may be contraindicated.

Your health and circumstances are unique, so whether you are a candidate for Watchman depends on a lot of factors that can only be determined in conversation with your doctor. 

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Article Sources
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  1. U.S. Food and Drug Administration. WATCHMAN left atrial appendage closure device with delivery system and WATCHMAN FLX left atrial appendage closure device with delivery system - P130013/S035. Updated August 11, 2020.

  2. Cleveland Clinic. Left atrial appendage & closure. Updated June 11, 2019.

  3. Johns Hopkins Medicine. Left atrial appendage closure procedures.