WATCHMAN Implant

Your doctor has recommended or prescribed the WATCHMAN Implant for you because you have atrial fibrillation without significant heart valve disease, but with other risk factors that put you at an increased risk of stroke. Although you may take an anticoagulant (blood thinner) to reduce the risk of stroke, your doctor has recommended that you undergo implantation of the WATCHMAN Implant as an alternative to long-term use of these blood thinners. The following information about the WATCHMAN implant is important for you to know and will address many of the common questions you may have about your implant.

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What is the WATCHMAN implant?

The WATCHMAN Left Atrial Appendage Closure Device is implanted at the opening of the left atrial appendage (LAA) and is intended to prevent LAA blood clots from entering your bloodstream and potentially causing a stroke. The implant is designed to be a one-time implant that does not need to be replaced.

Understanding Your Heart

The normal heart

The heart is divided into four chambers: two upper chambers (a right and left atrium) and two lower ventricular chambers (a right and left ventricle). The four chambers fill with blood when the heart is at rest and then pump the blood throughout the body with each heartbeat (or contraction). Normally, your heart’s pumping rate is controlled by the heart’s internal pacemaker that is located in the upper portion of the right atrium. The electrical stimulation produced by the hearts internal pacemaker causes the heart muscle to contract and pump blood through the vessels. The heart then rests and fills with blood until the next contraction occurs. This cycle occurs millions of times a year.

Atrial fibrillation

In atrial fibrillation, the right and left atria no longer contract together in a coordinated fashion and the heartbeat (pulse) becomes irregular. Atrial fibrillation can cause you to have symptoms such as feeling tired (fatigue), lightheaded, short of breath, or have a fluttering sensation in your chest (palpitations). It is also possible that you have no symptoms.

Doctors often prescribe medications to prevent the pulse rate from getting too fast. These medications typically help patients feel well and able to do normal activities despite having atrial fibrillation. However, despite taking these medications some patients still feel poorly due to atrial fibrillation and require additional medications or special heart procedures (known as cardioversion and ablation) to try to stop atrial fibrillation altogether an keep the heart in a normal rhythm.

Atrial fibrillation, heart blood clots, and the risk of stroke

Because right and left atria no longer contract normally in atrial fibrillation, the blood flow within the atria can be slower than normal. This change in blood flow may also cause blood clots to form. During atrial fibrillation, most blood clots that originate in the heart develop in the LAA, which is a pouch-like structure that is part of the left atrium. These blood clot, or thromboembolus, can be dangerous if it blocks a blood vessel that supplies blood to an important body part. If the thromboembolus blocks a vessel that leads to the brain it could damage the brain. This damage is known as a stroke. Besides the brain, a thromboembolus can travel to other areas of the body and cause organ damage by blocking blood flow. Factors that increase the stroke risk include advancing age >75 years, high blood pressure, heart failure, diabetes, other cardiovascular (heart) disease, and a prior stroke. Patients with atrial fibrillation are at 5 times increased chance of stroke.

How is the WATCHMAN implanted?

The WATCHMAN Implant is placed into your heart using a minimally invasive procedure in a cardiac catheterization laboratory by a physician and his/her team who have experience and training. You will be lying on your back on a table while you are continuously monitored throughout the procedure by medical personnel. X-rays and transesophageal echocardiograms (TEE) will be used to help visualize the heart while the implant is being advanced into the correct position in your heart. Contrast media (dye) will also be injected to help guide the implant placement. You will be given general anesthesia.

A small puncture is made into a vein in your groin. A long, thin tube, called a catheter, is inserted into the vein and advanced into the right atrium of the heart. Another puncture is made through a thin muscle wall between the right atrium and the left atrium so that the catheter can be advanced into the left atrium. A thinner catheter is then advanced into the LAA under x-ray guidance. The WATCHMAN Implant is tightly compressed within the catheter and is passed through the catheter into the LAA. The physician will make sure that the implant is in the right place within the LAA and then deploy the implant (much like opening up a folded umbrella). After the procedure, the WATCHMAN Implant is the only material that remains in the body. A thin layer of tissue will grow over the surface of the WATCHMAN Implant within about 45 days.

After the procedure

After WATCHMAN is implanted, you will rest in the hospital where you will be monitored during your recovery. Most patients are discharged home the 1st day after the procedure.

Your doctor will instruct you to take a blood thinner and aspirin after your implant. After your WATCHMAN Implant has been in place for a minimum of 45 days, your doctor will take pictures o your heart by means of a TEE to determine if the implant has closed the opening of the LAA. Your doctor may stop your blood thinner at that time, depending on the results of the test. Your doctor will discuss any further blood thinning regimen with you at that follow up visit.

At about 12 months after your WATCHMAN Implant, your doctor will schedule another TEE to check on a device and make sure that your LAA is still closed. If the TEE that is performed at or around 45 days shows that the opening of the LAA is not adequately closed, TEEs will be performed at more frequent intervals to re-evaluate whether adequate closure of the LAA has occurred.

WATCHMAN device at the LAA, shortly after implant
Heart tissue grows over the device, typically within a few weeks
The LAA, the most common source of strokes in Afib patients, will be sealed off permanently

It is extremely important for you to take the recommended blood thinning medications at the recommended time. If you stop taking these medications or change their dosage before being instructed to do so by your doctor, the chances of blood clot formation, subsequent stroke, or even death are increased. Talk to your doctor before stopping your medications or changing the dosage.

If surgery or dental work is needed which will require you to stop taking these medications prematurely, you and your doctors should carefully consider the risks and benefits of this additional surgery or dental work versus the possible risks from stopping these medications early. Talk to your doctor about the timing of any medical procedures you may need.

Discharge Instructions

When You Leave the Hospital

• You will need someone to drive you home on the day of your discharge from the hospital.
• Make plans to have someone stay with you for the first night or two after you get home.
• Avoid driving, operating machinery, alcohol consumption, signing legal documents or participating in legal proceedings for 24 hours after receiving sedation.

Activities

• Do NOT take a bath, sit in a hot tub, or go swimming until your Structural Heart team says it is OK. We do not want the access site to get infected.
• It is OK to shower.
• You may resume normal activities, including light walking, after 24 hours.
• Avoid lifting more than 10 pounds, jogging, exercise classes, sports and vigorous activities for at least seven days.
• Avoid sitting for more than one consecutive hour during the first three days. If traveling, stop and walk for five minutes every hour.

Access Site Care

• The access site for your procedure is a small puncture site in your groin area. Keep the access site clean and dry.
• You do not need to apply any special dressings or bandages.

Medications

• You may be discharged with a blood thinner as well as other new medications
• If you are on Coumadin, have your INR checked in three-four days and the next week. The target INR 2.0-3.0. The nurse will discuss with you how often it is necessary to check your INR.

Follow-up schedule AFTER your WATCHMAN procedure

• The Structural Heart nurse will call you the day after your discharge.
• Around 45 Days
  • You will have a TEE and you will have a follow-up appointment with the cardiologist within a week after the TEE. You will be given further directions about your blood thinning medication after your TEE.

Dentist visits

• The first six months after the procedure you will need antibiotics before you have dental work.

Potential problems: please call if you develop:

• A fever of 100 or higher during your first few days at home.
• Increased swelling of a groin bruise. A groin bruise is to be expected due to the blood thinners used during your procedure. Discoloration will spread as you move about but swelling should decrease.
• Persistent throat and groin soreness/discomfort that does NOT resolve within a few days.
• Shortness of breath or a heart rate of more than 120 beats per minute.
• A new persistent cough or unexplained shortness of breath.
• Decreased urination and weight gain (more than three pounds overnight).