Left Atrial Appendage Occlusion

The left atrial appendage occluder (LAAO), or WATCHMAN, implant procedure is an advanced treatment for people with non-valvular atrial fibrillation (an irregular heartbeat not caused by a heart valve problem).

The insertion of this lightweight, umbrella- or parachute-shaped device can reduce stroke risk and enable patients to stop taking blood thinners. The procedure is performed under general anesthesia in our catheterization laboratory using a standard percutaneous (minimally invasive) technique.

In patients with non-valvular atrial fibrillation, more than 90% of stroke-causing clots that come from the left atrium are formed in the left atrial appendage. Implantation of the LAAO/WATCHMAN device, a one-time procedure, closes off the left atrial appendage, preventing blood clots from migrating out.

Conditions

 Your doctor may recommend LAAO implantation if you:

have experienced intercranial hemorrhaging
have non-hemorrhoidal GI bleeding with no treatable etiology
experience recurrent bleeding issues (e.g., hemorrhoidal disease, epistaxis, hematuria) with no treatable etiology
have severe anemia (hemoglobin < 7) or thrombocytopenia (platelet < 50,000) assessed by a hematologist with no treatable etiology and a high risk of recurrent bleeding
have amyloid angiopathy

You may also be considered for the procedure if:

you have a history of recurrent or traumatic falls
your lifestyle is associated with a risk of bleeding (e.g., if you participate in aggressive recreational sports that increase risk of fall/trauma)
you have vocational duties associated with a risk of bleeding (i.e., duties involving the use of sharp objects, ladders or heavy machinery)

LAAO implantation is not recommended if you:

are allergic to a material in the device, such as nickel or titanium
can’t take blood thinners
need to take blood thinners for a reason other than AFib
should not (or cannot) undergo heart catheterization procedures

 What’s Next for Candidates

After your doctor determines you are a candidate for the device, you will meet with one of our implanting physicians for an in-depth discussion regarding whether you think this procedure is right for you and want to proceed, as well as the risks that are associated with the procedure.

Each patient is part of the shared decision to proceed with the procedure. Our multidisciplinary team will jointly discuss your case, and you may be asked to undergo additional testing which may include:

a follow-up appointment with an expert in another specialty (e.g., neurologist, gastroenterologist, oncologist, hematologist)
a transesophageal echocardiogram, or TEE (one thing we look for during this process is a clot in the left atrial appendage; if one is found, you may need treatment and a repeat TEE to see if it has disappeared before we can implant the LAAO/WATCHMAN device)
computerized tomography (CT) scan
other non-invasive testing

What to Expect During LAAO Implantation Procedure

The procedure takes place in our cardiac catheterization lab, which has specialized equipment your doctor can use to test the electrical activity of your heart. After you are placed under general anesthesia, your doctor will make a small incision in your groin and insert a thin, flexible tube called a catheter into a blood vessel. At the end of the catheter is the LAAO/WATCHMAN device.

The doctor will guide the catheter to the opening of your left atrial appendage. The LAAO/WATCHMAN device is spring-loaded to expand to about the size of a quarter once placed. The device has no batteries or wires and is intended to be left in place permanently.

The procedure takes about an hour and will require you to stay in the hospital overnight. You will also be required to take blood-thinning medication until scar tissue grows over the device and seals off the left atrial appendage. Most patients can stop taking blood thinners within 45 days.

Follow-Up Visits

Forty-five (45) days after the procedure, you will need to return for another TEE to see if the device has sealed. During this appointment, you will receive instructions regarding your anticoagulation.

Six (6) months after the procedure, you will need a follow-up visit with your implanter. One (1) year after the procedure, you must follow up with either your primary care provider, implanter or primary cardiologist. Two (2) years after the procedure, you will need another follow-up visit with your primary care provider, implanter or primary cardiologist.