The Watchman procedure can reduce your risk of stroke if you have atrial fibrillation and cannot take blood thinners. However, it’s also associated with some risks that you should be aware of.

Atrial fibrillation (AFib) is a common type of arrhythmia where the upper chambers of your heart beat irregularly and often too quickly. Between 3 and 6 million people in the United States have AFib.

The effects of AFib can cause blood to pool in your heart, increasing your risk of blood clots that can lead to stroke. In fact, people with AFib have a five-fold increased risk of stroke, according to the Centers for Disease Control and Prevention (CDC).

Implantation of a Watchman device is a procedure that can help reduce stroke risk in people with AFib. This article explains what the Watchman procedure is all about, who’s a good candidate, and its risks and benefits.

Illustration showing how a Watchman device is implantedShare on Pinterest
Watchman procedure for atrial fibrillation. Medical illustration by Alexis Lira

One goal of AFib treatment is reducing the risk of serious blood clots that can lead to stroke or other health complications. Often, a healthcare professional prescribes long-term use of blood thinners to help prevent blood clots from forming.

However, in many people with AFib, a healthcare professional does not prescribe blood thinning medications. This may be due to factors like:

The Watchman procedure is another approach to reducing the risk of stroke in people with AFib. It uses a catheter to place a small, parachute-shaped device that blocks off the left atrial appendage (LAA).

The LAA is a small pouch located in the upper left chamber of your heart. It’s estimated to be the source of over 90% of blood clots that lead to stroke in people with AFib. As such, blocking the LAA can greatly lower your risk of stroke.

Does the Watchman procedure cure atrial fibrillation?

The Watchman procedure does not cure AFib. It’s used to help reduce the risk of stroke due to AFib.

There’s currently no cure for AFib. However, there are treatments that can help manage its symptoms and lower the risk of complications.

Was this helpful?

Generally speaking, the Watchman procedure is a treatment option for people with AFib who cannot take blood thinners long term to reduce the risk of stroke.

One of the major side effects of blood thinners is bleeding. In many cases, this bleeding is minor. However, serious bleeding events can also occur, such as bleeding within the skull or gastrointestinal tract.

Your doctor will assess your risk of bleeding prior to prescribing blood thinners. They often use an assessment tool called the HAS-BLED score, which considers many factors, including:

There may also be other reasons that you cannot take blood thinners long term. Some examples include being allergic to one or more blood thinners or taking medications that may interact with blood thinners.

If you’re at a high risk of bleeding or have another situation that prevents you from taking blood thinners, your doctor may instead recommend the Watchman procedure to reduce your stroke risk.

Who should not have the Watchman procedure?

The Watchman procedure is not recommended if you:

  • are currently receiving treatment for a blood clot in your heart (although you can have the Watchman procedure after the treatment of your blood clot has concluded)
  • have previously had an atrial septal repair or closure device
  • have an LAA that’s too large for the Watchman device
  • cannot safely undergo heart catheterization
  • cannot take blood thinners, aspirin, or both on a short-term basis to prevent blood clots after the Watchman procedure
  • have an allergy or sensitivity to any of the components of the Watchman device
  • have AFib that’s due to heart valve disease
Was this helpful?

Early clinical trials, referred to as PROTECT-AF and PREVAIL, found that the Watchman procedure was noninferior to warfarin, a blood thinner used for AFib, in preventing stroke.

More recent research indicated that LAA occlusion procedures, which include the Watchman procedure, were noninferior to direct oral anticoagulants (DOACs) at preventing major cardiovascular, neurological, or bleeding events related to AFib. DOACs are another type of blood thinner used for AFib.

Saying that the procedure is noninferior means that it did not perform worse than blood thinners. This supports the Watchman procedure being an option for people who cannot take blood thinners as a long-term therapy.

Further study of the Watchman procedure in the PROTECT-AF and PREVAIL trials found that the procedure success rate was 94%. Compared to no treatment, stroke rates were reduced by 78% and 69% in the PROTECT-AF and PREVAIL trials, respectively.

Like any procedure or surgery, the Watchman procedure is associated with a variety of risks. Some of the potential complications of the Watchman procedure include:

  • a reaction to the anesthesia or to the device
  • infection
  • major bleeding
  • blood clots, including those that form around the device
  • pericardial effusion, which is when fluid builds up around the heart
  • stroke
  • leaking or displacement of the device
  • the need to repeat the procedure

The risk of complications is rare overall. Some studies have estimated that the complication rate for the Watchman procedure is 1.9%. Others have estimated that it’s higher, noting 5.72%. Complication risk may also be higher in women than in men.

Your doctor will go over potential complications with you prior to your procedure. Always be sure to ask any questions that come to mind.

In addition to the Watchman procedure and blood thinners, which both aim to prevent strokes, there are other treatments for AFib. These include:

The Watchman procedure can help prevent stroke in people with AFib. It may be recommended for people who cannot take blood thinners to reduce stroke risk.

Having the Watchman procedure can effectively reduce your risk of stroke if you have AFib. However, it’s also associated with a variety of potential risks as well.

Your doctor will make you aware of the advantages and challenges of having a Watchman device implanted prior to having the procedure. Be sure to ask any questions or discuss any concerns that you may have during this time.