Screenshot from a Boston Scientific Cardiology YouTube video.During my most recent a-fib ablation, my left atrial appendage, or LAA, was ablated and isolated. Because of that I will need to be on a blood thinner, such as Eliquis, for the rest of my life, or have the Watchman implant put in.
I’m only 50 years old so the the prospect of being on a blood thinner for the rest of my life is a no-go. I didn’t hesitate for a minute to get the Watchman implant scheduled. If all goes well, I will have it put in on April 27th.
I say, “if all goes well,” because I’m nervous my health insurance won’t cover it as I was told by my primary doctor that most health insurance plans don’t cover it. Gee, thanks doc for stressing me out! I just assumed it would be covered since my ablations have been covered to date without any issues.
Unfortunately, we are being forced into a different health insurance plan on April 1st so I won’t know what’s going on until then when I can contact the new health insurance company to see if they’re going to cover this procedure. If they don’t, I don’t know what I’m going to do. I will take out a second mortgage on our house if I have to because I’m not staying on a blood thinner for the rest of my life. No thank you.
You might be wondering what all this LAA ablation stuff is all about and why I would need to be on a blood thinner for life, or get the Watchman implant put in.
The LAA is a small pouch that hangs off the left atrium. Blood naturally fills this pouch. Now I don’t know exactly how the LAA functions, but what I’ve been told is that it contracts slightly to push the blood out of the pouch to keep the blood moving so it doesn’t clot.
When you ablate the LAA, you permanently cripple it. It can’t function normally. The blood that would normally be moved out of the pouch just sits in the pouch and eventually a clot will form. Then when that clot breaks free it can cause a stroke!
To prevent the blood from forming a clot inside the LAA, you either need to take a blood thinner or seal the LAA so blood can’t even enter it. That’s where the Watchman implant comes into play. It permanently seals the LAA. Here is a video of how the Watchman implant works:
The reason my LAA was ablated in the first place was because it was a source of my atrial fibrillation when they did the EP study during my last ablation. Obviously if the LAA wasn’t ablated then I’d be battling a-fib for the rest of my life. The doctor had no choice. He had to ablate it, and I’m grateful he did!
I will post another update about my upcoming procedure after I have a chance to talk to the new insurance company in April to see if they’ll cover this procedure. I’m praying they will. We shall see what happens!
Here is another video that does a good job of explaining the LAA and Watchman device:
In seeking the best possible solution for our condition, we must examine and weigh the facts using unadulterated and double blind studies without bias. The Watchman, unfortunately, has not followed the guidelines to support their claims of success for their device. I dont post this lightly and I m not attempting to change your mind, but I believe for others looking into this device, they need to research and carefully understand the facts vs one company’s claims. It has been found to not reduce the stroke risk anymore than Warfarin, which is far inferior to Eliquis. I am not the most anti Med person you may ever meet, but I am anti daily med and looking to alternatives as you are so I am hopeful for anything that would accomplish this. A 1-2% reduction is a negative wash with a 2-3% complication risk added for the Watchman. To lose in some trials to Warfarin (13 strokes to 1), is like the Dodgers losing to a Minor league team. Also left out of these studies are the very patients it could benefit, those who for whatever reason cant take NOACs. Two things are certain, You needed the LAA and now you need protection against stroke risk. Unfortunately, Im not seeing that WM is your best alternative and are inferior to NOACS. My question is where and how do we find true independent studies to draw an informed decision?
James:
It’s been a while. Good to hear from you!
For starters, just like getting an ablation by an expert EP, if you have an experienced operator implant the Watchman, the risks are virtually zero. I have ZERO fears of the Watchman, especially the latest iteration of the device. The Watchman has also been around for almost a decade now so it has a pretty solid track record. If there were concerning issues, doctors wouldn’t be putting them in and you wouldn’t be hearing about the device that much anymore. Instead, the device is only gaining in popularity and it is practically a normal and expected procedure for people with a-fib.
The Watchman completely seals the LAA. Once it seals over, you can’t even tell where the LAA was. That being the case, the chance of blood pooling in the LAA is ZERO because it is completely sealed off.
Now, the question becomes, what about the pooling of blood in the heart in general when you are in a-fib? That I don’t know, but right now that is not my concern because I’m not in a-fib. For now, I need the LAA sealed shut so I don’t have to worry about that right now.
But even if a-fib returns after my Watchman is in place and fully sealed, I will still not take a blood thinner as it is proven that the bulk of a-fib related strokes come from the LAA. You might find this video useful:
As I’ve said before, each to their own. Some people will favor taking pills the rest of their life and are fine with the potential long-term risks that come with them. Some people, like myself, will favor mechanical solutions and are fine with the potential long-term risks that may come with them. There are risks with everything, but I’ll bank on mechanical solutions all day long over medications, which is why I’ve had two ablations without hesitation and will have two more if necessary.
Travis
And I completely understand and empathize with your situation in what you desire for a solution. Your analogy for choosing the same EP for the WM because he was highly skilled with your ablation has merit. This also could be reversed to mean that 90-95% of those EPs who are failures with ablation could also be failures with the WM. The hard fact is that WM tho not a med has failed against an inferior thinner in Warfarin, leaks in 20% of patients and failed against the Amulet by a high rate in clinical trials. Having the worlds best EP certainly increases your odds, we agree on that. However, For me I would need a higher threshold for success to simply stop taking one med for life, but as you say, were all different. I believe those taking a lighter dose of thinners with the WM have a healthy fear of stroke from other health circumstances than AF. The Dr in this video you posted has stated many times that AF does NOT causes stroke. I agree with that in principle.
James:
Where do you get all those facts? I would never do the Amulet as it is a more rigid device vs the pliable and flexible Watchman. I would also add that if the Amulet was superior to the Watchman, there is no way top EPs like Natale would favor the Watchman over it, which they do. I’m not saying the Amulet is bad. I’m just saying the Watchman device is far more common today than the Amulet. There has to be a reason!
And 20% leaks? No way. I don’t buy it. If the Watchman leaked that bad, it wouldn’t even be used. That’s an abysmal failure rate. I suspect you are quoting an old stat based on the original Watchman. The new device comes in different sizes to ensure it fits any size and type of LAA, and is super flexible and is retractable. Bottom line, there is no way it leaks at a rate of 20%. If that stat is true, I’d like to see the data behind it because there is no way it fails that bad if done by an EP with experience putting them in.
Unlike ablations that truly do require expert EPs, the Watchman can be put in successfully by almost any EP or EP center that has experience putting them in. I know several people that have had Watchman devices put in and none of them were put in by “expert EPs.” They were put in by local EPs. None of them have had ANY issues whatsoever. Keep in mind, when they put it in they ensure it’s not leaking. If it is, they will continue to reset the device in the LAA and reposition it until there isn’t any leakage. That’s the beauty of the device. They can reposition the device as many times as they need to in order to ensure a complete seal. I don’t think the Amulet, for example, can be retracted and reset multiple times but I could be wrong. Then when you are done, you are kept on blood thinners for usually 3 months so even in the off chance it starts to leak after you leave, you are protected.
You also have multiple TEE’s after the Watchman is put in place. For example, my TEE’s will be done at 6 weeks, 6 months, and one year. What they are looking for during each TEE is leakage. In most cases, the Watchman will be fully sealed over by tissue within 6 weeks (sometimes it takes up to 8 weeks I’ve been told). You’ll know at the first TEE if there are leakage issues! That’s why your 20% leakage rate is way off. I guarantee you that statistic is totally false (or based on old data). At 6-8 weeks, the Watchman is fully sealed over with tissue to the point you can’t even see where the LAA was. Once tissue grows over the Watchman, there is zero chance of leakage. Again, that is confirmed by the TEE’s. That’s why they do as many as they do, to ensure there isn’t any leaking before they take you off blood thinners for good.
Right now, based on what I’ve read and have bene told, the Watchman is the safest and most effective LAA occlusion device available. Steve Ryan of a-fib.com (who also now has a Watchman device) told me they are working on a device that goes into the LAA and then twists it into a ball and then the twisted ball is basically tied off or sealed off somehow. Steve said it was hard to describe but it was a totally new way of occluding the LAA. He said it was presented at a recent heart symposium and all the EPs were impressed with it. It will be a while before it gets perfected, goes through trials, and is actually being used, but until then, the Watchman is as good as it gets. If you are cool taking pills for the rest of your life, go for it, but if you want to get off of them, you shouldn’t have any fears or concerns about getting the Watchman device. At least talk to an EP in your area that does them and get more information.
Travis
Ok, before this goes off the rails with both laundry lists of statistics and opinions, lets bring it back to the original intent of our posts, The WM is a device which hopefully replaces dangerous meds used for stroke prevention. I would hope you have done all the research on this sans the skewed and cherry picked studies from the manufacturer, not someone who comes on your site who knows little of it but from a few searches and studies finds some disturbing facts. Two critical points again are, why were those patients who are ineligible for NOACs excluded from the trials and where do we find the evidence of independent trials, that is device in fact a safer and more effective replacement of meds . If this doesnt raise a red flag, then possibly we agree to disagree. I also made it abundantly clear and have done so many times here, I am NOT a fan of meds. I have declined ablation and meds since 2014 and reduced my burden of AF to 1 every 16-20 months, naturally, so yes I am all in on a SAFE device to replace dangerous meds. Ill grant you the leak stat is high, the risk has lowered, some and many anecdotal stories support your decision. The worst case scenario for you is, you go back to a 2.5, safe and effective thinner along with the WM. I guess that would alleviate my fear of DRT’s and failure. That still does not remove my doubt that this is a better preventive than AC meds for stroke risk. That burden of proof should be 100 fold on the manufacturer, not us, and Im finding less to support that claim and many more questions than answers.
Thank you William and Travis for your honesty on your life, and all there is, to think about! Liked your article, Travis, too!
Thanks Marlene!
I am 60 years old with Afib. I have had it for approximately 15 years. When first diagnosed, I had a Cardioversion done. I don’t know how long it held because I rarely have any symptoms. I was told my heart was out of rhythm and had Afib when I caught pneumonia about 12 years after my Cardioversion.
My cardiologist tells me my fitness level is “golden” and I have a strong heart, and other than I have an electrical problem…Afib, I have no issues. My Afib is permanent. I have chosen not to have any surgical procedures. I suspect my Afib probably worsened when I caught Covid at the end of 2022. I had what I would consider to be a “medium” level of symptoms but I around day 9 they started to alleviate and I thought I was out of the “woods.” I then proceeded to get Covid pneumonia.
I spent two nights in the hospital. Never needed or came close to having to go on any type of breathing apparatus -thank you, Jesus. After I was cleared and released, my Cardiologist told me that I had a choice – Watchman or Eliquis for life. He said let’s start with Eliquis as you work your way back to rebuilding your lung capacity and regaining your fitness level. I did that.
I have chosen to to take Eliquis. I am not a fan of any type of surgical procedure(s). I am not comfortable with potential complications during, after and longer-term after surgery, along with the insurance obstacles/challenges. It simply is not worth it too me. My Cardiologist has repeatedly told me that based on my lifestyle and fitness level; as long as I keep taking care of myself, I am doing all the right things for myself. I have been told Eliquis will not cause bleeding; it can make it worse…but it won’t do what drugs like Coumadin will do. I mountain trail run, hike in mountains, swim and do strength training. I have not encountered any complications or bruising.
I am curious…your hard “NO” to Eliquis…is that a personal choice of yours or am I missing some important information?
I really appreciate and respect how you make yourself vulnerable/transparent your journey, and how detailed and informative you are in your diary. Thank you!
William:
Thanks for your comments! Here are my reasons for not wanting to be on Eliquis the rest of my life…
1. I’m “only” 50. If the good Lord lets me live even to 70, that’s still 20 years. We don’t know what the long-term side effects are of being on Eliquis that long because it hasn’t even been around for 20 years. My gut tells me it’s probably not a good idea to be on a blood thinner for 20+ years. There are bound to be unwanted side effects.
2. I fear having a major bleeding event – either internal or external. Any blood thinner is not without this risk. I would never run on mountain trails or hike in the mountains being on any blood thinner. I live in the Midwest (Minnesota) and I fear walking out to my mailbox when it’s slippery out because I’m fearful I might fall and have some kind of internal bleeding event. I admit it’s probably a totally irrational fear, but it’s one I have nonetheless. I’m too young and too active to have to worry about falling or having some kind of freak accident where I might bleed to death either internally or externally.
3. I hate having to worry about the foods I eat, the beverages I drink, or the supplements and vitamins I take when I’m on Eliquis. I have to constantly think about and adjust what I’m consuming to ensure it doesn’t interfere with Eliquis. I like to take fish oil supplements, for example, but I’ve had to cut way back because you can’t combine “large doses” of fish oil with Eliquis. I’d love to take natto supplements, an incredibly powerful supplement for health, but I can’t take them because they have the potential to thin my blood too much.
4. I hate being a prisoner to my pills. I have to literally set alarms on my Apple watch to remind me when I take my pills, and it seems whenever those annoying alarms go off, it’s never convenient. I’m always in the middle of something, or my pills are in the other room. And given that my LAA was ablated, I am now at a very high risk of stroke if I miss even one dose.
5. What happens if I go on a vacation or have to leave town for a weekend and I forget my stupid Eliquis pills? Or what if I accidentally pack my Eliquis in my checked bag and my bag gets lost? Again, if I miss even one dose I’m at a serious risk of having a stroke.
6. Why would I choose to deal with all the issues above when there is a perfectly safe and effective alternative that exists today (the Watchman) that erases all those issues? It’s a no-brainer to me.
I fully admit there are people that are totally fine with the issues I’ve outlined and to them getting the Watchman is far more daunting than taking pills the rest of their lives. Each to their own, but I’ll choose the option all day long that allows me to be free of pills and all the issues that come with pills.
Travis
True. There are a few out there who have decided after the Watchman was implanted to remain on thinners or take periodically. For a device with such outlandish claims, it certainly has left many with more doubt and questions than answers. If I seem too critical, then Ill accept that as my allopatchic badge of honor because medical error is the number 3 killer in this country.
James:
I noticed that as well – that some continue a low-dose of Eliquis, for example, even after the Watchman is completely sealed over and the LAA is completely shut off from the heart. I asked a couple people that are way smarter than I in the a-fib space and both had two totally different takes. The first person I talked to said a low-dose is often continued as a way to prevent all strokes – not just a-fib related strokes. This person said that a low-dose Eliquis (2.5 mg taken twice daily) is as harmless as a daily aspirin (and probably safer long-term).
The other person I talked to had my take, why would you take any blood thinners after the Watchman is fully sealed over? We both concluded that we didn’t understand why anyone would continue to take any blood thinner because the whole point of having the Watchman is to get off blood thinners. He, like me, sees little risk in stopping blood thinners completely once the Watchman is in place and sealed over. And by “little risk,” we are talking strictly a-fib related stroke risk, not overall stroke risk.
Bottom line, different strokes for different folks. I will say this, however, I would feel a lot better having the Watchman in place while still taking a low-dose Eliquis for life vs. taking a full dose of Eliquis for life alone. The combination of the Watchman and low-dose Eliquis would seem to me to be the absolute best protection from stroke with minimal long-term side effects from the drug since it’s taken at lower doses. For that reason alone I would want the Watchman in place. I’d be for anything that would allow me to take less of any drug.
Travis
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