My First TEE after My Watchman Implant

My Watchman implant was put in on April 27, 2023. This is a detailed post about my first TEE experience. Enjoy.

What is a TEE and Why Do You Need One?

A TEE, or transesophageal echocardiogram, is a procedure where a probe with an ultrasound transducer is put down your throat to create pictures of your heart.

A TEE is typically done around 45 days after your Watchman implant is put in, and then again at 6 months, and then a final one is done at the one-year mark.

What they are looking for is to ensure the Watchman is fully endothelialized, or “sealed over,” to ensure the LAA (left atrial appendage) is fully closed off. Once this occurs, most people can stop their blood thinners completely. That is the goal of having the Watchman put in – to get off blood thinners!

I wasn’t able to get my first TEE scheduled until three months, or roughly 90 days, after my Watchman implant was put in. My first TEE was done on Wednesday, July 26th.

I had it done at St. David’s in Austin, TX. Dr. Natale, the EP that has done all three of my ablations, practices there and I wanted his team to do the TEE to keep everything “in house” verses having it done locally here in Minnesota. We flew down there the day before on July 25th, and then we flew back home to Minnesota the morning after the TEE on July 27th.

Prepping for the TEE

I got lucky as I was the first TEE scheduled for the day. My procedure was scheduled for 8:00 am but I had to be at the hospital at 6:00 am. After filling out some paperwork and getting checked in, I was brought to the procedure room at 6:30 am to be prepped for the procedure.

I had to strip down and get into my hospital gown and then the nurse came back in to take my vitals. Here’s what they were:

• Heart Rate (as per an EKG): 69 bpm, normal sinus rhythm
• Blood Pressure: 125/79

The nurse then put the IV in. She put it in on the side of my wrist, which was a first. I thought for sure it was going to be painful because it was such an odd place to put it, but it wasn’t painful at all. Here is a picture of my wrist after they pulled the IV out when I was discharged (I meant to take a picture of the actual IV line before they took it out but I forgot):

Not to get too sidetracked here, but being the curious creature I am, I asked the nurse why the IV is always put in different places. I always thought IV’s were put in on the inside elbow. She said it’s totally up to each nurse. She said every nurse has their “favorite spot” to put the IV in. Some put it in at the elbow, others put it on top of the hand (like they did for me during my last ablation), and some nurses like her put it in on the side of the wrist. You learn something new every day!

With the IV in and the vitals out of the way, the nurse went over more paperwork and gave me a run down of what to expect. She told me the procedure itself takes less than 15 minutes, followed by a one-hour recovery since I would be fully sedated for the procedure.

After all that, the nurse left and I had about 45 minutes to wait before the procedure began.

My TEE Experience

At around 7:40 am the anesthesiologist came in to go over some things with me and to let me know I would be fully sedated with propofol. I LOVE propofol so I was actually pretty excited. I know that might sound kind of crazy to say, but I’m just fascinated how it works and I love the fact that it puts you to sleep so fast and you have no recollection of anything. And for me, I don’t suffer from any side effects from it so it makes any procedure I’m going through a piece of cake.

Then around 7:50 am the cardiologist who would be doing the TEE came in to introduce herself and to let me know that we’d be starting shortly.

Then like clockwork, at 8:00 am the “team” assembled in the room to get the procedure underway. The team consisted of the prep nurse, the cardiologist, a technician, and the anesthesiologist. An oxygen mask was put over my nose for a few minutes while everyone was getting settled in.

Before the propofol was administered, the technician put a plastic dental device in my mouth that had a hole in the center of it. The probe is threaded through the hole during the procedure and the device is what keeps your mouth from clamping shut during the procedure. Then they put the oxygen mask back over my nose and I was asked to take two deep breaths. By the end of the second breath, I was out like a light.

My Post TEE Experience

Just like that I was coming to, and everyone was gone except the prep nurse. She asked me how I was feeling and I told her I felt great!

I had zero side effects from the TEE. I had no nausea from the anesthesia (although I never do but some do get nausea from anesthesia), and I didn’t have a sore throat or a scratchy throat. Given that a probe was down my throat for roughly 15 minutes, I thought for sure I’d at least have a slight sore throat or scratchy throat and I didn’t have either. It was like nothing had been done and that I just taken a brief 15-minute nap.

After resting for about 15 minutes, a huge breakfast was delivered to the room. Hospital food never looked so good because I was starving. The last food I had was at 7:00 pm the night before (because I was going to be fully sedated I couldn’t eat anything after dinner the night before).

For breakfast I had a sausage patty, scrambled eggs, a bowl of cereal, a carton of milk, a blueberry muffin, and a glass of orange juice! As a side note, I actually do enjoy hospital food. It’s always been delicious to me (said no one ever, right…lol).

After breakfast I had to hang out for another 30 minutes or so before I was allowed to get dressed. Dr. Natale was doing ablations that day so he reviewed the results of the TEEs in between his ablations. They didn’t know when he’d be in between ablations so I was discharged but I had to wait back in the lobby until he called me back to go over the results.

My TEE Results

Fortunately, I only had to wait in the lobby for about five minutes before Dr. Natale’s nurse called me back to the consult room. When I got into the room Dr. Natale was already there waiting for me. After a brief greeting and handshake, we sat down and he gave me the low down.

He said everything was looking great and healing well and my heart was perfectly healthy. He said I had to continue on my half dose of Eliquis (2.5 mg, twice daily) and that I had to come back in four months for the next TEE. He said after that TEE if everything continued to look good I would be given the green light to stop the blood thinners. I said o.k., shook his hands, and left. The whole meeting took less than five minutes.

I have to be honest. I never feel comfortable talking to him because I know he’s super busy so I rarely ask him any questions or engage in any conversation with him. I don’t want to impose, and truth be told, I rarely have any questions anyway. And if I do, I always just follow up with his nurses after the fact.

The one thing I forgot to do, however, was request a physical copy of the TEE results while I was there (something you should always do). Now I’ll have to request a copy through the hospital’s system and it will probably take a week or two to get one. Once I get my hands on one, I’ll update this post with a copy of it.

My Thoughts after the TEE

I have to admit I was very bummed and frustrated after my meeting with Dr. Natale. I was under the impression that if everything looked good after the first TEE you could come off blood thinners completely. I didn’t understand why I had to wait for another TEE.

It turns out I was misinformed. I don’t know where I got my information, but after posting a question about this on the afibbers.org forum and reaching out to my good friend, Shannon, the owner of afibbers.org, I learned that you don’t get the green light to come off blood thinners until the second TEE, which is around the 6-month mark. In short, I learned that everything was on the right track, and I was doing great. I just had to be patient and wait another four months and then I’d likely be able to stop Eliquis.

After learning all that, I felt much better about everything. I was still bummed I had to wait another four months, but in the scheme of things it wasn’t a big deal. I could wait a while longer, I guess.

The Next TEE

Given that my second TEE will have to be sometime in late October/early November, I may actually explore having it done locally here in Minnesota. That time of year is going to be busy for us, and to be honest, I’ve had my fill of flying to Austin, TX. We’ve been down there now three times in the past seven months. I also don’t particularly enjoy flying and these trips to Texas get expensive when you factor in flights, car rentals, food, and lodging.

Having my TEE done locally has some potential challenges, however. For one, Dr. Natale is very particular about the images he needs to see from the TEEs. Whoever would do it locally would have to coordinate with him so they understand exactly what images he needs to see. And while rare, sometimes when you have someone else do the TEE they miss the specific images Dr. Natale has to see so then you have to go back in for another TEE! That’s what Dr. Natale’s nurse told me anyway.

The other issue is sometimes it can take up to a month to get the results of the TEE if you do it locally. The reason for the delay is that it takes time for one hospital to coordinate with another to get the images sent over. Then there takes additional time for Dr. Natale to actually get them in his hands to review them. If I have the TEE done locally in late October or early November, I may not get the results of the TEE until Christmas, meaning I’d be stuck taking blood thinners until then!

Then there is the issue of finding a provider here locally that I’m comfortable with, and then there is the whole insurance stuff to sort through with another provider, etc. It all gives me a headache thinking about it.

The other concern I have about doing it locally is not every cardiologist does full sedation like St. David’s. My TEE was a breeze because they do full sedation. There is no way I’m doing a TEE with partial sedation where you’re awake and only “slightly drugged” during the procedure. I’ve received emails from people that have shared their nightmare experiences having a TEE done only partially sedated. No way, I’m not doing that!

I have to decide quickly what I’m going to do because if I’m going to do the next TEE locally, I need to get started on trying to find someone to do it. It seems like it takes 2-3 months these days to get an appointment with any specialist, so I’ll need to get moving if I go that route.

I’m honestly on the fence right now but I’m leaning heavily on just sucking it up and going to Texas again. While it’s expensive and a pain in the butt to fly to Austin, TX, it is nice not having to do anything since I’m already in the system and I know and trust Dr. Natale and his entire team. I also know what to expect and I know the TEE will be a breeze.

On the other hand, it would be nice to save some money and not have to deal with the hassle of flying to Texas for a simple 15-minute procedure. We’ll see how things unfold in the coming weeks. I’ll be sure to do another detailed post after my next TEE.

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