A device to prevent strokes in afib

Q. I have occasional atrial fibrillation and take anti-clotting medication. My doctor suggested that I consider getting a Watchman device. What exactly is this, and are there any drawbacks?

A. The Watchman device is a tiny, basket-like device that's implanted inside the heart (see illustration). It's designed to help prevent clots from traveling from the heart to the brain, where they might block a blood vessel and cause a stroke. Blood clots tend to form during bouts of atrial fibrillation (afib) because the heart's upper chambers (atria) quiver instead of beating normally. As a result, blood tends to stagnate and form clots, most of which form in a tiny pouch that hangs off the upper left side of the heart called the left atrial appendage (LAA).

Some people with afib take warfarin (Coumadin) to prevent blood clots. But most take direct oral anticoagulants such as apixaban (Eliquis) or rivaroxaban (Xarelto). While these medications all help lower stroke risk, they increase the risk of bleeding, which is usually minor but sometimes serious.

The Watchman device can be a good alternative for people with afib who have already experienced serious bleeding in the brain, gastrointestinal tract, or elsewhere, according to Dr. Jeremy Ruskin, founder of the arrhythmia service at Harvard-affiliated Massachusetts General Hospital. Older people who face a high risk for bleeding or experiencing a fall may also be good candidates for the device, as are those who cannot tolerate anti-clotting medications.

After receiving a Watchman device, people need to take anti-clotting drugs for about six weeks until a layer of cells grows over the device. After that, they can stop the medications. As with any medical procedure, there are risks associated with implanting the device. As Dr. Ruskin explains, the Watchman resembles a tiny, inverted umbrella, and the small prongs that grip the opening of the LAA as the device expands can perforate the heart. As a result, fluid can accumulate around the heart. This problem, known as pericardial effusion, occurs in only about 1% of cases, although the risk of any major complication is around 4%.

For unknown reasons, women are more likely than men to have complications. But the FDA maintains that for women who are appropriate candidates, the benefits of a Watchman still outweigh the risks. The risk of dangerous bleeding is almost completely eliminated, and for people with afib and a history of brain bleeds on anti-clotting drugs, the Watchman can be a godsend, Dr. Ruskin says. Ask your cardiologist whether he or she thinks you would be a candidate — and to explain whether your age and any other health conditions you have could affect your decision, he advises.

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