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WATCHMAN: An Alternative to Blood Thinners for AFib Patients

Blood thinners have traditionally been the default method for reducing stroke risk in patients with Atrial Fibrillation, or AFib.

Unfortunately, not everyone tolerates these medications well. The WATCHMAN implant allows people with AFib to get off blood thinners around 6 weeks after they have the minimally invasive WATCHMAN procedure.

Marin General Hospital interventional cardiologist Arun Raghupathy, MD, FACC, has performed numerous WATCHMAN procedures. In this podcast, he discusses who is a good candidate for the minimally invasive procedure and explains how the implant works.
WATCHMAN: An Alternative to Blood Thinners for AFib Patients
Featuring:
Arun Raghupathy, MD, FACC
Arun Raghupathy, MD, FACC is an interventional cardiologist who specializes in invasive cardiology procedures such as angioplasty and stenting of blood vessels.  He has additional experience and training in structural heart interventions and peripheral vascular disease. As a member of the Structural Heart Team, Dr. Raghupathy has a special interest in treating patients with advanced valvular heart conditions like aortic stenosis, using minimally invasive procedures such as transcatheter aortic valve replacement (TAVR).  He also performs procedures to close the left atrial appendage in patients with atrial fibrillation who are not able to safely take anticoagulation.

Learn more about Arun Raghupathy, MD
Transcription:

Bill Klaproth (Host): For people with atrial fibrillation or A-Fib who need an alternative to taking long-term blood thinners; there is a new procedure called the Watchman Implant. And here to talk with us about the Watchman Implant is Dr. Arun Raghupathy, an interventional cardiologist at Marin General Hospital. Dr. Raghupathy, thanks for your time. So, what is the Watchman Implant and how does it work?

Arun Raghupathy, MD, FACC (Guest): The Watchman Implant is a device that an interventional cardiologist or electrophysiologist can offer to a patient who has atrial fibrillation and who has difficulty taking blood thinners for the long-term.

Bill: The blood thinner issue, why do some people have a problem with blood thinners long-term?

Dr. Raghupathy: It’s a good question. The patients with atrial fibrillation have an increased risk of developing blood clots in their heart and that can be a dangerous situation, if the blood clots in the heart get to the brain; that can cause a stroke which can be quite serious. So, certainly patients who take blood thinners are doing it for a good reason, to prevent a stroke. But the question you bring up is why these blood thinners are dangerous. Well, they can certainly increase the risk of bleeding. As we get older, we can run into problems with serious bleeding with stomach problems, GI bleeding, some elderly patients may fall or have difficulty taking blood thinners that interact with their other medications. Those are just a few of the examples.

Bill: So, what does the implant do that allows people to get off of blood thinners?

Dr. Raghupathy: So, to understand that, we really need to understand the anatomy of the heart. There is a small pocket of heart tissue in the heart called the left atrial appendage and that is basically the reservoir where blood clots can collect and for patients with atrial fibrillation; if those blood clots get to the brain, that’s what can cause a stroke. So, the Watchman Implant is basically an implantable stent that can close off that left atrial appendage, seal off that pocket, so that blood clots can’t form there and can’t travel to the brain to cause stroke.

Bill: So, can you tell us about the procedure? This certainly doesn’t sound like it’s outpatient; it sounds like it requires a hospital stay. Tell us about the procedure.

Dr. Raghupathy: Yes, once the patient is selected to receive the procedure, they will come to the hospital where a team of doctors will implant the device. It’s done under general anesthesia and takes about one hour. And patients will usually spend one night in the hospital and be discharged home the next day.

Bill: And how about the recovery?

Dr. Raghupathy: The recovery for a procedure like this is similar to other catheter procedures like having a stent or having a procedure in the heart like an ablation, that the patients will spend one night in the hospital and usually back to their usual activities in about a week.

Bill: And how long does the implant generally last?

Dr. Raghupathy: The implant is permanent. And that’s the benefit of having the procedure. Once implanted, patients can usually stop their blood thinners in about six weeks and it’s a permanent solution and a one-time procedure.

Bill: Well, this seems like such a win Dr. Raghupathy, for everyone that has A-Fib; why wouldn’t they all want this procedure?

Dr. Raghupathy: Well, that’s a good question too. I think it’s important to realize that blood thinners and anticoagulation has been around for a long time and that many, many patients have benefited from reduced strokes by using blood thinners. But it’s really for the patients who need that alternative; the ones that are having difficulty taking that medication, that are looking for an alternative that we would want to offer this important procedure for. I think certainly as more scientific trials are developed to study the device in different populations; the question you asked will certainly be raised again and one day it may actually be not just an alternative, but the primary treatment for patients.

Bill: And this procedure generally then allows people to get off of their medication?

Dr. Raghupathy: Absolutely. So, patients who have this procedure will have it done and in about four to six weeks after the implant; we will reassess how well their atrial appendage is closed and over 99% of patients will be able to stop their blood thinners.

Bill: How many people do you perform this procedure on? Is this a popular procedure or is this something fairly new?

Dr. Raghupathy: The procedure itself has been around for over a decade. It’s been studied in clinical trials over that time and the FDA approved the device for commercial use in 2016. There has been about 50,000 implants worldwide. We perform between four and eight of these procedures a month and it’s certainly something that is applied in a selective fashion to patients who would most benefit from it. That being said, it’s certainly a great alternative for those patients who need an alternative.

Bill: And are there any risk factors with the procedure?

Dr. Raghupathy: There are always some risks to having invasive procedures done and this procedure is considered to be minimally invasive. It’s important to talk to your doctor about specific risks that pertain to you as an individual. But in general, the procedure is highly successful with a low rate of complications.

Bill: Well this has been so informative Dr. Raghupathy. Thanks for your time. For more information on the Watchman procedure, visit www.maringeneral.org, that’s www.maringeneral.org. The is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.