The WATCHMAN device offers a minimally invasive alternative to long-term oral blood thinners for individuals with non-valvular Atrial Fibrillation (AFib). The device permanently closes off the left atrial appendage (LAA), a small pouch in the heart where blood can pool and form clots that may lead to a stroke. Since most stroke-causing clots in AFib patients originate here, sealing the LAA reduces stroke risk without the need for chronic anticoagulation medication. Understanding the entire timeline, from initial preparation to long-term medical follow-up, is helpful for patients considering this procedure.
Timeline Before the Procedure
Preparation begins well before the patient enters the cardiac catheterization lab, often requiring several hours at the hospital or clinic. Patients are instructed not to eat, drink, or chew anything after midnight before the procedure to prepare for general anesthesia. This fasting is a standard safety measure for any procedure requiring sedation.
Upon arrival, the patient is moved to a pre-operative area where nurses perform initial assessments, including blood work, vital sign checks, and IV line placement. The care team, including the interventional cardiologist and anesthesiologist, will meet with the patient to review the plan. This preparatory phase, which includes final checks and transport, generally adds two to four hours to the overall hospital time before the device implantation can begin.
The final pre-procedural step involves a Transesophageal Echocardiogram (TEE) or computed tomography (CT) scan to precisely measure the left atrial appendage. Accurate measurements are necessary to select the correct size of the WATCHMAN device for optimal fit and seal. Once pre-operative steps are complete, the patient is moved into the catheterization lab.
How Long the Procedure Takes
The actual implantation of the WATCHMAN device is a minimally invasive procedure that typically takes about one hour. The patient is under general anesthesia or deep sedation for the entire duration to ensure comfort and immobility. The procedure takes place in a specialized cardiac catheterization lab, involving a team of specialists including an interventional cardiologist and an imaging specialist.
The process begins with the physician making a small incision, usually in the upper leg, to access the femoral vein. A thin catheter is then inserted through this vessel and guided up to the heart. Using advanced imaging, such as fluoroscopy and TEE, the physician performs a transseptal puncture to cross from the right side of the heart to the left atrium, where the LAA is located.
Once the delivery catheter is correctly positioned, the compressed, parachute-shaped WATCHMAN device is advanced and deployed into the opening of the LAA. Placement is verified using imaging tools to confirm the device is securely anchored and that the LAA is sealed off. While the average time is one hour, the procedure may extend to two hours depending on the anatomical complexity or the need for multiple attempts to achieve a satisfactory seal.
Immediate Recovery and Hospital Stay
Immediately following the device placement, the patient is moved to a recovery area for monitoring as they wake up from the anesthesia. Mandatory bed rest is required to allow the access site in the groin to heal. This bed rest, with the leg kept straight, typically lasts four to six hours to prevent bleeding or complications at the puncture site.
During this time, nurses continuously monitor the patient’s heart rhythm, blood pressure, and the groin incision. Once the bed rest period is successfully completed, the patient can usually sit up and begin walking short distances. Most patients are kept overnight for observation, meaning the total hospital stay is typically one day.
The overnight stay allows the clinical team to monitor for any delayed complications, such as fluid buildup around the heart or issues with the access site. Discharge criteria include stable vital signs, a clear chest X-ray, and a stable puncture site, allowing most patients to go home the morning after the procedure. Patients should avoid strenuous activity and heavy lifting for about one week to protect the femoral vein site.
Long-Term Follow-Up Milestones
The timeline commitment continues for several months after the patient leaves the hospital, focusing on device integration and the transition off blood thinners. Following the procedure, patients must adhere to a specific medication regimen, initially involving an oral blood thinner (like warfarin) and aspirin. This is necessary to prevent clots from forming on the device until the body’s own tissue has fully grown over it.
The first major follow-up milestone occurs at approximately 45 days post-procedure. The patient undergoes a repeat TEE to assess the device. This imaging test confirms that the LAA is adequately sealed, showing no significant peridevice leak, and that no clot has formed on the device surface.
If the 45-day TEE confirms successful sealing and a clot-free device, the patient can usually discontinue the oral blood thinner. They will then transition to dual antiplatelet therapy, often aspirin and clopidogrel, which continues until the next scheduled TEE at six months. The six-month TEE confirms the long-term stability of the device and, if everything remains stable, allows the patient to transition to a single antiplatelet medication, such as aspirin, indefinitely.