What is the Watchman Procedure?
The Watchman FLX is a small plug-like device implanted in the left atrial appendage (LAA) — a small pouch in the upper left chamber of the heart where over 90% of stroke-causing blood clots form in patients with non-valvular atrial fibrillation. By sealing off this pouch, the Watchman device prevents clots from escaping into the bloodstream, reducing stroke risk without the need for lifelong anticoagulation.
The LAA is not essential for normal heart function — it is essentially a blind pouch that collects blood and forms clots in AF. Closing it off eliminates the #1 source of cardioembolic stroke in atrial fibrillation.
Who is a Candidate for Watchman?
Watchman is appropriate for patients with non-valvular atrial fibrillation who have an elevated stroke risk (CHA₂DS₂-VASc score ≥2 in men, ≥3 in women) AND a reason that oral anticoagulation is not ideal for them long-term:
- History of serious bleeding on blood thinners (GI bleed, intracranial hemorrhage)
- High fall risk or lifestyle that makes anticoagulation dangerous
- Chronic kidney disease or liver disease that complicates anticoagulation
- Patient preference after shared decision-making discussion
- Need for upcoming surgical procedure that would require stopping anticoagulation frequently
The Watchman Procedure
Watchman implantation is performed under general anesthesia with transesophageal echocardiographic (TEE) guidance. A catheter is advanced from the femoral vein in the groin, through a small puncture in the wall between the heart's upper chambers (transseptal puncture), and into the left atrial appendage. The Watchman FLX device is sized based on detailed CT measurements of the LAA and deployed to seal it completely.
After the Procedure
After Watchman implantation, patients take aspirin plus clopidogrel (DAPT) for 45 days, then aspirin alone long-term. A follow-up TEE at 45 days confirms the device is properly sealed and tissue has grown over it (endothelialization). Once confirmed, anticoagulation can be stopped.
Key Clinical Trial Evidence
Dr. Khan's LAA Occlusion Practice
Dr. Khan developed extensive LAA closure experience during his structural heart training at NYU Langone Health. CT-based pre-procedural planning is used for every case to optimize device sizing, understand LAA morphology (chicken-wing, cauliflower, windsock, cactus), and anticipate challenging anatomy. Challenging morphologies — particularly short chicken-wing LAAs and wide ostia — require individualized approaches that experience and careful imaging planning make achievable.
Frequently Asked Questions
Can I stop blood thinners completely after Watchman?
Most patients stop oral anticoagulation after the 45-day TEE confirms complete device sealing. You continue aspirin long-term. This is the primary goal of the procedure for patients who cannot safely take blood thinners indefinitely.
Is the Watchman procedure safe?
Watchman has been performed in hundreds of thousands of patients worldwide. Major complications are uncommon in experienced centers. Pericardial effusion (fluid around the heart) requiring drainage occurs in approximately 1% of cases.
What is the difference between Watchman and Watchman FLX?
Watchman FLX is the newer generation device with a more flexible, rounded design that conforms better to different LAA shapes and has significantly reduced pericardial effusion rates compared to the original Watchman device.