A multidisciplinary team of interventionalists, electrophysiologists, and cardiac imaging specialists in the division of cardiology performed the procedure on September 16.


The WATCHMAN left atrial appendage device.

Atrial fibrillation (AF), the most common cardiac dysrhythmia, is associated with a high risk for stroke in many patients. To reduce this risk, many patients are prescribed anticoagulant medications such as warfarin, apixaban, or rivaroxaban.

Often times, however, patients are not suited for long-term anticoagulation therapy. They may have had a prior bleeding event with anticoagulation, have a predisposition to bleeding, or felt to be too high risk for anticoagulation because of a risk for falls.

An alternative to anticoagulation is the WATCHMAN left atrial appendage (LAA) closure device. A small mesh parachute is placed into the LAA where the vast majority of blood clots tend to form in AF patients. By threading a catheter through the femoral vein and across the interatrial septum, the WATCHMAN device can be deployed in the LAA. Careful imaging and sizing is done during the procedure to select an appropriate sized device and achieve an adequate seal. The procedure is done in approximately one-hour under general anesthesia and patients spend one night in the hospital with a minimal recovery period. Patients take anticoagulation for 6 weeks after the procedure and then antiplatelet medications (aspirin and clopidogrel) for six months while a layer of tissue grows over the device. Thereafter, a daily aspirin is all that’s needed. Large-scale clinical trials have demonstrated that a Watchman implant provides as much protection from stroke as standard anticoagulation.

At UNC, a multidisciplinary team of interventionalists, electrophysiologists, and cardiac imaging specialists perform the procedure together. On September 16, the UNC team implanted their 100th Watchman device and thus far has demonstrated that >95% of appendages can be successfully sealed off with an extremely low (<1%) complication rate.

“AF-related strokes can be devastating,” said Anil Gehi, MD, Sewell Family-McAllister Distinguished Professor and Director of Clinical Cardiac Electrophysiology at UNC Medical Center. “In the past there was no good option for patients with AF who were not candidates for long-term anticoagulation – they just had to take their chances. But now, left atrial appendage occlusion with the WATCHMAN allows for a low-risk alternative option. It’s important for patients and providers to consider left atrial appendage occlusion and not just accept the risk.”

“This fall the next generation of WATCHMAN device will be available – the WATCHMAN FLX,” said Joseph S. Rossi, MD, Director of the Cardiac Catheterization Lab at UNC Medical Center. “Studies of this new device demonstrate an even higher success rate (98%) with even lower complication rate (0.5%). However, these devices aren’t needed for most patients. But every patient has the same goals- to reduce the risk of stroke, and reduce the risk of bleeding. These devices are a good option to achieve both of those goals.”

To learn more about the LAA occlusion program or to make an appointment, call our AF Coordinator, Kelly Garner, BSN, RN: Kelly.garner@unchealth.unc.edu, (984) 974-5298.