What is a WATCHMAN Device? Why do I need it?

Idrees Agha • September 29, 2022

What is a WATCHMAN Device? Why do I need it?

The WATCHMAN device has been introduced as an alternative to anticoagulant drugs (blood thinners) in patients with atrial fibrillation (AF). It has reduced the bleeding complications associated with blood thinners and is used in AF patients with normal heart valves. AF causes the atria (smaller chambers of the heart) to beat at a very rapid rate which impairs the normal contractile power of the atria leading to blood stasis and clot formation. Clots can dislodge and cause complications like stroke.

The left atrium is the most common site of clot formation because it has an extra communicating small cavitary structure called the left atrial appendage (LAA). The WATCHMAN device is implanted in the LAA to seal it permanently from the main atrial cavity. It is a self-expanding device designed in a parachute shape containing numerous anchors at one end and a fabric cap at the other end. The fabric end faces the main atrial cavity. The heart’s inner layer—the endocardium—grows over the fabric cap after implantation and seals the LAA from the main atrial cavity.

Images of a WATCHMAN device are available here.

When Do I Need a WATCHMAN Device?

If you have AF with normal heart valves and you need to take blood thinners plus any of the following:

· Previous history or future risk of bleeding.

· Occupation or lifestyle that increases the risk of bleeding e.g., Contact sports.

· Noncompliance with medications.

· Intake of other drugs that have possible interactions with blood thinners, therefore, increasing the risk of bleeding. ¹

Are There Preprocedural Requirements?

Your doctor will assess you through a detailed history, examination, and certain blood and imaging tests. These are necessary to determine the indications or contraindications, and the size of the device. One important imaging test of the heart is transesophageal echocardiography (TEE). It is an invasive test in which a probe is inserted into the esophagus.

What are the Contraindications for WATCHMAN Device Implantation?

The device is not recommended if you have:

· A low risk of stroke based on a scoring system, which considers certain health conditions.

· A disease related to heart valves.

· An active infection.

· Left atrial clot or tumor.

· Presence of a defect or a device in the septum between the right and left atria.

· Left atrial appendage with significantly short depth.

· Another health condition that necessitates the need for blood thinners.

· High risk of bleeding with short-term therapy of blood thinners.

How is The Procedure Performed and what are possible complications?

You will be moved to a special room—the catheterization laboratory—where different procedures are performed on blood vessels and the heart through the insertion of a catheter into blood vessels. You will probably be sent back home the same or the next day. During the procedure:

· You will be deeply sedated to avoid complications caused by movement.

· You will be given the antibiotic drug for the prevention of infection.

· You will be given a dose of blood thinning drug directly into your veins via an IV.

· A catheter will be inserted into the major vessel of the thigh and directed to the heart through continuous imaging.

· WATCHMAN device will be inserted into the LAA.

Various complications can occur during or after the procedure, but the most dangerous complications are:

· Fluid accumulation in the cavity around the heart.

· Perforation of heart tissue.

· Dislocation of the device.

· Clot formation due to the device.

· Persistence of the defect in the septum between atria due to catheter. penetration.

· Stroke. ²

Will I need Follow-up visits and Medications?

You need to take a blood thinning drug and aspirin for at least six weeks to prevent the complication of device-related clot formation.

After six weeks, the doctor will assess the status of the device implantation. If implantation is successful, the blood thinning drug will be stopped. It will be replaced by another drug with less potential for bleeding complications.

After six months, aspirin must be continued indefinitely.

Has WATCHMAN Device Proved to Replace Blood Thinners?

Thousands of patients with WATCHMAN device implant were followed up for years. The results showed that the device was almost equivalent to blood thinners in the prevention of stroke, and the bleeding risk was significantly lower than those of blood thinners. Hence, WATCHMAN device has been accepted as an alternative to blood thinners in AF patients with normal valves. ³

Ask your doctor if a WATCHMAN device would be beneficial in your situation.

References:

1. Akinapelli A, Bansal O, Chen JP, et al. Left Atrial Appendage Closure – The WATCHMAN Device. Curr Cardiol Rev. 2015;11(4):334-340. doi:10.2174/1573403X11666150805115822

2. Agasthi P, Arsanjani R. Catheter Management Of Left Atrial Appendage Closure Devices. In: StatPearls. StatPearls Publishing; 2022. Accessed September 24, 2022. http://www.ncbi.nlm.nih.gov/books/NBK557458/

3. Magdi M, Renjithal SLM, Mubasher M, et al. The WATCHMAN device and post-implantation anticoagulation management. A review of key studies and the risk of device-related thrombosis. Am J Cardiovasc Dis. 2021;11(6):714-722.

Thank you for reading Patient Education Essentials, the Write Shift RN blog.

Disclaimer: This article was written as a guest post for Write Shift RN LLC's blog. The information in it may not be wholly fact-checked or edited, allowing the reader to see the writer's work and skills firsthand. This information is not intended as medical advice. It is for informational and educational purposes only. Always talk to your doctor or other qualified healthcare providers about any questions or concerns you may have regarding medical conditions.

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Steroid Injections vs. PRP

By Kristina Van Winkle • October 7, 2024

A Comparative Overview for Pain Management Steroid injections and Platelet-Rich Plasma (PRP) injections are two commonly used pain management treatments. While both aim to alleviate pain and promote healing, they have different mechanisms of action and long-term effects . What Are Steroid Injections ? Corticosteroids are potent drugs used extensively across various medical fields to manage a broad spectrum of conditions, making them one of the most widely prescribed drug classes in the world. They can be administered via nearly every route, including direct injection into painful or inflamed joints. "Corticosteroids" typically refers to the class of drugs that produce glucocorticoid effects. Glucocorticoids are stress hormones that regulate numerous physiologic processes within the body. They have vasoconstrictive, immunosuppressive, and anti-inflammatory effects and play a role in metabolism. What do steroid injections treat? Corticosteroids function by suppressing the immune system and reducing inflammation within the body. They inhibit the production of the body's pro-inflammatory chemicals, leading to decreased inflammation and, consequently, pain. They are prescribed for hundreds of medical conditions, including: Allergic and autoimmune disorders Adrenocortical secretion disorders Infections and inflammation Pathologic hypoglycemia Organ and graft rejections Neurological disorders Hypercalcemia Blood disorders Skin disorders Shock What are the side effects of steroid injections? Although steroids are known to some as “wonder drugs,” they impact various bodily systems, including metabolism, water and electrolyte balance, the central nervous system, and blood cells. As a result, they are associated with many adverse side effects, especially when administered in large doses or over extended periods. Adverse effects may occur in up to 90% of individuals who take them for longer than sixty days. These side effects may include: Suppression of the hypothalamic-pituitary-adrenal axis Gastrointestinal disturbances Osteoporosis and fractures Psychiatric disturbances Carpal tunnel syndrome Cardiovascular disease Immunosuppression Cushingoid features Hyperglycemia Skin disorders Glaucoma Myopathy Cataracts Diabetes The risk of adverse side effects is particularly high when taken systemically. However, side effect occurrences vary when administered as local injections for pain management. Data indicates that steroid injections into joints and the spine can produce systemic effects that can last for weeks. When assessing the risk factors associated with steroid injections, healthcare providers must consider all types and doses of steroids the person is taking, including both oral and injectable forms. Additionally, special caution is advised for certain populations, such as those who may undergo surgery soon, postmenopausal women, and individuals with diabetes. What is Platelet-Rich Plasma (PRP) ? Platelet-rich plasma (PRP) injections use an individual's own blood to promote cellular regeneration. Through the extraction and reinjection of platelets, growth factors, and other bioactive proteins from the person's blood, PRP therapy offers long-lasting improvements, sustained pain relief, and enhanced tissue function. What do PRP injections treat? PRP injections can stimulate healthy cell growth, reduce inflammation, promote tissue repair, form new blood vessels, rejuvenate the skin and hair, and accelerate recovery after a traumatic injury. It can treat a wide range of conditions, including: Pain resulting from traumatic injury or degenerative conditions such as arthritis and chronic back pain Musculoskeletal conditions Tendinopathies and tears Compressive neuropathy Scars and stretch marks Osteochondral lesions Rheumatoid arthritis Erectile dysfunction Muscular injuries Plantar fasciitis Vaginal atrophy Osteoarthritis Epicondylitis Infertility Psoriasis Wounds Bursitis Vitiligo What are the side effects of PRP? Since PRP is derived from the person's own blood, the risk of allergic reactions or rejection is significantly lower compared to other injectables, such as steroids. PRP typically does not cause major side effects, though you may experience some soreness or bruising at the injection site. In rare cases, potential side effects may include: Tissue damage Nerve injuries Bleeding Infection Comparison of Steroid Injections and PRP Injections A study in the Journal of Orthopaedic Surgery and Research compared steroid injections with PRP injections in patients with mild to moderate symptomatic knee osteoarthritis (OA). The findings indicated that both treatments were safe and effective in improving short-term pain and functioning, with no significant differences observed. However, PRP therapy demonstrated superior outcomes in the long term, with benefits extending up to one year. Additionally, a literature review in Cureus Journal of Medical Science analyzed multiple studies comparing steroid injections with PRP in lumbar spondylosis and sacroiliac arthropathy. The review found that PRP was equally as effective, if not superior, to steroid injections in the short term. Neither treatment was associated with major complications, and there were no significant differences in minor complications between the two. The review concluded that both PRP and steroid injections are safe and effective for treating lumbar spondylosis and sacroiliac arthropathy, with some evidence that PRP may offer more benefits in the long term. Research has confirmed that both steroid and PRP therapy are valuable options for pain management and tissue healing. Steroid injections offer potent anti-inflammatory benefits that can provide immediate relief. However, their systemic side effects and limited duration of efficacy should be carefully considered, especially in high-risk populations. While PRP may take longer to show results, its long-term benefits make it an increasingly popular choice for treating various conditions. Ultimately, the choice between these treatments should be based on the specific needs of the individual patient, with careful attention to the patient's medical history. Thank you for reading the Write Shift RN blog. If you need an experienced RN writer for your health or healthcare educational content, contact me !