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Watchman: Left Atrial Appendage Occlusion
Left atrial appendage occlusion (LAAO), most often done with the Watchman device, lowers stroke risk for people with atrial fibrillation who need an alternative to long-term blood thinners.
What it is
In atrial fibrillation (AFib), the heart's upper chambers quiver instead of squeezing normally. Blood can pool in the left atrial appendage, a small pouch off the left upper chamber, and form clots. In AFib not caused by a valve problem, most stroke-causing clots form in this pouch. Blood thinners lower that risk, but some people cannot take them safely for years. LAAO places a small, umbrella-like implant at the opening of the pouch. Over the following weeks, heart tissue grows over the implant and seals the pouch off.
Who it may help
LAAO is for adults with AFib not caused by a heart valve problem who have a raised stroke risk, who can take a blood thinner for a short time, and who have a sound reason to seek an alternative to lifelong blood thinners. Common reasons include a history of serious bleeding, a high bleeding risk, frequent falls, or trouble staying on blood thinners. LAAO does not treat the AFib itself; your heart rhythm stays the same. Medicare requires a shared decision-making visit to review the options before the procedure.
How it's done
The procedure is usually done under general anesthesia or deep sedation. A catheter is placed in the large vein at the top of the leg, guided to the heart, and passed across the thin wall between the upper chambers. Using ultrasound from a transesophageal (TEE) or intracardiac (ICE) probe, the doctor sizes the pouch and places the implant. The procedure often takes about an hour.
Recovery
Most patients go home the next day. You will take a blood thinner or antiplatelet medicine for a period while tissue covers the implant. Follow-up imaging, often at about 45 days, checks the seal. Many patients can then stop long-term blood thinners, but the plan is set for each person.
Risks
Possible risks include bleeding or injury to the leg vein, fluid collecting around the heart that may need to be drained, a clot forming on the implant, the implant moving out of place, and stroke. Rarely, emergency surgery is needed or the procedure results in death. Your team will explain how these risks compare with the risks of staying on blood thinners.
Dr. Smith's experience
Dr. Smith has been primary operator for more than 35 left atrial appendage occlusions since joining Cardiovascular Institute of the South in 2023, among more than 180 structural heart procedures. He has lectured on left atrial appendage closure at the New Cardiovascular Horizons conference in New Orleans in 2025 and 2026. He is board certified in echocardiography and cardiac CT, both used to plan and check the implant.
Frequently asked questions
Does Watchman cure atrial fibrillation?
No. It lowers the risk of stroke from clots that form in the left atrial appendage. Your heart rhythm does not change, and AFib treatment continues as before.
Will I be able to stop my blood thinner?
Most patients can stop long-term blood thinners after the implant has healed in place, confirmed by follow-up imaging. Some people cannot, and your doctor will set your plan.
Can I feel the implant?
No. The implant sits inside the heart and is not felt.
How long is the hospital stay?
Most patients go home the day after the procedure.
Who is a good candidate?
Adults with atrial fibrillation not caused by a valve problem who have a raised stroke risk and a sound reason to avoid long-term blood thinners, such as a history of serious bleeding. An evaluation with a cardiologist is the first step.
Is Watchman the only option for stroke prevention in AFib?
No. Blood thinners remain the standard treatment for most people with AFib. LAAO is an alternative for selected patients. Your cardiologist will review the choices with you.
Ask about Watchman at Cardiovascular Institute of the South
Dr. Smith sees patients at CIS Baton Rouge, 8401 Picardy Avenue · (225) 308-0247, and CIS Zachary, 6550 Main Street, Suite 1000 · (225) 654-1559. Your primary care doctor or cardiologist can also send a referral.