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Watchman Occlusion Device – Blood Thinners Alternative
The Watchman™ Device: An Alternative to Blood Thinners
Illustration of the Left Atrial Appendage (LAA) in the Left Atrium
By Steve S. Ryan, PhD, Last updated: September 4, 2026
Do you hate having to take an anticoagulant? Hate the side effects? A replacement for taking blood thinners is an occlusion device such as the Watchman from Boston Scientific.
It’s known that 90%-95% of A-Fib related clots originate in a small pouch at the top of the heart called the Left Atrial Appendage (LAA). The Watchman is a one-time, minimally invasive heart implant used to close off the LAA to reduce stroke risk in people with atrial fibrillation.
Watchman barbs
The very low risk procedure takes about 30 minutes under general anesthesia, and most patients go home within a day. Afterwards you usually do not need to be on an anticoagulant.
It has been used to treat more than 100,000 patients worldwide. Some patients with challenging heart anatomies, such as a shallow appendage, may not be good candidates for the procedure.
The Watchman Procedure
The Watchman device comes in multiple sizes to accommodate the different shapes of LAAs. Once a patient’s Left Atrial Appendage is measured, a wide-sheathed catheter with a spline is used to insert the Watchman device which has a self-expanding open-ended circular frame.
Illustration: Watchman placement in LAA
The atrial surface of this frame is covered with a thin, permeable 160 μm (micron) pore filter made of polyester material. This filter allows blood to pass through while stopping clots. Little hooks or anchors called fixation barbs at the middle of the device make sure it is attached firmly to the LAA wall.
Before the catheter is removed (which fixes the Watchman in place), contrast agents are used to make sure the Watchman is stable and closes off the LAA opening.
Over time heart tissue grows over the polyester (PET) material so that it completely closes off the LAA with smooth heart tissue similar to other heart surfaces.
After Watchman Installation
Watchmen anatomical view 9 months after install (autopsy image of patient who died from non-heart related causes.)
Patients continue on their anticoagulant for several weeks after the Watchman device is inserted.
They are then examined using a Transesophageal Echocardiogram (TEE) to make sure there is complete closure of the LAA. At that time your doctor with determine if and how long you should continue on your anticoagulant.
You can think of the Watchman as a replacement for blood thinners. Both reduce but do not totally eliminate the risk of stroke. The stroke risk is reduced to that of a person with a normal heart.
Catheter Ablation + Watchman Concomitant Procedure
Many patients today undergoing a catheter ablation are also having a Watchman device installed, often in the same procedure.
The catheter ablation treats the source of A-Fib while the Watchman device reduces A-Fib-related stroke risk, eliminating the need for lifelong blood thinners.
The OPTION randomized controlled clinical trial concluded in 2025 after 3-years of follow-up. It found for people who had both procedures at the same time, getting an ablation and Watchman implant was just as safe as getting an ablation alone.
After an ablation, the Watchman implant was shown to be just as safe as blood thinners and just as effective at reducing stroke risk – plus, people with the Watchman were 50% less likely to have a bleeding event.
Is There a Watchman or a Concomitant Procedure in Your Future?
If don’t want to be on an anticoagulant, consider having your Left Atrial Appendage closed off to keep A-Fib related clots from escaping and causing a stroke. If you are considering a catheter ablation to cure your A-Fib, ask your Electrophysiologist about having a concomitant procedure—a two-for-one procedure.
To learn more about the Watchman device, watch a video of the Watchman being installed.
VIDEO: Placement of the Watchman FLX™ Left Atrial Appendage Closure Device. Illustrates insertion of the Watchman FLX™ by a catheter through the groin to the heart and positioning to close off the Left Atrial Appendage; Narration, illustrations and animation. (1:58 min.) Go to video->
Return to Article Index: Drug Therapies and Medicines
If you find any errors on this page, email us. Y Last updated: Friday, September 4, 2026
A-Fib & Obstructive Sleep Apnea=Higher Mortality Rate, Longer Hospital Stays
At least 43% of patients with Atrial Fibrillation also suffer from Obstructive Sleep Apnea (OSA), a disorder characterized by recurrent collapse of the upper airway during sleep. It occurs when the muscles supporting the soft tissues in the throat relax, the airway is narrowed, and breathing is momentarily cut off.
Recent research indicates sleep apnea may contribute to A-Fib by causing stress on the Pulmonary Vein openings and/or by depriving the lungs and body of adequate oxygen supply (Hypoxemic Hypoxia).
Obstructive Sleep Apnea: a Major Public Health Problem
OSA affects almost one billion individuals worldwide. Ninety percent of patients with OSA are still undiagnosed. Some reports have estimated that at least 20.2% of men and 10.0% of women are affected with moderate-severe OSA.
Aside from causing or triggering A-Fib, untreated sleep apnea can cause many other serious health threats. Research reveals that patients with sleep apnea have a higher mortality rate, a longer duration of hospitalization, and incur greater medical costs.
The Wisconsin Sleep Cohort Study
Beginning in 1989, the U. of Wisconsin study used a random sample of 1,522 Wisconsin state employees. The participants underwent overnight sleep apnea studies and many other tests at four-year intervals. They were not selected because they had known sleep problems. (After the testing, researchers contacted participants with severe sleep apnea and explained the health risks.)
Researchers examined 22-years of mortality data on the study’s participants and revealed the numerous life-altering and life-threatening health issues associated with sleep apnea.
Patients with severe sleep apnea are…
• 4X more likely to have a stroke
• 5X greater risk of cardiovascular death
• 2X as likely to develop depression
• 5X more likely to die from cancer
And more likely on average to:
• develop cognitive impairment a decade earlier
• develop Alzheimer’s 5 years earlier
Sleep Apnea: a condition in which one or more pauses in breathing occur while sleeping, pauses can last a few seconds to minutes and can occur 30 times or more an hour.
More EPs are Sending Patients for Sleep Studies
So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study.
Although an in-lab sleep study (called “attended polysomnography” or PSG) is the gold standard to diagnose OSA, it is time-consuming and is associated with higher costs. Home Sleep Apnea Testing (HSAT) is now available to diagnose OSA (requires a prescription from your doctor).
It’s now available at a fraction of the cost of an in-lab sleep study ($250–$300 vs. $1100–$2,000). And it’s convenient (especially if being away from home overnight is problematic).
A home sleep apnea test is a very simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort while worn. It does not fully capture what is monitored with an overnight sleep study.
Additional Benefit of Treatment: Patients receiving CPAP therapy appear to have a lower risk of A-Fib recurrence after having a catheter ablation.
Treatments for Sleep Apnea
The most common treatment is a CPAP (Continuous Positive Airway Pressure) machine that blows steady air through a mask to keep your airway open while you sleep. Other treatment choices include a custom mouth guard to move your jaw forward; Lifestyle changes like weight loss; Or surgery to open blocked airways.
Take Action: Sleep Apnea Can be Lethal
Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. (Just like A-Fib, you don’t have to just live with it).
If your significant other tells you that you pause breathing when you sleep or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)
Talk with your doctors about testing for sleep apnea. A Home Sleep Apnea Test may be just what the doctors orders. If more extensive data is needed, you may need an in-lab sleep study.
See also: Possible Sleep Apnea? Oximeter is DIY Way to Check your Blood’s Oxygen Level
and, Which Comorbid Risks Are Making Your A-Fib More Severe? Do You Have Them Under Control?
On a Personal Note: My wife. Patti, has sleep apnea (but not A-Fib). While sleeping, she would actually stop breathing for what seemed like a long time, then suddenly gasp for air. It was very scary! But now she uses a CPAP machine, sleeps soundly and wakes up rested.
Patti’s last sleep study was a Home Sleep Apnea Test. An overnight kit was supplied through her doctor’s office. She watched a YouTube video about setup and returned the kit the next day for diagnosis.
BTW: Sleep apnea may run in families. Her brother has sleep apnea also.
Which Comorbid Risks Do You Have That Make Your A-Fib More Severe? And What To Do
Most A-Fib patients have at least one concurrent medical condition, i.e., comorbidity, that makes Atrial Fibrillation symptoms more severe and makes treating A-Fib more difficult with increased risk of complications. They can also affect the longevity of a treatment such as a catheter ablation.
Concurrent Medical Conditions
Concurrent conditions, or comorbidities, are risk factors that can interfere with the biological mechanisms or processes (pathogenesis) of your A-Fib. The leading concurrent conditions affecting Atrial Fibrillation patients are:
• Obstructive Sleep Apnea
• Diabetes
• Hypertension (high blood pressure)
• Heat Failure
• Air pollution
• Respiratory Disease
• Chronic Kidney Disease
• Mental health disorders
Comorbidities and the Impact on Your Atrial Fibrillation
Obstructive Sleep Apnea (OSA): At least 43% of patients with Atrial Fibrillation also suffer from Obstructive Sleep Apnea. …->Continue reading about each of the concurrent conditions on our list and the risks for Atrial Fibrillations and learn what to do…->Go to read my full article.
Which Lifestyle Choices Make Your A-Fib More Severe? What You Can Do
Most A-Fib patients have one or more lifestyle factor risk that makes A-Fib symptoms more severe and makes treating A-Fib more difficult with increased risk of complications.
Modifying lifestyle factors can have an enormous impact on the severity of your A-Fib symptoms, reduce the frequency of A-Fib episodes, or even eliminate it entirely.
Lifestyle factors can also affect the longevity of a treatment such as a catheter ablation. Lifestyle factors that can affect your A-Fib include:
• Obesity
• Smoking
• Drug Abuse
• Excess alcohol use
• Lack of exercise
• Poor nutrition
Changing Lifestyle Factors and the Impact on Your Atrial Fibrillation
Multiple research studies have shown that modifying these lifestyle factors risks can…
Continue reading->…to learn more and what you can do to modify your lifestyle factors to lessen your A-Fib symptoms and even reverse your Atrial Fibrillation.-> Go to my full article.
Lifestyle Factor Risks That Make Your A-Fib More Severe: Which Ones Can You Modify?
Most A-Fib patients have one or more lifestyle factor risk that makes A-Fib symptoms more severe. This makes treating A-Fib more difficult with increased risk of complications. Lifestyle factors can also affect the longevity of a treatment such as a catheter ablation.
The lifestyle factors that can affect your A-Fib include:
• Obesity
• Smoking
• Drug Abuse
• Excess alcohol use
• Lack of exercise
• Poor nutrition
Where to Start: When Was Your Last Physical Exam?
Check with your doctor or healthcare provider for the date of your last physical. If it’s been over a year, schedule an exam.
The results of your exam may reveal you have undiagnosed conditions that could exacerbating your A-Fib.
Tip: You can request to have your blood draw/urine lab tests be done beforehand so you can discuss these findings during your physical exam along with the in-office testing.
Changing Lifestyle Factors and the Impact on Your Atrial Fibrillation
Multiple research studies have shown that modifying these lifestyle factors risks can:
• Lessen A-Fib symptoms and reduce the number of A-Fib episodes
• Slow A-Fib progression
• Reverse persistent A-Fib to paroxysmal A-Fib
• Eliminate A-Fib entirely
Obesity: Associated with the progression of A-Fib, obesity results in changes to the myocardium substrate of your heart. A-Fib patients who are overweight should target 10% weight loss to reduce A-Fib symptoms, burden, recurrence and progress to Persistent A-Fib. Recommended are progressive goals to achieve a target BMI of ≤25 kg/m2 and initial low intensity exercise for 20 minutes 3 times weekly, increasing to 150-200 min./wk. of moderate-intensity activity.
Weight fluctuation of >5% (unstable weight) was independently associated with A-Fib recurrence. Losing as little as 5-10 lbs. can lessen A-Fib symptoms and improve the long-term effectiveness of a catheter ablation.
Smoking: Tobacco use has been associated with increased A-Fib risk. A-Fib patients are advised to quit smoking to mitigate increased risk of A-Fib-related cardiovascular complications.
Drug Abuse: There’s an association between use of cannabis, cocaine, methamphetamine or opiates with the increased incidence of A-Fib.
Excessive Alcohol: For some A-Fib patients alcohol is a known trigger (but not for everyone). Excessive alcohol may serve as a sustainer of A-Fib via atrial remodeling and autonomic effects. Binge drinking, i.e., “Holiday Heart”, is common around celebrations like Christmas, New Year’s Eve and the Super Bowl with a rush of emergency room visits with drinkers experiencing discrete or new-onset atrial fibrillation. Practicing moderation is always a good habit.
Exercise: The recommendation for A-Fib patients is at least 150 min/wk. of moderate-intensity or 75 min/wk. of vigorous-intensity physical activity. But, extreme levels of exercise may be associated with a higher risk of A-Fib. Since so many of us suffer from a sedentary lifestyle, the use of a pedometer or smartphone/watch which can provide activity feedback is an effective strategy to increase daily physical activity. Setting a step goal (e.g., 5000 steps per day initially and then working up to >10000 steps per day) can help to sustain effort over time. The benefit: reduction of A-Fib symptoms and burden, an increase in maintenance of normal sinus rhythm, and improved Quality of Life.
Nutrition: According to the Cleveland Clinic, there is no single specialized diet for Atrial Fibrillation. The Mediterranean and DASH diets have both been clinically studied and proven to support overall heart health, including the management of blood pressure, blood cholesterol, blood sugar, triglycerides and weight management.
A good place to start is cutting down on processed foods and sugary and artificially sweetened drinks and eating more “whole” foods, i.e., more vegetables and fruits.
You Can Change…
Modifying lifestyle factors can have an enormous impact on the severity of your A-Fib symptoms, reduce the frequency of A-Fib episodes, or even eliminate it entirely.
Existing evidence suggests that improvements in obesity, physical fitness, sleep apnea, Hypertension (Blood Pressure), and Diabetes, as well as modification of other risk factors such as alcohol consumption, may reduce A-Fib burden, often to a degree that exceeds that of catheter ablation and other invasive approaches.
…But Know You’re Not Alone
You are directly in control of these factors. But you aren’t alone! Solicit your family and loved ones to help you. Losing weight and stopping smoking are huge tasks that require support from those around you.
Improve your fitness by recruiting family and friends to workout together, and plan celebrations that don’t center around excessive drinking of alcoholic beverages.
These “Lifestyle” changes take effort but will be worth it when your A-Fib symptoms and frequency lessen (or disappear), your Quality of Life improves, and you have long-term success with your A-Fib treatment plan.
Remember to Seek Your A-Fib cure. Don’t just aim to ‘manage’ your A-Fib with medications. It will all be worth it when you no longer suffer under the burden of Atrial Fibrillation.
Resources to Help You
Below are some resources to help you learn more about Lifestyle Factors.
Personal A-Fib Stories of Hope
Under our Personal A-Fib Stories of Hope, over 100 A-Fib patients have written about their journey to a life free from the burden of Atrial Fibrillation. Among their lists of ‘Lessons Learned’, you’ll find many have made changes in lifestyle factors.
To help inspire you and help you find a story by subject matter, we cross-referenced stories by five major Themes/Topics. We encourage you to look for stories similar to your own. Go to Personal A-Fib Stories of Hope.
Recommended Reading
♥ Alcohol: Research into Alcohol & A-Fib: How Many Drinks are Too Many?
♥ Exercise: Moderate Exercise Impact on A-Fib Recurrence After Ablation
♥ Nutrition: FAQs Coping with A-Fib: Diet & Lifestyle
♥ FAQs Natural Therapies: Whole Food or Organic Diet?
♥ Personal A-Fib Story: Lifestyle Changes/Meds Restore Normal Sinus Rhythm
Video: A-Fib Best Treated by Changes to Diet and Lifestyle Says Dr. John Mandrola
Interview with Dr. John Mandrola, MD, cardiac electrophysiologist, Louisville, KY, on the impact of lifestyle factors on patients with atrial fibrillation, metabolic risk factors like obesity, poor diet, sleep apnea, alcohol intake, and lack of exercise; Managing these risk factors can make a significant impact on the patient’s heart rhythm. (5:29). Click to go to video.
Reminder: Schedule a Physical Exam. You may find you have undiagnosed conditions exacerbating your A-Fib.
Get Your COVID-19 Virus Booster Shots: A-Fib Patients at Higher Risk
COVID-19 (caused by the coronavirus SARS-CoV-2) typically is a threat to the lungs, but it also can worsen any existing cardiovascular disease.
Atrial Fibrillation and COVID-19 are a common and potentially a lethal combination.
Comorbid Conditions Increase Fatality Rate
Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.
“Comorbid” means the simultaneous presence of two chronic diseases or conditions in a patient.
According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients with no comorbid conditions had a case fatality rate of 0.9%. Conversely, patients with the following comorbid conditions had much higher fatality rates:
+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.
Among critical cases, the case fatality rate is unsurprisingly highest at 49%.
Worsening of Existing A-Fib
Developing A-Fib is a common occurrence for those striken with the COVID-19 virus.
For those of us with pre-existing A-Fib, COVID-19 can exacerbate our Atrial Fibrillation. COVID-19 causes an inflammatory response and puts stress on the heart which can lead to:
• More frequent A-Fib episodes
• Increased severity of symptoms
• Greater risk of complications, such as stroke
COVID19 enhances “thrombo-inflammation”, a vicious, self-amplifying cycle where blood clotting (thrombosis) and immune-driven inflammation continuously trigger one another which intensifies coagulation and may increase the risk of cardiac embolism in patients with A-Fib.
You Must Stay Current with Your COVID-19 Booster Shot
Because of higher risk, Atrial Fibrillation patients need to stay current with their COVID-19 booster shots.
Locally, Patti and I visit our CVS drug store to get our booster shots, then we report the information to our doctor (the pharmacy also sends in a report).
Make it a Family Affair
Act Today! Ask your healthcare professional to check if you and your family are current with your COVID-19 booster. And if not, ask about scheduling an appointment or where to go locally to get your booster. You owe it to your family!
It’s a preventative step to avoid the high cardiovascular risk of having A-Fib combined with getting a SARS-CoV-2 infection.
2026 AF Symposium Live Case: Combining PVI with Watchman Device
A Concomitant Ablation combines a Pulmonary Vein Ablation and installation of a Watchman occlusion device in the Left Atrial Appendage (LAA) in one procedure. While once considered innovative or somewhat unusual, it’s no longer so. Instead, at many A-Fib centers it’s a standardized or normal practice.
At the 2026 AF Symposium, I counted 9 sessions and/or cases dealing with concomitant ablation.
In this live case transmission, Symposium attendees observed Dr. David Weisman, Jupiter Medical Center Physicians Group, Jupiter, FL, as he performed a concomitant ablation on a 76-year-old woman with very symptomatic paroxysmal A-Fib who had failed multiple antiarrhythmic drug therapies.
In her case, Dr. Weisman was looking for an alternative to oral anticoagulation, hence the Watchman device. Continue reading about this live transmission using the Nuvision 4D Intracardiac Echocardiography (ICE) ultrasound catheter. —>
Research: Moderate Exercise Impact on A-Fib Recurrence After Catheter Ablation
We all know the cardiovascular benefits of exercise for a healthy heart, but its effects on A-Fib recurrence following a catheter ablation and staying A-Fib-free long-term hasn’t been studied. Until now! While this is a small study, it’s important to Atrial Fibrillation patients seeking a catheter ablation and a life free from A-Fib.
Researchers at the University of Colorado Anschutz interviewed 163 consecutive patients who underwent first-time catheter ablation for Atrial Fibrillation between 2020-2022.
The mean age of patients was 69.3 ± 10.9 years, 39.8% were women and CHA2DS2-VASc stroke risk score was 3.24 ± 1.8.
At a 2 year follow up, their average weekly level of physical activity was determined as well as exercise intensity and duration. Continue reading for the Results on the impact of moderate exercise on A-Fib recurrence. (3 minute read)->
2026 AF Symposium: Safety of PFA—Session 1: MANIFEST-US Study
The 2026 AF Symposium had two full sessions with several speakers on the safety of Pulse Field Ablation (PFA) for treating Atrial Fibrillation, reflecting the increased scrutiny and challenges that have arisen with the rapid, widespread adoption of Pulse Field Ablation.
In a second talk of Session 1: Pulsed Field Ablation Safety, Dr. Vivek Reddy (Mount Sinai Medical Center, New York, NY) gave a presentation on “Real-World Safety of Pulsed Field Ablation in 40,000 Patients”.
Dr. Reddy discussed the 2025 MANIFEST-US and compared it to the 2024 MANIFEST-17 study.
Of the 435 US A-Fib centers invited to participate in the 2025 MANIFEST-US study, 102 of the centers (23%) volunteered. The study had 41,968 patients, and follow-up was from February 2024 to July 2025. It is the largest safety study of Pulsed Field Ablation (PFA) to date. It’s unusual in that it was non-sponsored, i.e., not paid for by drug or device companies.
Keep reading to learn the results...and about the 3 sudden deaths soon after receiving a Pulsed Field Ablation (PFA) that Dr. Reddy said couldn’t be explained—>
Physical Activity Following Catheter Ablation: Significant Reduction of Atrial Fibrillation Recurrence
The cardiovascular benefits of exercise are known, but its effects on A-Fib recurrence following a catheter ablation and on long-term arrhythmia-free rates have not been studied.
Researchers at the University of Colorado Anschutz interviewed 163 consecutive patients who underwent first-time catheter ablation for Atrial Fibrillation between 2020-2022.
The mean age of patients was 69.3 ± 10.9 years, 39.8% were women and CHA2DS2-VASc stroke risk score was 3.24 ± 1.8.
At a 2 year follow up, their average weekly level of physical activity was determined as well as exercise intensity and duration.
Results: Risk of A-Fib Recurrence
Of the 163 patients, 114 (70%) participated in more than 90 minutes of weekly moderate physical activity (MPA).
At the 2 year follow up, researchers noted 50% less risk of recurrence in the physically active patients.
The reduction in A-Fib recurrence was also observed in a multivariate model after adjusting for type of A-Fib, use of antiarrhythmic drugs, Left Atrial End-Systolic Volume Index (LAESVI), sex, and Body Mass Index (BMI).
Conclusion
Among patients with Atrial Fibrillation who recently underwent a catheter ablation, participation in at least 90 minutes of moderate intensity exercise weekly was associated with 50% reduced risk of recurrent A-Fib.
More Research Needed
Larger randomized trials are required to investigate optimal exercise duration, load, and timing of exercise initiation.
Editor’s Comments
Editor’s CommentsReducing A-Fib recurrence after an ablation is a big deal for us A-Fib patients! Ninety minutes of moderate physical activity per week is a small effort most of us can do—with a huge payoff— living your life without A-Fib.
Though this study is limited in the number of catheter ablation A-Fib patients, it gives us another factor that can influence staying A-Fib free after your catheter ablation.
We’d like to thank Dr. Lohit Garg, Department of Medicine, University of Colorado Anschutz for answering our questions about this study.
