I get a lot of questions about atrial fibrillation and the Watchman device, so today I want to explain the difference between two important treatments used to reduce stroke risk in patients with atrial fibrillation: the Watchman device and the AtriClip device.

Both are designed to address the left atrial appendage, a small pouch located on the left side of the heart. In patients with atrial fibrillation, blood clots can form in this area, and if a clot travels to the brain, it can cause a stroke.

The Watchman device is placed inside the heart, typically by a cardiologist using a catheter inserted through a vein in the leg. It is commonly recommended for patients with non-valvular atrial fibrillation who are at increased risk for stroke but are not ideal candidates for long-term blood thinners.

The AtriClip device is different. It is placed on the outside of the heart by a cardiac surgeon, usually during heart surgery such as bypass surgery, valve surgery, or a surgical ablation procedure. The clip seals off the left atrial appendage externally to prevent clot formation.

So while both devices are designed to reduce stroke risk, they are used in different ways. The Watchman is a catheter-based procedure performed from inside the heart, while the AtriClip is a surgical device placed on the outside of the heart during surgery.

Neither option is automatically better for every patient. The right choice depends on several factors, including the patient’s anatomy, stroke risk, bleeding risk, ability to take blood thinners, and whether they are already undergoing heart surgery. For patients already having cardiac surgery, placing an AtriClip during the procedure is often the preferred option.

Current guidelines support surgical left atrial appendage exclusion in appropriate atrial fibrillation patients undergoing cardiac surgery. They also support percutaneous left atrial appendage closure, such as the Watchman device, for selected patients with non-valvular atrial fibrillation who cannot tolerate long-term anticoagulation therapy.

The most important thing to remember is this: atrial fibrillation is not just an irregular heartbeat. It is a significant risk factor for stroke.

Choosing the right treatment requires careful evaluation, and your cardiologist or cardiac surgeon can help determine whether a Watchman device or an AtriClip is the best option for you.