Anesthesia for the Watchman Procedure: What You Need to Know
- Jen Overton
- Jun 11
- 5 min read
Watchman procedure can be a life-changing option for those with atrial fibrillation (AF). As a nurse anesthetist, I understand that facing any heart procedure can feel overwhelming, but my goal is to ease your concerns by explaining a little about the Watchman procedure, why it’s needed, the anesthesia used, and what recovery looks like. I am committed to helping you feel as informed and confident as possible, knowing your anesthesia team is truly dedicated to keeping you safe and comfortable every step of the way. Remember, prepared patients have better outcomes.
What Is the Watchman Procedure?
The Watchman procedure is a minimally invasive treatment designed to reduce stroke risk in patients with atrial fibrillation (AF), a common heart rhythm disorder where the upper chambers of the heart (atria) beat irregularly. Because the atria do not empty blood well in AF, that blood can pool in a small pouch in the heart called the left atrial appendage (LAA). This pooling can cause blood clots to form. If a clot travels to your brain, it can cause a stroke.
The Watchman device is a small, parachute-like implant placed in the LAA to seal it off and prevent clots from escaping. This procedure is performed in an electrophysiology (EP) lab by a cardiologist. Using a catheter inserted through a vein in the groin, the cardiologist guides the device to the heart, often with the help of transesophageal echocardiography (TEE, an ultrasound probe in the esophagus) and fluoroscopy (X-ray imaging).
Over time, heart tissue grows over the device, permanently closing the LAA. This allows many patients to stop taking long-term blood thinners, reducing the risk of bleeding complications. Lots of wins here!
Click below to view a very short video that shows how and where the device deploys in your heart.
Why Might You Need the Watchman Procedure?
The Watchman procedure is typically recommended for AF patients who:
Have a high risk of stroke
Cannot tolerate long-term blood thinners
Prefer an alternative to lifelong anticoagulation due to lifestyle factors or medication side effects.
By addressing stroke risk without relying on blood thinners, the Watchman procedure improves quality of life and provides peace of mind.
If you're also having cardiac ablation and missed the article about Anesthesia for Cardiac Ablation, click the image below to access.
Anesthesia Options for the Watchman Procedure
The anesthesia for the Watchman procedure is tailored to your health, the procedure’s requirements, and your cardiologist’s preferences. As with cardiac ablation (covered in our article, Anesthesia for Cardiac Ablation: What to Expect), the two primary anesthesia approaches are general anesthesia (GA) and monitored anesthesia care (MAC), also known as IV sedation or “twilight anesthesia.” Your anesthesia team considers factors like your heart function, lung health, and conditions such as sleep apnea or obesity to choose the safest option. Below, I’ll explain these options, why one might be preferred, and how they ensure your comfort.
General Anesthesia (GA)
What It Is: With general anesthesia, you’re fully unconscious, with a breathing tube (Placed AFTER you fall asleep) to support your breathing.
Why It’s Used: GA is commonly preferred for the Watchman procedure because it ensures comfort and complete immobility, which is critical for precise device placement in the LAA. The procedure also often requires prolonged periods of transesophageal echocardiography. Additionally, sometimes AF patients have other pre-existing conditions like heart failure, lung disease, or sleep apnea. These conditions are often easier to manage under general anesthesia due to better airway control.
Benefits: You’re completely unaware of the procedure, feel no pain, and stay perfectly still, enhancing safety and success.
Considerations: Recovery from GA may take a couple of hours, and you might experience minor side effects like a sore throat or nausea which we manage with medications. GA is often chosen for its reliability in complex cases like this.
Still curious about general anesthesia? Click the image below to read General Anesthesia: The Patient Experience from Start to Finish
Monitored Anesthesia Care (MAC)
What It Is: We administer IV medications like midazolam, fentanyl, or propofol. You feel relaxed and drowsy but breathing on your own. You may be lightly sedated or in a deeper twilight state.
Why It’s Used: MAC is sometimes used for the Watchman procedure in select patients, particularly if the procedure is expected to be straightforward and TEE is not required. It’s suitable for healthier patients with good heart and lung function who can tolerate lighter sedation and remain still.
Benefits: MAC allows faster recovery and discharge, often within a few hours, and avoids the need for a breathing tube. It’s less invasive, with fewer side effects like nausea.
Considerations: MAC is sometimes less ideal for patients with severe sleep apnea or obesity, as sedation can affect breathing. Rest assured that your anesthesia provider is watchful and ready for anything. Occasionally, we need to convert to GA, and if so, the transition is seamless.
Post-Operative Care and Recovery
The Watchman procedure is typically an outpatient procedure, meaning most patients go home the same day after a few hours of observation.
What to Expect Post-Procedure
Recovery Area: After the procedure, you’ll wake up in the recovery area. Nurses will monitor your heart rhythm, blood pressure, and oxygen levels. If you had GA, you might feel groggy for a few hours, but we’ll ensure you’re comfortable with medications for nausea or pain. For MAC, you’ll likely feel alert sooner.
Groin Site Care: You’ll need to lie flat for a few hours to prevent bleeding at the catheter insertion site. Mild soreness is common but usually resolves quickly.
You’re in Safe Hands
As a nurse anesthetist, I know how important it is to feel secure during a procedure like the Watchman. Whether you receive GA or MAC, your anesthesia team is by your side, monitoring your vital signs, heart rhythm, and breathing, ready to adjust instantly to keep you safe. We work closely with your cardiologist to ensure the procedure is successful, from catheter insertion to device placement.
The Watchman procedure is a powerful tool for reducing stroke risk and freeing you from the challenges of long-term blood thinners. As discussed in the cardiac ablation article, anesthesia for heart procedures is carefully planned to prioritize your comfort and safety.
You can trust that we’re watching over you every moment, every breath, every heartbeat, using advanced technology and years of expertise to make your experience as worry-free as possible. If you have additional questions about the Watchman procedure, reach out to your healthcare team—they're here to support you on this journey to better heart health. And if you have more questions about anesthesia, feel free to check out more articles all about typical anesthesia for different surgeries.
Remember, prepared patients have better outcomes.
Want to read more articles about anesthesia for different types of surgeries? Click the worryfreeanesthesia.com icon below for a list of Articles to learn more.
**Information provided is intended as general healthcare information for the public and should be used as a guide. This information should not be substituted for the specific personal advice recommended by your own healthcare team who are familiar with your specific health history.*
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