The Watchman device and diving

I had a Watchman device implanted after developing atrial fibrillation (AFib). My cardiac ejection
fraction is normal, and I no longer take blood thinners but am still in AFib. I take medications for
elevated blood pressure but am otherwise in excellent physical condition. Can I return to diving?
Fulfilling the metabolic needs of a diver depends on the heart’s ability to deliver an adequate
cardiac output to the rest of the body. AFib, a common heart-rhythm abnormality affecting millions of people, impairs this crucial delivery. The heart’s natural pacemaker, called the sinoatrial (SA) node, usually fires impulses at 60–100 beats per minute that cause the left and right atria to simultaneously contract and fill the ventricles. The impulse then slows when going through the atrioventricular (AV) node, allowing time for the ventricles to fill with blood. The impulse continues into the left and right ventricles, causing them to simultaneously contract.
In AFib, however, the atria fire off impulses at a higher rate (up to 300 beats per minute), which
causes the upper chambers of the heart to quiver, creating an irregular and chaotic atrial rhythm. The AV node cannot transmit at such a high rate; the speed at which it can transmit these impulses varies by patient depending on factors such as age, medications and other medical conditions. The AV node transmits what impulses it can to the ventricles, resulting in an irregular pulse. The atrial contractions lose their effectiveness in maximizing blood to the ventricles, decreasing the cardiac output and reducing the maximal exercise capacity if it persists.
The quivering action of the atria can cause blood to pool in the left atrium appendage. This pooled blood may begin to clot, and the clots can be pumped to the brain, resulting in
a stroke. Interventional cardiologist Dr. Douglas Ebersole, who is also an avid diver and dive instructor, reports that people who develop AFib increase their risk of a stroke fivefold.
To mitigate this risk, physicians often prescribe blood thinners or anticoagulants, which can decrease the risk of a stroke by 60–70 percent but increase the risk of hemorrhage. Some patients, however, are unable to tolerate long-term anticoagulation therapy due to prior bleeding or a high risk of bleeding due to health or occupational conditions.
The Watchman device is indicated for those patients who have a CHA2DS2-VASc score of 3 or more. The CHA2DS2-VASc score uses age, gender and other medical conditions to estimate an individual’s stroke risk. Scuba diving alone is not a reason to get a Watchman device and be
exposed to the inherent risks of the procedure, Dr. Ebersole advises. Approximately 45 days after surgeons implant the Watchman device in the left atrial appendage of the heart, tissue that has grown over the device closes off the appendage, stopping any clots from escaping and
entering circulation. Most patients are able to return to full activity about a week after the procedure and will need to take anticoagulants and aspirin for 45 days and then transition to an aspirin and clopidogrel for several months before transitioning to just aspirin.
Divers who have AFib should be well rate controlled, both at rest and when performing moderate exercise, and understand the possible complications of their condition before considering diving. We recommend not diving while taking anticoagulants.
Discuss your condition and current medications with a physician trained in dive medicine to
understand the risks associated with diving. If the physician approves your return to diving, be cautious and dive near a facility that can provide adequate medical care should a bleeding problem occur. Contact DAN for a referral to a dive medicine physician near you.
— Robert Soncini, NR-P, DM
fraction is normal, and I no longer take blood thinners but am still in AFib. I take medications for
elevated blood pressure but am otherwise in excellent physical condition. Can I return to diving?
Fulfilling the metabolic needs of a diver depends on the heart’s ability to deliver an adequate
cardiac output to the rest of the body. AFib, a common heart-rhythm abnormality affecting millions of people, impairs this crucial delivery. The heart’s natural pacemaker, called the sinoatrial (SA) node, usually fires impulses at 60–100 beats per minute that cause the left and right atria to simultaneously contract and fill the ventricles. The impulse then slows when going through the atrioventricular (AV) node, allowing time for the ventricles to fill with blood. The impulse continues into the left and right ventricles, causing them to simultaneously contract.
In AFib, however, the atria fire off impulses at a higher rate (up to 300 beats per minute), which
causes the upper chambers of the heart to quiver, creating an irregular and chaotic atrial rhythm. The AV node cannot transmit at such a high rate; the speed at which it can transmit these impulses varies by patient depending on factors such as age, medications and other medical conditions. The AV node transmits what impulses it can to the ventricles, resulting in an irregular pulse. The atrial contractions lose their effectiveness in maximizing blood to the ventricles, decreasing the cardiac output and reducing the maximal exercise capacity if it persists.
The quivering action of the atria can cause blood to pool in the left atrium appendage. This pooled blood may begin to clot, and the clots can be pumped to the brain, resulting in
a stroke. Interventional cardiologist Dr. Douglas Ebersole, who is also an avid diver and dive instructor, reports that people who develop AFib increase their risk of a stroke fivefold.
To mitigate this risk, physicians often prescribe blood thinners or anticoagulants, which can decrease the risk of a stroke by 60–70 percent but increase the risk of hemorrhage. Some patients, however, are unable to tolerate long-term anticoagulation therapy due to prior bleeding or a high risk of bleeding due to health or occupational conditions.
The Watchman device is indicated for those patients who have a CHA2DS2-VASc score of 3 or more. The CHA2DS2-VASc score uses age, gender and other medical conditions to estimate an individual’s stroke risk. Scuba diving alone is not a reason to get a Watchman device and be
exposed to the inherent risks of the procedure, Dr. Ebersole advises. Approximately 45 days after surgeons implant the Watchman device in the left atrial appendage of the heart, tissue that has grown over the device closes off the appendage, stopping any clots from escaping and
entering circulation. Most patients are able to return to full activity about a week after the procedure and will need to take anticoagulants and aspirin for 45 days and then transition to an aspirin and clopidogrel for several months before transitioning to just aspirin.
Divers who have AFib should be well rate controlled, both at rest and when performing moderate exercise, and understand the possible complications of their condition before considering diving. We recommend not diving while taking anticoagulants.
Discuss your condition and current medications with a physician trained in dive medicine to
understand the risks associated with diving. If the physician approves your return to diving, be cautious and dive near a facility that can provide adequate medical care should a bleeding problem occur. Contact DAN for a referral to a dive medicine physician near you.
— Robert Soncini, NR-P, DM
Posted in Alert Diver Fall Editions, Alert Diver Winter Editions, Dive Safety FAQ
Tagged with Heart rate, Watchman device, Surgery, anticoagulants, Blood thinners
Tagged with Heart rate, Watchman device, Surgery, anticoagulants, Blood thinners
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March