Israeli First At Shaare Zedek: Cardiac Ablation for Atrial Fibrillation via Balloon

As part of Shaare Zedek Medical Center’s ongoing effort to promote advancements in medicine for the benefit of patients and the general medical community, the hospital recently introduced a groundbreaking new program – the first of its kind in Israel.
Read The Jerusalem Post (click link) profile of this new initiative, in place within the Jesselson Heart Center that has the potential to help hundreds of cardiac patients in the years ahead.

For the first time in Israel, Shaare Zedek Medical Center cardiologists have used a tiny balloon filled with helium to destroy cardiac tissue that caused three patients’ heartbeats to go haywire and endanger their lives. Until now, cardiac ablation for atrial fibrillation (AF) has been performed here only via hot radio frequency.

The procedure, which thus far has been performed in only 200 medical centers around the world on some 20,000 AF patients, is believed to be faster and more effective than using heat. Inserted through a vein in the groin, the deflated balloon is inserted via a catheter at the junction between the pulmonary vein and the left atrium. This is the spot that is know to cause irregular electrical activity and make the heart contract much too quickly.

Dr. Aharon Medina, head of the electrophysiology unit at Shaare Zedek, learned to conduct the procedure in Boston, after having been using the heating technique for years.

The hospital purchased the helium equipment from Medtronic, with participation of Dr. Michael Ilan, head of the pacemaker unit, and interventional cardiologist Dr. David Meerkin. Each of the balloons costs $5,000, somewhat more expensive than hot ablation balloons.

Prof. Dan Tzivoni, head of cardiology at the Jerusalem hospital, told The Jerusalem Post that cold ablation is beneficial in that if the first ablation is performed in the wrong place, it can be done again without causing permanent damage. In addition, just as a very cold finger sticks to glass, the helium-cooled device sticks to the beating heart, which makes the device more stable and enables diseased tissue to be removed more easily. The device kills a ring-shaped piece of heart tissue, while the other method has to be applied point by point, much like making a tattoo.

AF can cause the heart to beat as much as 400 times a minute, said Tzivoni. Patients with the condition suffer from chronic tiredness, respiratory problems and coronary insufficiency, and it can also lead to stroke and death.

AF becomes more common in people as they age – after age 80, some 8 percent of people suffer from it – and it has affected some 70,000 Israelis. As such, cardiac ablation by any means is included in the basket of health services.

The three Jerusalemite patients in their 50s and 60s remained in the hospital overnight and were discharged without the fibrillation the next day.

Although the cold technique is faster than heating ablation, said Medina, “it still takes a few hours. It is very delicate. We believe that as we get more experience, it will be faster.” The initial cases were given general anesthesia, but in the future the doctors hope to do so under deep sedation, as unlike with heat, employing cold is painful.

Ablation success rates are around 70%, thus having an additional technology is better – as if one does not work, the other likely will. The hospital is ready to perform cardiac ablation on additional AF patients.

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