For the first time in Israel, Shaare Zedek Medical Center cardiologists have
used a tiny balloon filled with nitrous oxide 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
Dr. Aharon Medina, head of the electrophysiology unit at
Shaare Zedek, learned in Boston to conduct the procedure after having spent
years using the heating technique.
The hospital purchased the nitrous oxide
equipment from Medtronic, with participation from Dr. Michael Ilan, head of the
pacemaker unit, and interventional cardiologist Dr.
David Meerkin. Each
of the balloons cost $5,000, which is somewhat more expensive than hot ablation
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 nitrous oxide-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 be
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 has affected some 70,000 Israelis.
As such, cardiac
ablation by any means is included in the basket of health services.
three Jerusalemite patients in their 50s and 60s remained in the hospital
overnight and were discharged without the fibrillation the next
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.
About eight years ago, Medina performed a few
cryoablation procedures on patients at Jerusalem’s Bikur Cholim Hospital using
primitive equipment made by a different company, which did not include an
It has since been taken off the market.