Israeli cardiologists improve rapid heartbeat treatment

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 too quickly.

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 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 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.

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.

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 inflatable balloon.

It has since been taken off the market.