Ablation is a procedure used to treat an irregular heartbeat triggered by areas of abnormal heart tissue that negatively affect the electrical system of the heart, according to the Heart and Stroke Foundation of Canada.
The procedure is often conducted with catheters through a non-surgical procedure that inserts thin, flexible tubes into the heart through the blood vessels using a fluoroscope to identify where the problematic tissue is located, and then a special ablation catheter to destroy the abnormal tissue with high-frequency electrical energy, making it incapable of initiating the electrical signal that caused the arrhythmia (irregular heartbeat).
"For many years we have been performing the ablation procedures and getting better at them all the time," said Prof. David Luria, director of the Arrhythmia Unit in the Department of Cardiology. "There are cases where we need to reach injured areas that are in the outer layer of the heart that cannot be reached through the blood vessels, so we perform the procedure by direct puncture through the chest."
While the atrium is thin enough for doctors to perform ablation through the blood vessels, there are cases when there are areas with problematic access, including the anterior wall of the left atrium, explained Luria.
"If in this area there is a cycle of arrhythmia (atrial fibrillation), as happens in half of the cases of left atrial fibrillation, the wall thickness can prevent effective ablation and thereby obstruct the procedure," he said.
Patients whose procedure failed due to this difficulty have continued to suffer from heart palpitations and heart failure, and were significantly limited in their day-to-day activity. These patients had to undergo repeated and sometimes unsuccessful procedures, receive powerful drug treatments and eventually end up needing a pacemaker.
When a patient who had already undergone ablation several times for arrhythmia arrived at Hadassah, the medical team decided to conduct the ablation through a puncture in the thorax instead of the standard method which is done by catheterizing blood vessels.
The new treatment had been done in the past for ventricular arrhythmias, but had never been attempted in Israel for the treatment of complicated areas in the atrium.
The procedure was "very successful," said Luria, adding that a number of other additional patients were subsequently treated with the new procedure as well. The method proved to be effective in complex cases that were not helped with routine methods.
While the procedure is currently only conducted at Hadassah, Luria believes that additional hospitals will begin using the new treatment soon.
Two additional hospitals in other locations around the world have tried the procedure. "This is just the beginning, but it is very important and promising," Luria said.
"Hadassah is more of a home for me, since my family members worked there for many years," said Ronen (pseudonym), the patient who underwent the procedure. "I trusted Prof. Luria with my eyes closed, so I had no fear. Happily, the procedure was successful and I can finally get back to work and the life I was used to."I am very happy and excited to do and try new things that promote the world of medicine. After the procedure was successful, I am proud to say that the world of medicine is constantly moving forward – and I am the proof of that."