Rambam is the second health care facility in the world to carry out this advanced surgical operation. This new procedure has only been performed ten times globally to date, in a heart surgery medical facility in the Netherlands. The duration of the catheterization stage has been reduced significantly, consequently decreasing patient exposure to radiation by 75% (compared to standard procedures).  80,000 Israelis suffer from Atrial Fibrillation.

This “hybrid” surgical procedure was performed for the first time in Israel (second in the world only to Holland). The procedure combines cutting edge technology of heart surgery and cardiology, aimed at improving treatment of patients suffering from Atrial Fibrillation.

Atrial Fibrillation is a disorder of the heart rhythm. It is quite common and especially so in elderly people. It may cause strokes due to blood clots that are formed in the heart and travel to the brain. Blood diluting medications such as Coumadin are often prescribed for patients, and standard treatment entails many possible complications. About 80,000 Israelis suffer from heart rate disorders of type Atrial Fibrillation. Patients have a hard time performing simple everyday tasks such as climbing stairs and certain physical activities. Today, only relatively few of the patients are treated by catheterization or surgery because of a low success rate of 50-70%.

So far, options for treatment (other than prescribed oral medication) have been non-satisfying:

 Catheterization: A catheterization is performed. The procedure includes mapping of the heart’s electro physiological activity and an internal ablation. While accuracy is obtained in the mapping procedure, the ablation process yields less accurate results.

 Surgical procedure: The heart is approached through small holes in the chest wall and an accurate ablation of the part of the heart causing Atrial Fibrillation is performed externally. Inability to perform a heart scan in order to view and assess the results is a disadvantage here.

The “hybrid” procedure which is performed for the first time in Israel combines the advantages of both procedures:

Heart surgeons begin the procedure with a minute approach, without opening the chest, by inserting a video camera into the patient’s chest and performing an ablation around the left atrium of the heart using a special “probe” developed specifically for this procedure.

In the second stage the cardiologist performs an advanced internal heart scan by catheterization and identifies the ablation line created by the surgeon. This scan enables identification of the point or points that still need to be ablated in order to complete the ablation circle.

The end result is better than in the first two procedures performed separately. The patient is also exposed to a significantly smaller amount of radiation due to the shorter time the procedure requires. (The Ministry of Health has recently issued a warning about high exposure to radiation during diagnostic catheterization.)    

The Future

There is a 90% expected success rate in the “hybrid” procedure. This will justify operating on a large number of patients resulting in significant reduction of the probability for strokes and in less usage of blood diluting medication such as Coumadin.

The professional team:

Dr. Gil Bolotin –  Director, Department of Cardiac Surgery, Rambam, Israel
Dr. Mark La Meir – Department of Cardiothoracic Surgery, University Hospital, Maastricht, the Netherlands
Dr. Munther Boulos – Department of Cardiology, Rambam, Israel