Atrial Fibrillation – Left Atrial Appendage Closure
Atrial fibrillation is a relatively common type of abnormal heartbeat, which is usually irregular and often rapid. In this disorder, the atria (the two upper chambers of the heart) beat out of rhythm and not in coordination with the ventricles (the two lower chambers of the heart). It can be an occasional or persistent condition. While atrial fibrillation is not typically life-threatening, it is a serious medical condition that can put you at higher risk for heart failure, stroke, and other cardiac complications.
At Sheba Medical Center, atrial fibrillation is treated at The Eli and Zohara Davidai Arrhythmia Center, the largest and most cutting-edge cardiac facility in the country. Our unit features a modern Atrial Fibrillation Center, where world-class physicians provide individualized care to every patient, offering a wide range of advanced treatments for heart problems.
What are the symptoms of atrial fibrillation?
Some people with atrial fibrillation experience no symptoms, and only a comprehensive physical exam uncovers the condition.
Others may experience bothersome symptoms, the most common of which include:
- Heart palpitations; uncomfortable feelings of a racing heartbeat or fast pulse
- Shortness of breath
- Fatigue and weakness
- Lightheadedness and/or dizziness
- Reduced ability to exercise
- Chest pain
What are the complications of atrial fibrillation?
Atrial fibrillation may lead to the following complications:
- Heart failure: when uncontrolled, atrial fibrillation can weaken the heart and lead to a state where the heart can’t circulate blood sufficiently to satisfy the body’s needs
- Stroke: the irregular heart rhythm may cause blood to pool in the heart’s atria and form clots. If this happens, the blood clot can travel from the heart to other organs – such as the brain, possibly blocking healthy blood flow and leading to a stroke. This complication is more common in older patients, or in people with hypertension, diabetes, a history of cardiac failure, or a previous stroke.
What are the treatment options?
There are two primary treatment goals for atrial fibrillation – resetting the heart rate and/or preventing blood clots. Depending on how long you’ve had the condition, the specific cause of your disorder, and the severity of your symptoms, Sheba’s doctors will determine which treatment methods are most suitable. We will evaluate your case thoroughly to recommend the most effective personalized therapy.
Doctors may be able to use a procedure called cardioversion to reset your heart to its regular rhythm. The underlying cause of your condition will determine whether or not this therapy is warranted.
- Anticoagulants – Medications to thin the blood may be prescribed, such as Eliquis, Xarelto, Pradaxa or Coumadin. These drugs can reduce the risk of stroke, yet they are also associated with an increased risk of other health problems, such as internal bleeding. Therefore, they are not always suitable, depending on your personal medical history and condition.
- Left atrial appendage closure – The left atrial appendage is where blood clots tend to develop and break off to enter the bloodstream. By implanting a small basket-shaped device into this area of the heart, blood clots that may form are caught and stopped from travelling to other organs. Studies have determined that these devices are safe for many atrial fibrillation patients who cannot take anticoagulants.
How does left atrial appendage closure work?
To perform this minimally invasive procedure, Sheba’s cardiac specialists insert a flexible catheter through a vein in your leg. Then, they guide the catheter to the left atrium of your heart in order to insert the left atrial appendage closure device. This device seals off a small appendage (sac) in the left atrium. At Sheba, we use the FDA-approved Watchman Device or the Amulet, which are both made from common metals.
A specialized echo device (a tube with a small transducer that is inserted via the patient’s mouth through the esophagus and to the level of the heart) is generally used to provide a detailed view of the heart to direct the surgeon during the operation. The left atrial appendage closure procedure is done under general anesthesia and takes about one hour. Typically, patients need to remain hospitalized for 24 hours.
Following the procedure, it takes about 45 days for the heart tissue to fully heal and enclose the implanted device. During this time, you will be given antiplatelet therapy. After six weeks, you will need to undergo another imaging procedure that gives the physician a clear view of the device’s position and degree of closure. If the results are deemed satisfactory, then you will only need to take aspirin as further treatment.
What are the possible side effects of left atrial appendage closure?
Studies demonstrate that this implantation procedure has a high rate of safety and effectiveness. However, as with all surgeries, there is a risk of complication, including:
- Myocardial perforation
- Groin bleeding
- Device displacement
Who is a possible candidate for left atrial appendage closure?
Patients who have atrial fibrillation and are at an increased risk of stroke but cannot take anticoagulants (blood-thinners) because of other health risks may be suitable candidates for left atrial appendage closure. Also, if you are not a candidate for a more invasive procedure, such as open-heart surgery, this therapy may be appropriate.
Why choose Sheba for left atrial appendage closure in Israel?
The cardiac team at The Eli and Zohara Davidai Arrhythmia Center at Sheba comprises top doctors in the field who have trained in leading hospitals around the world. Our medical experts include arrhythmia specialists and imaging professionals who have extensive experience in performing left atrial appendage closure.
Established recently, our Atrial Fibrillation Center is equipped with state-of-the-art technologies, enabling us to provide the most advanced therapies to enhance cardiac function efficacy. We are proud to offer patients at risk of heart failure with efficient treatments and an improved quality of life.
We understand the physical and emotional stress that receiving treatment for a cardiac condition places on every patient and their family. To enable the smoothest, most comfortable treatment process for every individual, we assign a personal medical coordinator from our International Medical Tourism Division to provide assistance throughout every step of the comprehensive, integrative care at Sheba.
Meet the Directors
Sheba Medical Center
Victor Guetta, MD
Prof. Victor Guetta, MD
Director, Invasive and Interventional Cardiology Unit
Prof. Guetta is responsible for the daily operations of the Invasive and Interventional Cardiology Unit, in addition to introducing new technologies and treatments to the department. He received his medical degree from Ben Gurion University of the Negev, Beersheba, Israel. Prof. Guetta also holds a research fellowship at the National Institute of Health (NIH) in Bethesda, Maryland, and a clinical fellowship at the Cleveland Clinic Foundation. He is actively engaged in many research studies at Tel-Aviv University, where he also works as an Associate Professor of Cardiology.
Sheba Medical Center
Amit Segev, MD
Prof. Amit Segev, MD
Director, The Olga and Lev Leviev Heart Center
Prof. Segev specializes in all aspects of interventional cardiology. Prior to taking his current post as Director of The Heart Center, he served as Director of the Cardiac Catheterization Services and Deputy Director of The Heart Center. He was also the Secretary General of the Israeli Heart Society from 2011-2015, and is currently a member of the Interventional Cardiology Council of the Israeli Heart Society. He has published more than 100 medical papers and book chapters and is widely respected internationally as an eminent lecturer on cardiology.
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