At 77, he couldn’t take blood thinners: How docs treated his heart in a rare procedure

What is atrial fibrillation (AF)?

AF is the most common type of abnormal heart rhythm. When the heart does not beat regularly, blood can remain in one part of the heart for longer than usual and form a clot. A small pouch in the heart called the left atrial appendage is a common site for these clots in people with AF. If a clot travels to the brain, it can cause a stroke.

People with AF may therefore be prescribed blood-thinning medicines. These reduce the chance of a clot forming, but some patients can develop serious bleeding while taking them. In Shah’s case, the bleeding was severe enough to require blood transfusions, and doctors had to stop the medicines.

What were the procedures about?

The first part of the procedure was aimed at preventing clots from forming in the left atrial appendage. Doctors inserted a thin catheter through a vein in the groin and guided it through the blood vessels to the heart. From the right side of the heart, they crossed the wall separating the two upper chambers — the interatrial septum — to reach the left atrium. This is known as transseptal access and allows doctors to reach the left side of the heart without open-heart surgery.

Using imaging to guide the catheter, the team positioned it at the opening of the left atrial appendage. A collapsible plug-like device was then delivered through the catheter and expanded inside the appendage. Once its position and stability were confirmed, the device was released, sealing off the pouch from the rest of the left atrium.

This procedure, known as left atrial appendage occlusion (LAAO), is intended to prevent blood from pooling inside the appendage and to reduce the risk of clots escaping into the bloodstream. Over time, tissue grows over the device, further sealing the opening.

The second part of the procedure addressed the abnormal electrical activity causing Shah’s irregular heartbeat. In atrial fibrillation, disorganised electrical signals in the upper chambers of the heart can cause the atria to quiver instead of contracting normally. In many patients, abnormal signals originate around the pulmonary veins, which bring blood from the lungs into the left atrium.

Doctors guided a specialised catheter into the left atrium and positioned it around the areas where these abnormal signals were originating. Instead of using heat or freezing, they delivered a series of very short, high-voltage electrical pulses. These pulses temporarily create pores in the membranes of targeted heart muscle cells. When the exposure is sufficient, the damage becomes irreversible, and the affected cells die, producing small areas of scar tissue that can no longer conduct the abnormal electrical signals.

This technique is called pulsed field ablation (PFA). By creating an electrical barrier around the pulmonary veins, doctors aim to prevent abnormal impulses from triggering or sustaining atrial fibrillation.

Unlike conventional thermal ablation, which destroys tissue using heat or extreme cold, PFA uses electrical energy to selectively affect the targeted cardiac tissue.

Why is this surgery one of its kind?

“Jagdip Shah presented a unique challenge with his age and multiple risk factors for stroke; episodes of bleeding made it difficult for him to remain on blood thinners for life. Our objective was to address both issues in a single procedure. During the procedure, we eliminated the primary source of clot formation and treated the abnormal heart rhythm,” says Dr Gupta.

The two procedures were performed during the same minimally invasive intervention. Because both involve catheter access to the left side of the heart, the team could perform them sequentially during the same session rather than subjecting Shah to two separate procedures. The combined procedure took about one-and-a-half hours.

Shah recovered at home after the procedure and is now completely off blood-thinning medication. At a follow-up examination on August 27, specialised imaging showed that the device was in the correct position and he was maintaining a normal heart rhythm, Dr Gupta says.

For Shah’s family, the biggest change has been being able to live without the constant fear of another bleeding episode. “For years my father lived with constant uncertainty. While he was taking the blood thinners, he faced a risk of serious bleeding, which affected his daily life and his confidence to live life freely. Simple activities became a source of everyday worry,” says son Kaushal Shah.

“Since undergoing the procedure, he has regained his confidence to get back to his routine and enjoy life without the same constant fear,” he adds.

Age alone does not determine whether a patient is suitable. According to Dr Gupta, a patient’s overall fitness and frailty are more important. Patients should generally be mobile and need little help with their everyday activities. “In experienced hands, the combined procedure takes around 90 minutes, and most patients can go home the following day,” says Dr Gupta.