In a significant advancement in cardiac care, Lilavati Hospital and Research Centre, Mumbai, has successfully performed India’s first combined cardiac procedure involving Pulsed Field Ablation (PFA) for Atrial Fibrillation (AF) and Left Atrial Appendage Occlusion (LAAO) in a 77-year-old patient. The first-of-its-kind intervention represents an important milestone in the management of complex cardiac conditions by combining two advanced, minimally invasive procedures to address irregular heart rhythm and reduce the risk of stroke in a single sitting.
Jagdip Shah, a resident of Juhu, Mumbai, had a longstanding history of heart failure following coronary artery bypass surgery performed several years ago. Over the years, he developed recurrent and debilitating episodes of atrial fibrillation (AF), the most common cardiac rhythm disorder and a significant risk factor for stroke. AF can increase the risk of stroke by up to five times because of the possibility of blood clot formation in the left atrial appendage (LAA), a small pouch located in the heart.
To lower his risk of stroke, the patient was prescribed oral anticoagulants (NOACs) at the lowest possible doses. However, every attempt to continue blood-thinning medication resulted in severe gastrointestinal bleeding caused by stomach ulcers. These episodes frequently required blood transfusions and led to the discontinuation of the medication. Considering his underlying cardiac condition and multiple comorbidities, the patient remained at high risk of stroke. At the same time, his inability to tolerate blood thinners made long-term management particularly challenging.
To address both concerns, a multidisciplinary team led by Dr Dhiraj Gupta, and including Dr Darshan Jhala, Dr Vivek Mehan, Dr Malav Jhala, Anaesthetists Dr Jay Kothari and Dr Madhuri Kharwadkar, and Dr Nitin Gokhale, performed the complex combined procedure on 14th August, involving Pulsed Field Ablation and Left Atrial Appendage Occlusion. By treating atrial fibrillation and addressing the risk of stroke during the same intervention, the team demonstrated its ability to provide advanced, patient-focused care for high-risk cardiac patients.
Explaining the procedure, Dr Dhiraj Gupta, Visiting Cardiologist and Electrophysiologist, Lilavati Hospital and Research Centre, Mumbai, said, “Jagdip Shah presented a unique challenge with his age and multiple risk factors of stroke; episodes of bleeding made it difficult for him to remain on blood thinners for life. Our objective was to address both the issues in a single procedure. During the procedure, we eliminated the primary source of clot formation with LAAO and treated the abnormal heart rhythm with PFA. The minimally invasive approach allowed us to perform the case in one hour 30 minutes and provide a safe and more effective solution for the elderly, high-risk patient, helping reduce his stroke risk while improving his quality of life. Recently introduced in India, pulsed field ablation (PFA) is becoming an innovative advancement in the field of field ablation treatment.”
Recalling his father’s experience, Kaushal Shah said, “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. Since undergoing the procedure, he has regained his confidence to get back to his routine and enjoy life without the same constant fear. It has given him and all of us a new sense of hope. We are grateful to the medical team of Lilavati Hospital and Research Centre for giving him a chance to enjoy a better quality of life.”
“When the patient was reviewed two weeks later, on the 27th of August, imaging confirmed that the LAAO device was well positioned, and he was maintaining normal rhythm,” added Dr Dhiraj.
The successful case highlights the role of multidisciplinary expertise, advanced medical technology, and minimally invasive treatment approaches in improving care and outcomes for patients with complex cardiac conditions in India.
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