Jagdip Shah, a resident of Juhu in Mumbai, had a longstanding history of heart failure following coronary artery bypass surgery performed several years ago. Over time, he developed recurrent and debilitating episodes of atrial fibrillation, the most common cardiac rhythm disorder and a major risk factor for stroke. AF increases the risk of stroke by up to five times due to the formation of blood clots within the left atrial appendage (LAA), a small pouch in the heart.
To reduce this risk, Shah was prescribed oral anticoagulants (NOACs) at the lowest possible doses. However, every attempt at blood-thinning therapy resulted in severe gastrointestinal bleeding from stomach ulcers, often requiring blood transfusions and discontinuation of the medication. His underlying condition and multiple comorbidities placed him at an increased risk of stroke, while his inability to tolerate blood thinners significantly complicated his management.
To address the issue, 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 addressing atrial fibrillation and stroke risk in a single intervention, the team demonstrated its capability to deliver advanced, patient-centric care for high-risk cardiac cases.
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 journey, 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 case showcases the role of multidisciplinary treatment, clinical expertise and cutting-edge technology in improving outcomes for complicated cardiac patients in India.
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