Hybrid Cardiac Catheterization Lab Keeps the Rhythm Alive
New electrophysiology (EP) capabilities in Children Hospital's hybrid cardiac catheterization laboratory are helping us cure abnormal heart rhythms.
"This is a significant step for the pediatric cardiology program at Children's," says John Kugler, M.D., director of cardiology at Children's Hospital & Medical Center and chief of the Joint Division of Pediatric Cardiology. "Not only can serious arrhythmias disrupt every day life for children and their families, they can become quite dangerous. Our ability to provide such a specialized and advanced form of treatment in a setting designed to meet the specific needs of pediatric patients is important."
Two-year-old Erykah Moore of Crete, Neb., was one of the first patients to be treated at Children's with this technology. Erykah was born with Wolff-Parkinson-White Syndrome, or WPW.
In a normal heart, one pathway allows an electrical signal to move between the upper and lower chambers. When this signal reaches the heart muscle of the lower chamber, blood is pumped out of the heart and the heartbeat is completed. In patients with WPW the extra pathway provides the potential for the electrical signal to beat through both the normal and the extra pathway creating an abnormal heart rhythm and very rapid beating known as tachycardia.
Pediatric cardiologist and electrophysiologist Christopher Erickson, M.D., began seeing Erykah at Children's when she was just a baby.
"Early on, Erykah had few effects of WPW," he explains. "As she grew, some of the symptoms began to show. In June 2007, she became noticeably pale and fatigued. She had a decreased appetite and she'd been vomiting."
What looked like a regular childhood virus was actually much worse. Erykah's heart was beating 270 times per minute, much more rapidly than the normal 120 to 130 beats per minute of a child her age and size.
"We began to notice that she would become physically ill when her heart rhythm wasn't normal," says Erykah's mother, Laurie Moore. "This started happening when she was about a year and a-half old."
Erykah took medication in an effort to control these episodes of tachycardia but it wasn't effective.
"If she was playing hard and running around, we would stop her and put a hand on her chest to see how her heart was beating," says her dad, Shawn Moore. "She started doing that to us, too, and she would say, ‘Let me check you.' You don't think of your two-year-old doing that."
It became clear that Erykah needed a more advanced form of treatment.
"Erykah was making regular trips to the Emergency Department and the only other medication we could've tried is known to have serious side effects," says Dr. Erickson. "We decided that we could best help her by performing a radiofrequency ablation." The goal of this procedure was to permanently block the extra electrical pathway in Erykah's heart. While a pediatric anesthesiologist provided essential general anesthesia, Dr. Erickson and the cath lab team at Children's carefully inserted small catheters in large veins in the child's upper legs, as well as a catheter in her esophagus. The team induced a fast heart rhythm to confirm that WPW was the cause of Erykah's arrhythmia. Once that was done, they mapped out the extra pathway.
"Once we identified the unwanted pathway, we performed an ablation," explains Dr. Erickson. "In Erykah's case, we used radiofrequency energy to create a small burn, eliminating the pathway and causing a permanent interruption. This is not just a treatment. For most children, it is a cure."
"Erykah had so many traumatic episodes that it is difficult to believe those are actually over," says Laurie.
"We're just so relieved," adds Shawn. "The day of her procedure felt like Christmas day."
Erykah's recovery is going well. She spent about four hours in the cath lab, followed by several hours in the Children's Ambulatory Recovery and Express Services (CARES) unit. No overnight stay was needed.
"WPW is just one of many abnormal tachycardia conditions in children, adolescents and young adults that we are able to potentially cure with the ablation technique," says Dr. Kugler.
"It's great to offer this technique at Children's, adds Dr. Erickson. "We're excited for the possibilities that exist and look forward to continued success."
In the Children's hybrid cardiac catheterization lab, highly skilled specialists can perform electrophysiology studies as well as catheter ablation using either radiofrequency energy (cautery) or cryothermal energy (freezing).
The Children's Hospital hybrid lab was one of the first such pediatric facilities in the nation. The hybrid designation means the lab meets strict standards and can double as an operating room, should combination procedures or emergency procedures be needed.