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'Radio antenna' helps cardiologists pinpoint source of
man's irregular heart rhythm
Thomas Evans broke into a grin when asked about his
history with University of Iowa Hospitals and Clinics.
"I was born with a congenital heart defect, and all the
work I've had done has been here. I've been a pediatric
cardiology patient for years!" he laughed. "And I'm very
thankful for that. I owe my life to the people at this
hospital."
Evans, 31, was born with dextrocardia, a condition
wherein the heart is situated on the right side of the chest
and has only one pumping chamber. He was raised in Wellman,
Iowa, about 25 miles southwest of Iowa City, and in 1980
traveled with his parents to UI Hospitals and Clinics to
undergo a Fontan operation, a palliative procedure for those
with only single ventricle circulation.
"There have been many Fontan operations performed at The
University of Iowa," said Ian Law, M.D., a University of Iowa Children's Hospital pediatric cardiologist and one of only two
interventional pediatric electrophysiologists in Iowa.
"Unfortunately, if you've had this operation, you are left
with a scar and elevated pressures that can eventually cause
an irregular heartbeat."
Evans has had atrial flutter for a number of years, which
was resistant to standard treatment. Law discussed with him
the Endocardial Solutions, Inc. (ESI) technology, an
advanced mapping system that might correct the problem. "UI
Hospitals and Clinics is one of only four centers in the
nation that has this specialized equipment available for
pediatric cardiology," Law said.
Aware that the risk of death in Fontan patients who
develop an irregular heartbeat is nearly 20 times greater
than in those without abnormal heart rhythms, Evans agreed
to undergo the 14-hour procedure. Early in the procedure,
Law and his UI Heart and Vascular Center team inserted a non-contact
catheter into Evans' heart chamber via a vein in the groin.
Once in place, the catheter expanded to fully deploy a
wire-mesh array containing 64 electrodes.
Functioning like a radio antenna, the electrodes received
electrical signals from the walls of the heart and
transmitted them to a computer, where they were displayed on
a three-dimensional model of the heart. By analyzing the
three-dimensional map, Law pinpointed the exact location of
Evans' scar and the circuit causing the abnormal heart
rhythm.
Using this information, Law completed the procedure by
performing radio frequency ablation (a therapeutic procedure
that alters or destroys tissue in the heart to block or
eliminate cardiac arrhythmias). "This was kind of like
spot-welding," he said. "We placed a catheter inside the
heart, then made lesions from spot to spot around the scar
to make a protective barrier.
"It was not until 10 hours into the procedure that the
abnormal heart rhythm finally stopped," Law said. "Needless
to say, the entire team was overjoyed. I'm optimistic about
Thomas' long- term outcome. In the past, the success rate of
these procedures was 70 percent, with nearly half the
patients having a recurrence over time. With this new
technology, I'm hopeful that the initial success will be
greater and the long-term recurrence will be much lower."
Evans, who quickly returned to his job as an inventory
manager after the procedure, said his wife and two children
are "cautiously optimistic" that his atrial flutter has been
permanently corrected.
"I feel very fortunate to have lived so close to UI
Hospitals and Clinics," Evans said. "The staff here, on
every level, always gives 110 percent. I'm not sure I would
be living such a normal life if not for them."
Anyone with questions about the ESI technology may call
the UI Health
Access toll-free number listed below and ask for the
Department of Pediatrics-Cardiology. For consultation and
referral, physicians should call UI
Consult.
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