About one in every 1,000 children has an abnormal heart rhythm. Fixing this problem surgically used to require exposure to dangerous levels of radiation. Now, doctors have a safer way to zap hearts back into rhythm.
Devaughnte Walker, 17 years old, is hoping today will be the last day he can't perform his favorite hobbies.
"I like dancing, skating, rapping, and swimming," Walker told Ivanhoe.
Two years ago, doctors told him he had an abnormal heartbeat.
"[I] get woozy, dizzy, light-headed, and then [my] heart starts racing," Walker explained.
He is having a procedure called catheter ablation.
For the procedure, doctors insert tubes in the heart and a special machine delivered energy to troubled areas. In the past, X-rays and fluoroscopy were used to see areas of the heart. However, that exposed kids to dangerous radiation.
"The adaptation that we've made, and that others have made, is using that 3-D technology to really eliminate the use of radiation entirely in most cases." (:10)
Cleveland Clinic doctors used 3D mapping to plot Walker's heart, so they knew exactly where to deliver the ablation. This version of the procedure is about 95 percent successful.
"Really, the only difference has been using radiation before versus not using radiation now," Peter Aziz, MD, Pediatric Electrophysiologist, Cleveland Clinic Children's Hospital, told Ivanhoe.
Too much radiation exposure can lead to cancer or DNA mutations. Children are especially sensitive.
Walker and his mom are thankful for this safer alternative.
"I'm excited about the way that they do it, and that they are not using radiation." Kimberly Wilson, Walker's mom, told Ivanhoe.
"I'm going to be normal," Walker said. "I'm going to be peaches and cream."
Less radiation for the kids also means less radiation for the medical staff. About 20 percent of an average person's radiation exposure comes from a medical setting.
BACKGROUND: An irregular heart rate is known as an arrhythmia and affects many children. These arrhythmias may come from a heart defect or from outside factors such as a fever or infection. Most cases of child arrhythmias are harmless, but some can be severe. If a child's heart is beating at an abnormal rate, blood will flow through the body irregularly and could cause damage to the body's organs. Symptoms for identifying if your child has an arrhythmia include a fast or slow heartbeat, palpitations, tiredness, excessive sweating and shortness of breath. The overall outlook for children with arrhythmias is positive. Even the more serious cases can be successfully treated. (Source: http://my.clevelandclinic.org/childrens-hospital/health-info/diseases-conditions/heart/hic-arrhythmias-in-children.aspx)
TREATMENTS: Not all cases of arrhythmia in children require treatment, but for the more aggressive cases there are varying treatment options to normalize heart rate including:
· Medications to help control and regulate.
· Cardioversion is used to send an electrical shock to a heart.
· Pacemakers can be placed under the skin and use small electrical pulses.
· Maze surgery involves small cuts or burns being applied to the atria.
NEW TECHNOLOGY: There is now a safer way to put a child's heart back in the right rhythm. Traditional treatments using radiation from X-rays could be dangerous for a child dealing with an irregular heartbeat (arrhythmia), but doctors are now using catheter ablation to fix abnormal heart rates without the use of radiation. A long catheter is placed into the heart and ablates the area not beating properly. 3-D technology helps doctors see the heart in a whole new way and help them specifically target the troubled areas. With this procedure doctors can see exactly where to perform the ablation, making it a safer alternative for children. (Source: http://www.cincinnatichildrens.org/health/r/rf/)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Rita Newberg
newberr@ccf.org
216-444-9394
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com
Peter Aziz, M.D., Pediatric Electrophysiologist, Cleveland Clinic Children's
What is an arrhythmia?
Dr. Aziz: An arrhythmia is any abnormal heart rhythm problem.
Is it different in young people versus adults?
Dr. Aziz: There are several differences between young people and adults in terms of rhythm disorders. There many common rhythm disorders in adults that don't typically occur in children. Most of the rhythm disorders in children are of two types: 1) SVT, which is more common and rarely life-threatening and 2) Ventricular arrhythmias which are much more serious.
Is it more dangerous in young people or adults referring to the arrhythmia?
Dr. Aziz: That's a hard question to answer. It's difficult to say whether they are more troublesome in adults versus pediatrics. Any heart rhythm disorder in a pediatric patient is concerning because these are seemingly healthy, young children that should not be having heart problems. Adult heart rhythm disorders may have pre-disposing factors (warning signs)., Oftentimes in pediatrics rhythm disturbances will come out of nowhere in an otherwise healthy patient. This can be alarming for the patient themselves and certainly the families and caregivers.
What are the different ways an arrhythmia can be treated?
Dr. Aziz: Arrhythmias can be treated several different ways. If it's a common non life-threatening arrhythmia,like SVT for example, then wiggle room really exists because there is nothing that you absolutely have to do about it. It really depends on how troublesome the heart rhythm problem is, whether it's keeping the patients out of school or things of that nature. If we think that it is troublesome then we can prescribe medicination which is typically first line and if we feel like medicine isn't really doing the trick then catheter ablation is also an option.
Explain the difference in the new radiation free procedure versus the old protocol.
Dr. Aziz: Historically, ablations were performed using the fluoroscopic approach wherein x-ray technology is employed to take pictures of the heart. For several years now we have been using 3-D technology to decrease the amounts of radiation that we use. 3-D technology will provide an image for us without using radiation. The adaptation that we've made and that others have made is using that 3-D technology to eliminate the use of radiation entirely in most cases. The benefit really is one; you're decreasing fluoroscopy. Fortunately we have been able to demonstrate that procedure times are the same and the outcomes are the same relative to the flourscopic approach used in the past.
What's the benefit to the patient? What have you seen in terms of short and long-term outcomes of patients who've had this procedure?
Dr. Aziz: We have performed a study comparing our outcomes prior to using the traditional non-fluoroscopic approach where we use x-ray technology to assess catheter position and since October 2012 we've adopted a new approach using the non-fluoroscopic method where we rely more on the 3-D technology for our mapping procedures. With that we've seen our outcomes are better than 90-95 percent. Our risks are the same as they were before, which are rare. We didn't have any major complications with either approach. So both approaches are comparable with the only real being the reduction of radiation.
Is there anything on the horizon for the treatment of arrhythmias?
Dr. Aziz: Being at an institution like the Cleveland Clinic provides us with several tools. We have a very well established electrophysiology program here. We have several catheter rooms, several different catheters, several different mapping systems and several different ablation techniques and we have the advantage of being able to learn from our adult colleagues who I think are years ahead of us. We can apply this knowledge to pediatrics patients and advance the field more quickly than it would have otherwise. A lot of the technology goes into the adult population, a lot of the mapping systems and the catheters are made for adults. Having them here at this institution has allowed me to get my hands on them and use them and adapt them to our pediatric population, one clear advantage of being at the Cleveland Clinic.
Anything special about Devaughnte's case, anything you want to add?
Dr. Aziz: First and foremost is Devaughnte is a special patient to me. I feel like we go way back. We've had several phone conversations and it's nice to develop a patient relationship like that. He's just a vibrant, energetic type of guy. One of the reasons why I have gotten to know him so well is been burdened by troublesome arrhythmias in the past. Our objective is to provide improve his quality of life and reduce his risk of sudden death.
Once you get rid of the arrhythmia activity wise, can he get back to swimming and dancing and jogging and weightlifting?
Dr. Aziz: The beautiful thing about arrhythmias in pediatric patients, particularly the one that Devaughnte has which is WPW (Wolf Parkinson's White Syndrome), is that it's curable. So the hope and the expectation is that after his ablation he is cured and there is no restriction and no medicine and we one day never need to see each other again, in the doctor/patient setting or course.