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Six-year-old Jacob Kirby seems far too young and much too healthy to be a case study for a dangerous heart failure disorder.
A case report published in the Journal of Interventional Cardiac Electrophysiology suggests otherwise. The seven-page report, authored by three University of Iowa Children’s Hospital heart specialists, describes how Jacob’s condition was fixed using a new treatment called transcatheter cryothermal ablation with 3-D mapping.
Shawna Eckstein, Jacob’s mother, marvels at how well her son is doing. “Growth-wise, he is in the 50th percentile for his age, and he’s out for T-Ball for the first time,” she says. “He’s a pretty good hitter, too!”
Jacob’s story wasn’t so rosy two years ago. Then age 3, he faced a life and death struggle with atrial ectopic tachycardia (AET), a potentially dangerous and unusual form of a heart rhythm disorder called supraventricular tachycardia (SVT).
AET’s symptoms range from relatively mild episodes of tachycardia (rapid heart beat) to a persistent tachycardia that leads to congestive heart failure. When Jacob arrived at UI Children’s Hospital, his heart function was extremely poor, requiring intentional paralysis and placement on a ventilator to assist his breathing. In addition, he required many medications to slow his heart rate and help his heart squeeze.
Fortunately, with treatment, the rapid and persistent form of AET is reversible—as documented in the 2003 paper authored by UI specialists Nicholas Von Bergen, MD, Hadi Abu Rasheed, MD, and Ian Law, MD.
Historically, they noted, drug therapy was moderately successful, with surgery another last-ditch option. Surgery is now rare, thanks to the advent of radiofrequency catheter ablation (the use of electrical energy to destroy heart tissues that cause rhythm disturbances).
In addition, radio-frequency catheter ablation became significantly more accurate with the development of electromagnetic 3D mapping.
“Even so, many challenges remain in terms of delivering safe and accurate ablation in delicate locations,” Von Bergen says.
Enter cryothermal ablation, a newer therapy that uses a catheter to apply extreme cold to the cells that are causing abnormal heart beats. Combined with 3D mapping, it is proving to be a safe and effective alternative to radio frequency ablation.
With his heart beat racing to dangerous levels as high as 220 beats per minute (bpm), Jacob initially required care in the Pediatric Intensive Care Unit. Early treatment included drug-induced therapy to slow his heart rate through paralysis, which failed.
The UI team soon decided Jacob was an excellent candidate for cryoablation. Within a few days of the first procedure, his heart rate was successfully reduced to 90 to 140 bpm (a child’s normal rate would range from 70 to 120 bpm).
Six days after leaving the hospital, his heart rate zoomed again, exceeding 220 bpm. A second cryothermal treatment produced similar results (initial success followed by recurrence). Doctors were balancing the delicate risk of destroying sensitive heart cells against the need to reduce his heart rate.
Long-term success was achieved after the third cryoablation treatment.
While no one can guarantee the problem is ended, Jacob’s care team says the longer he goes without an AET episode, the less likely it will recur.
Shawna remains thrilled and humbled by the outcome. “We are grateful beyond words for the care Jacob received,” she says.
For more information about pediatric heart care at UI Children’s Hospital, parents and family members should:
For consultation or referral, physicians should call UI Consult at 319-384-8008 or 800-322-8442.
—Michael Sondergard
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Under Control
Now that his heart no longer races wildly out of control, Jacob Kirby (right), of Illinois City, Illinois, can better enjoy the companionship of his twin brother, Jeremiah.
Team Leaders
Pediatric electrophysiologists Nicholas Von Bergen, MD, and Ian Law, MD, partnered to resolve Jacob's heart rhythm episodes. |
