Electrophysiology Advances Restore Patient’s Quality of Life

A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist.

Lauren Flotman, 15, had experienced irregular heartbeats for years before Dr. Francesca Byrne, a pediatric cardiology specialist, diagnosed her with supraventricular tachycardia, or SVT, and Dr. Tony McCanta, a pediatric heart rhythm specialist, repaired the condition through radiofrequency ablation.

Lauren Flotman

The episodes first surfaced when Lauren was about 8 years old and they began increasing in frequency as she aged. They’d occur without warning or pattern.

For Lauren and her family, the sudden attacks caused great concern. Not only was she drained and tired after an episode, but Lauren dreaded them happening, especially during a pep squad routine when her teammates were depending on her.

Lauren was elated to finally have a name for her condition.

“It was a huge relief for sure to have a diagnosis,” she says. “I always had to just describe the feeling because I didn’t have a name. Now I can say I have SVT.”

Lauren’s diagnosis was reached after a Holter monitor captured her heart racing at 220 beats per minute. Dr. Byrne referred Lauren to Dr. McCanta to discuss treatment options, which included anti-arrhythmic medications or an ablation procedure.  After reviewing their options carefully, the Flotmans decided to pursue ablation.

For Lauren’s ablation, Dr. McCanta used a new technology called an intracardiac echocardiogram, or ICE, to create a three-dimensional map of the inside of her heart without using fluoroscopy (X-Ray radiation), enabling a catheter to apply radiofrequency energy to the precise location in her heart causing her SVT.

ICE technology involves a tiny ultrasound probe imbedded into a catheter that is advanced through the vein directly into the heart, allowing for very clear, accurate image quality. These ultrasound images then integrate with a three-dimensional electroanatomical mapping system, which acts like a GPS (global positioning system) for the catheters within patients’ hearts, to provide an accurate real-time shell of the inside of the patient’s heart. This allows the doctor to safely move catheters inside the beating heart without using radiation.

While radiofrequency ablation has become a safe and common treatment for SVT in children and adolescents since the mid-2000s, intracardiac echocardiography (ICE) has not traditionally been used in pediatrics due to the large-sized catheters. But when a smaller catheter was created, which was more suitable for the size of young patients, Dr. McCanta and the electrophysiology team from the CHOC Children’s Heart Institute were among the first in the world to routinely utilize the new technology in pediatric and adolescent patients.

“For a young, healthy patient like Lauren, increasing safety and minimizing the use of radiation are extremely important, while still being able to provide a cure for her arrhythmia with ablation” says Dr. McCanta.

After a few days of taking it easy following the procedure, Lauren felt back to her usual self – only without the constant fear her heart would suddenly begin racing.

“Our team loves utilizing advanced technologies like ICE and three-dimensional mapping to help children, adolescents, and young adults with heart rhythm problems,” says Dr. McCanta, “Seeing patients like Lauren get back to all of the things they love doing is why we do this!”

Since the procedure, Lauren has been vocal at church to educate her peers about being conscious and vocal about their health.

Learn more about CHOC’s electrophysiology program. 

Former CHOC Residents Head Electrophysiology Conference, Feb. 20-21

It was 2003, and two newly graduated physicians had just set foot at CHOC Children’s Hospital for their pediatric residencies. Dr. Anthony McCanta and Dr. Vincent Thomas remember the first time they were each called “doctor,” and became responsible for treating sick children. The responsibility drew the two together, initiating a friendship that remains strong today.

“We went through the trenches together. It was nice to have someone there there that you could run something by and that you could trust. That is something we can still count on from each other today,” Dr. Thomas says.

Dr. Anthony McCanta

The two, Dr. McCanta, a pediatric cardiologist specializing in electrophysiology at CHOC, and Dr. Thomas, a pediatric cardiologist specializing in electrophysiology at Children’s Hospital & Medical Center, Omaha, have joined forces again as co-course directors of the PACES Advancing the Field Conference, being held on Feb. 20-21, 2017 at Florida Hospital, in Orlando. Along with co-course director, Dr. Bhavya Trivedi, they’ve put together an exciting symposium to promote different diagnostic and treatment approaches for pediatric and adult congenital patients, and encourage collaboration among renowned experts in the field.

Dr. Vincent Thomas

The first half of the conference will focus on adult congenital electrophysiology, while the second half will focus on pediatrics. This includes discussions on innovative technology, such as leadless pacemakers – a minimally invasive device the size of a pen cap, which does not require the use of wire leads and is implanted directly in the heart. The new device is currently in research trials and has not been used on children yet.

Both physicians credit their mentor at CHOC, Dr. Melville Singer, a beloved and well-respected cardiologist who recently passed away, with the idea of continuously learning and exchanging ideas; which is perhaps the most important theme of the conference, explain Drs. McCanta and Thomas.

“Mel Singer was a great teacher and friend, who was instrumental in our interest of cardiology and what it entails,” Dr. Thomas says. “He was constantly trying to learn new things and that is really the whole idea behind this conference – to not just talk about what we already know; medicine is constantly changing and in order to provide the best care for our patients, we need to adapt to new challenges.”

The inaugural PACES conference in 2014 was well received due to the emphasis on open discussion, something Drs. McCanta and Thomas wanted to continue to see in their 2017 program.

“Most conferences have speakers just talking to you. We wanted a conference that focuses on discussion, including limiting the experts’ talks to 15 minutes or less to leave time for longer discussion. You learn so much from the audience; they have incredible insight,” Dr. McCanta says.

Plans are already underway for a 2019 conference. To contact Dr. McCanta, email amccanta@choc.org. To contact Dr. Thomas, email vthomas@childrensomaha.org.

Learn more about the PACES Advancing the Field Conference.  

Learn more about CHOC’s electrophysiology program.