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. 

In the Spotlight: Wyman Lai, M.D.

A nationally-recognized pediatric cardiologist with expertise in fetal cardiology and non-invasive imaging for heart disease in fetuses and children has joined CHOC Children’s. Dr. Wyman Lai is the new medical director of echocardiography at CHOC; co-medical director of the CHOC Heart Institute, and assistant division chief of cardiology with CHOC Children’s Specialists.

“CHOC has a fabulous mix of state-of-the-art care, community presence, and academic achievement. I thoroughly enjoy working with my colleagues, who strive to provide the very best care available. The administrative staff at CHOC has also been extremely supportive. Together we are building a pediatric service that rivals any in the region, and we have our sights on even higher goals,” Dr. Lai says.

Dr. Lai’s passion for helping others inspired him to become a doctor. His original plan was to go into academic primary care pediatrics, and he majored in maternal and child health for his Master of Public Health degree. Early in his training, he switched to pediatric cardiology after becoming fascinated with what the pediatric cardiologists were doing.

“In pediatric cardiology, we are able to make a profound difference in the lives of our patients. With our surgical colleagues, we have made incredible advances in life-saving therapies over the past five decades,” Dr. Lai says. “The heart is an amazingly complex organ; it starts off as a simple tube, and it’s a wonder that it ever develops normally into a four-chambered pumping organ that delivers oxygen efficiently throughout our body.”

Dr. Lai attended medical school at the Alpert Medical School of Brown University. He completed his residency at UCLA Ronald Reagan Medical Center, followed by a pediatric cardiology fellowship at UCLA Medical Center, and later, a pediatric cardiology MRI fellowship at Boston Children’s Hospital.

Since joining CHOC, Dr. Lai has been treating patients with complex congenital heart disease. He is also treating patients with the full spectrum of heart conditions, from heart murmurs to chest pain and syncope.

Dr. Lai’s approach towards his patients and their families is to treat them like family members.

“As with all families, however, not everyone is the same,” he explains. “Some patients and parents want more medical information and some less. Some want to be very involved in the decision-making process and some not so much. My practice is to provide them with enough information and support, so they feel comfortable with the decisions they are making.”

Along with Drs. Nita Doshi and Pierangelo Renella, Dr. Lai is helping to build a great program in fetal cardiology at CHOC. He is also working with Dr. Renella to grow the congenital cardiac MRI program, including the use in non-invasive imaging for creating 3D heart models.

“We recently used a 3D cardiac MRI dataset to print several heart models that were used to assist in the planning of care for a child with complex congenital heart disease. Another area of innovation is our purchase of new patient monitoring software in the cardiovascular ICU that will help us to identify patients at risk for acute deterioration before it happens,” Dr. Lai says.

In April, Dr. Lai will serve as co-program director for an inaugural conference hosted by CHOC, Pacific Coast Fetal Cardiology 2017: An Interactive and Case-Based Educational Symposium, in Newport Beach. The conference supports CHOC’s efforts to improve the success of fetal cardiac screening in the region, he says.

Dr. Lai is a prolific author who has published numerous journal articles and chapters, and has contributed to several high-level textbooks utilized throughout the country. He has lectured extensively in the United States and internationally. Dr. Lai is a member of the American College of Cardiology, American Society of Echocardiography, and American Academy of Pediatrics, among other professional organizations. In addition, he sits on the National Board of Echocardiography Board of Directors.

His ongoing academic interests include creating a reliable set of normal values for cardiovascular structures in newborns and children, developing pediatric cardiac MRI guidelines, and testing new cardiac MRI sequences.

In his spare time, Dr. Lai loves spending time with his family. He also enjoys swimming, biking and running. He hopes to run in this year’s Boston and New York marathons, which he has participated in the past. He is also attending classes for a health care executive MBA at UC Irvine.

To contact Dr. Lai, or to refer a patient, please call 714-509-3939.

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.

Sports Cardiology & Sudden Cardiac Arrest in the Young Conference, Jan. 20-21

Genomics of sudden cardiac arrest; athletes with implantable cardioverter defibrilators (ICDs); and ECG screening and automated external defibrilators (AED) in schools — the role of the primary care physician, are just some of the topics that will be featured at an upcoming CHOC conference, featuring the country’s top cardiac experts.

The Sports Cardiology & Sudden Cardiac Arrest in the Young Conference will be held on Jan. 20-21, 2017, at Disney’s Grand Californian Hotel, in Anaheim. The anticipated biennial event will create an opportunity for those involved in the care of athletes and young individuals, to gain the latest education related to athletic training and the diagnosis and management of inherited cardiac diseases, in the hope of preventing tragic young sudden deaths in the future.

CHOC designates this live activity for a maximum of 12.0 CME hours of AMA PRA Category 1 Credits™.

Click here to register and learn more.

In the Spotlight: Michael Recto, M.D.

As an internationally-recognized expert in interventional pediatric cardiology, and division chief of cardiology, CHOC Children’s Specialists, Dr. Michael Recto’s goal is to provide world-class cardiac care. He treats children with serious congenital heart defects, and performs both diagnostic and interventional cardiac catheterization procedures.

Dr. Michael Recto

Prior to coming to CHOC, Dr. Recto served as both chief of pediatric cardiology and director of cardiac catheterization at Tulane Medical Center in New Orleans. Previously, he was chief of pediatric cardiology and director of inpatient transplant services at Kosair Children’s Hospital in Louisville.

Dr. Recto takes great pride in having worked throughout his career with some of the top cardiologists in the field. When he joined the CHOC Children’s Heart Institute in 2013, he witnessed the same level of talent and knew instantly he was in the right place, he says.

“Everyone on the CHOC team is an expert in their field. We have experts in echocardiography (fetal, transthoracic and transesophageal echo), cardiac MRI, electrophysiology and cardiac intensive care. I am proud to be part of such a talented team,” he says.

Dr. Recto enjoys spending time in CHOC’s state-of-the-art cardiac catheterization laboratorities, where he is able to diagnose problems and if needed, perform an intervention and help a patient right on the spot, he explains.

Dr. Recto is board certified in pediatrics and pediatric cardiology. He attended medical school at University of the Philippines College of Medicine, followed by a pediatric internship and residency at New York University Medical Center in New York City. He completed a pediatric cardiology fellowship at Mount Sinai Medical Center in New York City, and a pediatric interventional cardiology senior fellowship at Texas Children’s Hospital, Baylor College of Medicine in Houston, under the tutelage of Dr. Charles E. Mullins, known as the Father of Modern Interventional Pediatric Cardiology.

In addition, Dr. Recto is a fellow of the American College of Cardiology (ACC) and a fellow of the Society for Cardiac Angiography and Interventions (SCAI), among other professional organizations. He has co-authored numerous articles in publications such as Pediatrics, Pediatric Cardiology, and Journal of the American College of Cardiology, to name a few.

Long before Dr. Recto was treating serious heart conditions, however, he thought of becoming an engineer or architect.  His mother asked if he had ever considered a career in medicine. Although unsure about this career path, he decided to give it a try. After his first semester as a pre-med student, Dr. Recto felt that he had never studied as much in his life, he says jokingly, and decided he better continue the hard work he had started. He was eventually accepted to the University of the Philippines College of Medicine, where only a small number of students are accepted every year.  The young doctor was first exposed to pediatric patients during his rotating internship at the Philippine General Hospital, where patients with some of the most complex clinical problems are sent for care.  That experience solidified his passion for pediatrics.

Today, Dr. Recto’s approach to delivering care is to treat his patients and their families the same way he would like his family to be treated. He has learned a lot from his patients and their families along the way, and is still surprised at the touching moments he experiences on a daily basis.

“I had a patient just the other day with an atrial septal defect and I explained to this child’s family that this particular hole between the two atria was going to be hard to close. The patient would possibly require open-heart surgery,” Dr. Recto says. “The patient’s father looked at me and said, ‘We have a lot of faith in you.’ I was indeed able to close the defect in the cath lab. When I came out of the procedure and told the entire family the good news, they stood up and applauded and the father gave me a big hug. I was not expecting that. A moment like that is one of the best things you can experience. It was truly gratifying and humbling.”

When Dr. Recto is not caring for patients at CHOC, he enjoys spending time with his wife, a pediatric emergency medicine physician at CHOC, and their three grown children. He and his wife enjoy eating out and traveling.  Dr. Recto is also an avid tennis player.

Dr. Recto is open to questions from community physicians, and encourages physicians to call him or use Pingmd. To contact him, or to refer a patient, please call 714-509-3939.