Procedure brings fast-beating hearts back to normal

Cayden Short with his dad, Jason

Cayden Short with his dad, Jason

Before Cayden Short was born, doctors at Akron Children’s studied his heart, ruling out a hereditary congenital heart defect through the use of a fetal echocardiogram. Though his heart rate was slightly elevated at birth, it did not last. By the time he was ready to be discharged, doctors detected nothing out of the ordinary.

At 4-weeks-old, his parents, Stephanie and Jason, took him to the Akron Children’s Heart Center for a follow-up to the fetal echocardiogram. During the exam, doctors noticed his heart rate had elevated once again, and it continued to increase.

Four weeks after his follow-up, Cayden’s heart would race more than 280 beats per minute.

“When he was 2 months, he was officially diagnosed with a form of SVT,” said Stephanie. SVT, or supraventricular tachycardia, is an unpredictable, abnormal heart rhythm that involves the upper and lower chambers of the heart.

An attack can occur at any time, for no particular reason, lasting for a few seconds, several minutes, a couple hours or even days. Then, it stops as quickly as it started.

In Cayden’s case, his heart rate was abnormally high all the time.

“Aside from the racing heartbeats (or tachycardias), some kids can experience chest pain, light headedness, shortness of breath and pallor,” said John Clark, MD, director of Akron Children's Arrhythmia Center. “But the bigger problem is its unpredictability.”

While Cayden’s outward symptoms were minimal, his increasing heart rate was cause for concern.

In August 2010, he was admitted to Akron Children’s and placed on a medication regimen to control his condition. As Dr. Clark puts it, and as the Short family quickly discovered, SVT is not a life-threatening condition, but a life-altering one.

Cayden Short

Cayden Short

“Think about taking a vacation or about staying the night at a friend’s house,” said Dr. Clark. “Parents have to plan ahead. There’s a constant worry about forgetting a dosage or trusting that other people would know what to do if their child has an acute attack. These are lifestyle factors that families have to face.”

Stephanie and Jason hoped their son would grow out of the condition by the time he reached 6 months. But during a follow-up appointment in December 2010, they discovered that his heart rate was increasing beyond what the medication could control.

On Dec. 20, 7-month-old Cayden underwent a procedure called catheter ablation to fix the abnormality. 

A safe way to fix a racing heart

About 75 children with arrhythmia disorders come to Akron Children’s downtown Akron campus every year for catheter ablation. While it’s the treatment of choice for children who are 5 and older, it’s an alternative option for children under 5, like Cayden, when medication cannot control the arrhythmia.

Akron Children’s is one of only a handful of providers that can perform an ablation on children this young.

“We were hoping to wait until he was older to have the procedure done,” said Stephanie. “But to know that there was a place that could perform this on someone his age, right in our own backyard, was absolutely wonderful.”

While Cayden slept under anesthetic, Dr. Clark and his team placed IVs in the veins of the leg and threaded tiny wires through those veins into the heart. Once inside, they received EKG signals from the electrode ends of the wires.

They stopped and started an SVT attack to map out the heart and pinpoint the area causing the issues. Then, using the tips of the wire, they destroyed the problematic cells through heating (radiofrequency ablation) and by freezing (cryoablation).

Surgeons typically have three options to see the catheter during the procedure: fluoroscopy (a type of x-ray), ultrasound or 3-D mapping.

In the past, fluoroscopy would have been used in a procedure like Cayden’s. However, exposing children to this type of radiation at a young age can cause long-term risks, possibly even cancer.

To eliminate these threats, Dr. Clark and his team started using a 3-D mapping system in 2003 that employs a type of GPS technology. It lets Dr. Clark see the catheter continually in real time, and it’s 100 percent radiation-free. Since 2006, catheter ablation procedures at Akron Children’s are virtually radiation free.

“That’s one of the unique opportunities at Akron Children’s,” said Dr. Clark. “We’re one of only two hospitals in the country that can perform an ablation without any fluoroscopy.”

In addition to training other providers how to perform the fluoroscopy-free treatment, Akron Children’s also is a part of a group of 12 hospitals around the country that is trying to define the usages of a non-fluoroscopy approach.

A smooth recovery

Cayden was home from the hospital the day after his procedure, and the results from his one-month follow-up procedure revealed that he’s maintaining a normal heart rate and pattern, and there are no signs of the condition returning.

“Words can’t express how grateful we are and how much we appreciate the care Cayden received,” said Stephanie. “It’s been such a smooth transition, and it’s given us comfort that we’ve been given such great care.”

Rhythm of the Heart
Publication: Children's Progress
Issue: Spring 2011

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