Seattle Children's Part II (a bit belated)

So we took Bri up to meet Dr. Salerno. The cardiologist & electrophysicist who will be doing her heart procedure. He is the head of electrophysiology at Children's, has done more than 500 procedures in his own and has done another 1,000+ as part of a team. He's very knowledgeable and has a 12-year old daughter too. 

I realize that I haven't really explained what WPW is, so this post will be a bit longer to fill in some background. WOW is an arrhythmia that occurs when you have an extra bundle of conductive tissue in your heart. The electrical signals that cause your heart to beat SHOULD go from the sinus node, to the AV node which causes the bottom of the heart to pump, and then dissipate to start again. In WPW, the extra conductive pathway is called an accessory pathway, and where it is & how strong it is, determine if it is low risk or high risk. A high risk pathway can lead to sudden cardiac death if she has a tachycardic episode that travels down the accessory pathway and puts her into a rhythm called v-fib. So nothing to take lightly. 

The first step was to meet with a cardiologist (Dr Trippel) & do another EKG. She was still in WPW, so the next step was a 24-hour Holter monitor. So it recorded 24-hours of heart activity & when Dr Trippel reviewed it, she never converted back to a normal rhythm. So the next step was a cardiac stress test. They hook you up to an EKG machine, put you on a treadmill, and every 3 minutes it gets faster at a higher incline until they max out your heart rate or you have to stop for some other reason. Bri called it quits at 5 mph & 18% incline because of knee pain. She really hasn't done much running or rehab since her surgeries. Her heart rate was just over 200. The good news was her heart responded appropriately to the exercise & recovered appropriately after. The bad news was, she never converted out of WPW. So we know her pathway can conduct up to 200 beats per minute. It's only considered high risk if it conducts at least 250 bpm but we don't know if hers will since we couldn't get her heart rate that high. 

So, they sent us to meet Dr. Salerno because they aren't able to prove that her pathway is low risk. Since her last knee surgery, she has also started reporting bouts of tachycardia. So, Dr Salerno said it would be helpful to catch some of these episodes on a heart monitor. They may give him a clue as to whether or not her episodes are dangerous. For the actual procedure, Dr Salerno doesn't usually recommend destroying the pathway if he can prove it is low risk. The risks of other heart damage during that process often outweigh the benefits. If it is a high risk pathway, it definitely needs to be destroyed. 

So, the initial plan, is 1 catheter into the neck to map her heart, find the pathway, & test it. If it's high risk, 3 more catheters will be inserted through the groin, 2 in one leg, 1 in the other, and they will destroy the accessory pathway. Unless the heart monitor she's sporting right now shows Dr S what he's looking for & knows up front that it's dangerous & needs to go. They'll still have to map it & find it, but there may be less testing. 

Depending on where it is determines if they burn it or freeze it & also dictates the various potential complications. Those range from bruising to stroke, pulmonary embolism to destroying her AV node requiring immediate placement of a pacemaker, and death. But, if it all goes off without a hitch, we go home same day. It's scheduled for March 14th.