Sunday, January 28, 2007

The Supplication

“Dear God,
I bet it is very hard to love all of every body in the world. There are only 4 people in our family and I could never do it.”
– Nan


“Dear God,
Thank you for my baby brother but what I prayed for was a puppy.”
- Joyce


"Dear God,
Instead of letting people die and having to make new ones, why don't you just keep the ones you got now?"
- Jane


She was a 38 year-old mother of two kids with a warm personality and delightful smile. She had been plagued much her life with asthma but she had otherwise been fairly healthy. Her heart, she disclosed to her internist, had this nasty propensity to race when she became upset, exercised, or used her inhaler often. She complained about this to her doctor who ordered an exercise stress test and this is what it showed after 5 minutes of exercise:

For those not used to seeing an EKG, this one’s not normal. It demonstrates a rapid, wide-complex ventricular tachycardia (rapid heart rhythm arising in the lower chambers of the heart). The left bundle branch, inferior axis morphology suggested the ventricular tachycardia arose from the right ventricular outflow tract, just beneath the pulmonary valve. Although the cardiologist performing the exercise stress test usually gets a bit nervous when this rhythm starts during a treadmill test, the nice thing about this heart rhythm disturbance is it usually occurs in people with structurally normal hearts and is curable with catheter ablation (cauterizing the focus from where the arrhythmia arises). Alternative therapy with beta-blockers was not attempted because of the patient’s history of asthma.

So after carefully discussing the various therapy options with the patient, she chose catheter ablation.

“I’ll pray for you, Dr. Fisher.”

I didn’t know what to say initially, but thanked her and told her I’d see her on her surgical date.


Two weeks later, she arrived in our pre-op holding area with her hospital gown, IV, and surgical cap in place. Her friends and family surrounded her. She smiled contently as we prepped her for the procedure.

“Are you ready?”

“Yes I am.”

“Any last questions before we take you in the room?”

“No. You went over it pretty well during our visit.”

“Great, then we’ll get started…”

“Oh, Dr. Fisher?”


“I had a dream last night. You see I prayed that your hands were guided to the exact spot of my fast heart beats. You’re going to do fine, you know.”

“Uh, sure, Ms. C. Thank you. I’ll see you in the room.”

I went to change into my scrubs and surgical attire. I entered the room and the staff were ready. I chose a simple approach using two catheters at first to make sure I could initiate the rhythm while she was sedated on our lab table. The catheters (wires) went in fine and I positioned one in the right ventricular apex and the other steerable ablation wire in the right atrium while we tried to start her rhythm in the lab.

At first we were not successful, but with the addition of a bit of Isuprel (an adrenaline-like medication we use to increase the heart rate), her tachycardia became easy to induce and was stable enough the permit careful mapping. I reached to the ablation catheter in the right atrium and placed it in the right ventricular outflow tract. The very first place I laid it appeared to be an excellent site for ablation. I couldn’t believe it. I asked my technician to pace from the ablation catheter tip. The paced EKG identically matched the spontaneous arrhythmia in all leads, even to the finest detail. The signal recorded from the ablation catheter tip preceded the surface electrocardiogram onset by 40 milliseconds (usually 30 milliseconds or so would suffice). Could it be? I dared not move the catheter.

I told my technician to prepare to perform the ablation. Once the energy settings and temperature adjustments were to my satisfaction, we applied radiofrequency energy to the tip of the ablation catheter. Her arrhythmia stopped three seconds after we started the lesion. Energy was continued for 47 seconds, then discontinued.

We tried and tried to re-initiate her heart rhythm disturbance and were no longer capable of re-starting the arrhythmia, even when she was given the Isuprel. We waited and kept trying to re-start the arrhythmia. Nothing happened. She was cured.

Total procedure time: 22 minutes.

Was it divine intervention? I have no idea. Frankly, it felt like pure blind luck. But to this day I have never had such a short, uncomplicated ablation procedure and I think back to her prediction and faith and I wonder...


References: Kids Pray to God


Bo... said...

This is a great story.....

Margaret Polaneczky, MD (aka TBTAM) said...

wonderful read - thanks.

Kim said...

Dang, I got VT just looking at the EKG! Great story!