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Just in Time

Hybrid Cardiac Ablation Stabilizes California Man's Heart Rhythm

Shawn Carter

Shawn Carter's heart was beating out of control. And he had run out of options.

"There were no doctors left in California who would touch me," Carter said, recalling the time last summer when his heart went into numerous bouts of ventricular tachycardia (VT) beating up to 180 times per minute.

The medical device engineer, a former Marine and now a Chief Warrant Officer 2 in the California State Military Department, had undergone multiple procedures in the 28 years since he was diagnosed with Wolff-Parkinson-White syndrome. In this rare heart condition, patients have an extra electrical pathway between the heart's upper and lower chamber, which can cause a rapid heartbeat.

"Shawn's situation was dire, but we told him we would find an innovative way to take care of him."

Over three decades, Carter had two open-heart surgeries and several catheter ablations to treat arrhythmias. His heart had been shocked back into a safe rhythm numerous times, both externally and by an implantable cardioverter defibrillator. He took several anti-arrhythmic medications

His most recent episodes were life threatening. Carter needed more ablation procedures to the endocardium (inner layer of the heart) as well as the epicardium (outer layer of the heart) to destroy the small areas of tissue triggering the abnormal rhythms. Scar tissue made it impossible to reach the outside of his heart using an open heart or catheter approach.

Carter turned to University of Chicago Medicine cardiac electrophysiologist Roderick Tung, MD, an internationally known expert on advanced therapies for heart rhythm disorders.

Tung and cardiac surgeon Husam Balkhy, MD, had recently collaborated on the first totally endoscopic robotic epicardial ablation for a patient with a ventricular arrhythmia.

Shawn Carter of California after cardiac ablation for VT

"Shawn's situation was dire," Tung said. "But we told him we would find an innovative way to take care of him." Carter was airlifted from a hospital in San Francisco to the University of Chicago Medicine.

Tung's team planned for Carter's two-part ablation treatment. Using a sophisticated mapping system, they created a 3-D reconstruction of his heart detailing the patterns and points of abnormal electrical activity.

In the first procedure, Tung and his team threaded a catheter through a large vein in Carter's leg into his heart and delivered radiofrequency energy to destroy dysfunctional tissue.

Using the da Vinci surgical robot system, Balkhy then accessed the outer surface of Carter's heart through three tiny incisions on the side of his chest.

"The robotic technology enabled us to dissect the scar tissue surrounding Shawn's heart safely using this least invasive approach," Balkhy said. "Once the heart muscle was exposed, we were able to find and eliminate the sources of arrhythmias on the outside of his heart."

The two minimally invasive procedures were successful and the electrical systems in Carter's heart were stabilized.

Today, Carter, 50, no longer takes cardiac medications. Although he feels an occasional palpitation, none has lasted long enough for his defibrillator to record or treat. He is back to his baseline fitness level, with a regimen of lifting weights and high intensity interval training five days a week.

"I work out for the cardiac benefits," he said, "so my heart will be stronger."

If Carter's heart needs more treatment in the future, his UChicago Medicine care team will be ready. "Shawn is forever in our family," Tung said.

July 2017