Clinical

Rhythms of the Heart: How a Cardiac Electrophysiologist Saved a Woman’s Life


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By Hannah Rhodes | May 31, 2017

For more than two months, Kim O’Neill, 61, spent nearly every night lying in bed, staring at the ceiling and wondering if she was going to die in her sleep. Her heart was beating so loudly in her chest she thought it might explode. During the day, she would struggle to walk up a flight of stairs to the second floor of her home and would run out of breath in the middle of a conversation with her husband. A typically active and positive person, O’Neill was terrified that this was her new normal.

Everything changed in December 2016 when she met Ramesh Hariharan, M.D., a cardiac electrophysiologist with McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann The Woodlands Hospital.

The story begins in 2009 when O’Neill had open-heart surgery to replace her narrowing aortic valve. During the procedure, the atrioventricular node, which controls electrical communication between the top and bottom of the heart, was damaged. According to Hariharan, this happens in about 10 percent of patients because of the proximity of the aortic valve to the atrioventricular node.

To help the two halves of the heart communicate and synchronize the rhythms manually, the doctor O’Neill was seeing at the time implanted a pacemaker. Becoming dependent on a pacemaker changes the natural sequence of the heart; and over time, O’Neill began experiencing heart failure. This condition happens when the heart muscle weakens and cannot pump enough blood to meet the body’s needs for blood and oxygen.

In late September 2016, O’Neill’s physician gave her a new pacemaker defibrillator to help manage her heart failure. A pacemaker defibrillator monitors heart rhythms and if it senses dangerous rhythms, delivers shocks to the heart. After the procedure, O’Neill immediately started to notice she was feeling exhausted and constantly out of breath.

“I tried to express my concerns to the physician but the doctor kept repeating that it was part of my heart failure and recalibrated my pacemaker several times. That didn’t work. I began to feel hopeless and that I would never feel like my normal self again,” O’Neill said.

While visiting her internist for a routine check-up, O’Neill described her symptoms and her latest procedure. The internist immediately suggested O’Neill get a second opinion and Hariharan was the only name she gave.

“My internist said the person she would send her family to was Dr. Hariharan,” said O’Neill.

On Dec. 3, 2016, within a week of seeing her internist, O’Neill had a Saturday appointment scheduled with Hariharan at the UT Physicians EP Heart Clinic in the Woodlands, near her home in Spring. It is one of eleven UT Physicians EP Heart Clinics across Greater Houston.

“The waiting room was full of positive energy and we waited for a very short time. Hariharan came into the room and was so intense and passionate. He had obviously reviewed all of my information. He wheeled his chair right up to me, asked me lots of questions, patiently answered any questions I had and then said the most beautiful four words to me, ‘I can fix this.’” O’Neill cried when she heard the news.

Hariharan found that O’Neill was experiencing atrial tachycardia, an arrhythmia that often precedes atrial fibrillation. Atrial fibrillation is a condition in which a quivering or irregular heartbeat can lead to blood clots, stroke, heart failure and other heart-related complications. At least 2.7 million Americans are living with Atrial fibrillation, according to the American Heart Association.

“Her heart would race 140 to 160 beats per minute, just while she was sitting down,” said Hariharan.

Cardiac electrophysiologists use advanced mapping techniques to study the electrical activity of the heart to find where abnormal heartbeats might be coming from. Hariharan used this mapping technology to pinpoint exactly where O’Neill’s heart was out of rhythm. He decided she would need a cardiac ablation to permanently fix the problem. Rather than feeling nervous about another heart procedure, O’Neill was thrilled.

“He’s diagnosed something. I knew there was something wrong and now he can fix it,” she said.

Hariharan needed to do something to tide her over until the ablation procedure. In the clinic, he recalibrated her pacemaker to completely ignore the top chamber of her heart, where the issues had originated. It worked.

O’Neill was quickly scheduled for an ablation procedure in Memorial Hermann The Woodlands Hospital. A catheter ablation is a procedure that uses radiofrequency energy to destroy a small area of heart tissue that is causing the rapid and irregular heartbeats. Destroying this tissue helps restore the heart’s regular rhythm.

“His staff was so friendly. As a patient, it really makes you feel confident and secure. You’re surrendering your life to whoever conducts the surgery. When Dr. Hariharan came into the surgical room, he greeted me and explained everything that was about to happen. It was such a comfortable environment and everything went beautifully,” said O’Neill.

Within hours after the procedure, O’Neill’s heart rate was back to normal. She had more energy, less anxiety and could work from her home office again. However, she continued to struggle with breathing and her path to recovery was not quite over.

Hariharan had also discovered that O’Neill had a re-narrowed and leaky aortic valve, which explained why she was still having such a hard time breathing. The valve had narrowed again after several years of “wear and tear.” He knew that in order for her to live a full life, the valve would need to be replaced. Hariharan referred her to his colleague Pranav Loyalka, M.D., a cardiovascular disease specialist with UTHealth and the Center for Advanced Heart Failure at Memorial Hermann Heart & Vascular Institute-Texas Medical Center, who performed an aortic valve replacement in February.

The normal size of an aortic valve is three centimeters. O’Neill’s was three quarters of a centimeter, which Hariharan described as “critically narrow.” Loyalka performed a transcatheter aortic valve implantation (TAVR), a minimally invasive procedure in which he wedged a replacement valve in place of the leaky aortic valve.

Since the TAVR procedure, O’Neill has felt better than ever. She has energy, breathes normally and feels incredibly grateful for the care she has received.

“I firmly believe that people who haven’t had a life-threatening experience take life and quality of life for granted. It has made me ask myself what am I going to do with this wonderful gift – how am I going to honor this gift?”

On a follow-up appointment with Hariharan in April, O’Neill’s husband announced that she had completely redone the landscaping for their yard, a task that would have been impossible just months earlier. O’Neill is also exercising every day for an hour.

“Kim is a model patient. She represents everything I went into this field to help do. All of these issues were not just from her pacemaker. They had an impact on the way the heart functions and the way the valve works. She is not lying in bed or sitting on the porch all day. She is doing what she wants to do. A lot of what we do is restore quality of life,” said Hariharan.

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