MARQUETTE – William Michelson of Marquette is alive today. But this might not be the case if he had not been treated by a team of specialists at Marquette General Hospital capable of performing ventricular tachycardia ablation using solely in-house staff.
Michelson, 77, experienced a sudden onset of ventricular tachycardia in the middle of the night. This VT, a faster-than-normal heart rate caused when signals transmitted across the heart muscle are sent too rapidly, was nothing new to Michelson. He had experienced frequent VT as a result of a previous heart attack and other heart problems. But this one was different; it wouldn’t stop.
“The last thing I remember is them putting me out after my defibrillator went off for the fortieth time,” Michelson said. “It ended up going off 180 times during the process and completely burnt out. It was a living Hell.”
Typically these ablation procedures are completed with a cardiologist specializing in heart rhythm problems (an electrophysiologist), anesthesiologist, three to four highly trained staff in electrophysiology, and an industry representative to operate the complex 3D mapping computer system that pinpoints the heart abnormality. But on a cold January night, Michelson’s life was saved because Marquette General staff had been trained to perform these procedures independently without support from industry representatives.
Dr. Rudolph Evonich of the Marquette Heart & Vascular Center had been working previously with Michelson to manage his VT through medication and an implanted defibrillator, a device connected to the heart with wires that senses when a VT is occurring and administers a lifesaving shock.
Because Michelson’s defibrillator had been activated so frequently in the last few months, Dr. Evonich had recommended in December that he undergo an ablation procedure that would short circuit the reoccurring VT and eliminate, or greatly reduce, the need for the defibrillator shocks.
“Every time that defibrillator sends a shock, it’s like getting kicked in the chest by a horse,” said Dr. Evonich. “He was requiring frequent hospitalization just to recover from the effects of the shock.”
Michelson hadn’t yet made a decision on the suggested ablation procedure when found himself again in the Emergency Department on that January night.
“His defibrillator had sent multiple shocks prior to his arrival in the Emergency Department, once in the ED, he had been given the appropriate medications, then more shocks, then more medications his heart just couldn’t come out of VT,” said Dr. Evonich.
After working on Michelson for two hours without success using conventional treatments, his heart rate was still 150 beats per minute with a fading pulse. They were going to lose Michelson without drastic interventional measures.
“Dr. Evonich talked to my wife and told her he didn’t know if I was going to make it, but that they wanted to try an emergency procedure,” Michelson said.
After explaining the dire situation to Michelson’s wife, Dr. Evonich engaged his electrophysiology team to perform an ablation procedure with the aid of a complex 3D mapping system. These mapping systems allow the EP team to pinpoint the area of the heart in which the abnormal rhythm is originating. Then, using a catheter with a special tip, a high-frequency electrical current is directed at the area of abnormality destroying a tiny amount of tissue.
Fortunately for Michelson, this emergency intervention was successful and the VT finally ceased. This was the same procedure that Dr. Evonich recommended Michelson undergo a month earlier. These procedures are typically scheduled ahead of time and are done with the support of an industry representative who would fly in to assist in the case.
“We are the only hospital in the nation that has this capability. In all other locations there is a dependency on industry support to operate the 3D mapping system, which makes it impossible for these hospitals to do an emergent case in the middle of the night,” said Dr. Evonich. “Because of our rural location, we can’t depend on industry representatives to always assist with our cases. The travel time makes it impractical for them to be here for urgent cases and the weather may prevent them from getting here for scheduled cases.”
Dr. Evonich spearheaded the effort to have his staff trained to perform this procedure and his team has been averaging three to four scheduled complex ablation cases per week for the past several years.
While Marquette General’s EP team regularly assembles and performs scheduled VT cases with a Biosense Webster representative, this was the first incident in which the team was called upon to tackle an emergent VT case without industry support. Dr. Evonich couldn’t be more pleased with the result.
“We were basically operating with one arm tied behind our backs compared to the staff we typically would have present for a case like this,” said Dr. Evonich. “But this is precisely why we pushed to have our staff trained they answered the call in an emergency and saved a life.”
Michelson added: “The care I received was fantastic. What those doctors did for me at that hour of night is exceptional. They did more than anyone else would have done for someone in my condition. If it would have happened anywhere else, I wouldn’t be here.”
Marquette General’s crew who worked with Dr. Evonich that night to save Michelson with this procedure included cardiologist Dr. Kristopher Dosh, Paul Alcott, RN, RCIS, Mike Parks, RN, BSN, and cardiovascular techs Scott Hentkowski, RCIS, CNMT, BS, Katrina Keough, RT(R)(ARRT)BS, and Jamie Rhoades, RT(R)(CI)(ARRT). Cardiovascular techs Audrey Johnson, LPN, Shannon Kauppila, LPN, RCIS, and Deb Wood, LPN, RCIS, are also members of the EP team who are trained and regularly perform 3D mapping ablation procedures. Marquette General’s robust EP program also includes Dr. Mark Cowan, Sue Negri RN, CEPS, and cardiovascular tech Brandy Jones RT(R)(CI)(ARRT), CEPS.
“We did something that no hospital in this country can do,” Dr. Evonich said. “This case speaks volumes about our team’s ability to treat and cure complex heart rhythm disorders here at Marquette General.”
Michelson has benefited from other Marquette General Heart and Vascular Institute services including treatment for a heart attack and peripheral artery disease (PAD) in his legs. Michelson’s PAD, a common yet painful condition in which plaque builds up in the arteries, was causing him so much trouble that at times he had to use a wheelchair.
“I enjoy flea markets in the summer and it makes me feel good knowing that I will be able to move around again without a wheelchair,” Michelson said. “I’m getting back to normal and every day gets better. The doctors have told me it will be a while but my heart has been checked out and everything is looking good. I’m happy to be able to be out walking again.”
-Marquette General Hospital