With every beat of his heart

When 14-year-old Sam presented with a heart arrhythmia never before documented in the medical journals, pediatric electrophysiologist, Dr. Sunita Ferns, found herself facing the most challenging case of her career.

Fourteen-year-old, Sam, always knew he was a bit different from his peers.

"I always had shorter breath than the other kids; I always couldn't run as fast as the other kids," explains Sam. "I just couldn't keep up no matter what."

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Dr. Sunita Ferns

His mother, Susan, just chalked it up to Sam being a bigger kid, even in middle school when he started experiencing periodic episodes that included headaches and nausea accompanied by shakes and chills.

"In retrospect, with what we know now, it all makes sense," says Susan. "But at the time, I wondered if he wasn't just trying to get out of school."

Everything changed during a visit to Sam's pediatrician's office in the family's hometown of Wilmington, N.C. An astute nurse practitioner examining Sam for a suspected case of bronchitis noticed pulsing in his neck and discovered Sam's heart rate was nearly twice as fast as it should be. These turned out to be important clues to a set of problems Sam had endured for years.

Sam was referred to James Loehr, MD, at UNC Children's cardiology practice in Wilmington. Testing revealed that Sam had supraventricular tachycardia (SVT), a condition that arises from improper electrical activity in the heart which presents as a rapid heart beat. Dr. Loehr referred Sam to Sunita Ferns, MD, MRCPCH, assistant professor of pediatric cardiology, who directs invasive electrophysiology program at N.C. Children's Hospital.

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Dr. Ferns hugs Sam's mother, Susan, while his grandmother looks on following surgery. Click to enlarge.
Dr. Ferns knows this to be a very serious condition.
 

"This is like running a marathon for your entire life through the day and night," Dr. Ferns explains, "and with time the heart function begins to take a toll, and you develop heart failure."

Dr. Ferns also realized Sam's was a very unusual case. The problem was occurring right on top of the tissue that normally controls the electrical impulses of the heart.

"It's in an extremely unusual location,"adds Dr. Ferns. "They are usually in a location that's far away from the normal conduction system, so they can be taken care of easily."

Resolving the arrhythmia without damaging Sam's normal conductive tissue would be tricky, if it was possible at all. With no effective pharmaceutical options, Dr. Ferns faced a dilemma: attempt to surgically address the arrhythmia by burning the wayward synapses, which could likely leave Sam in need of a pacemaker, or to leave the condition alone, which would ultimately be fatal.

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Sam goes for the basket following his surgery.
Complicating the decision was the fact that, despite an extensive search, the pediatric cardiology team couldn't find a single case like Sam's anywhere in the medical literature. Dr. Ferns and her team would be in completely uncharted territory with a surgical intervention, but complete heart failure some years from now was not an option.
 

Sam had his surgery at UNC Hospitals on Dec. 12, 2014. Using state-of-the-art equipment that measures heart tissue down to the tenth of a millimeter, Dr. Ferns and her team went to work on Sam's arrhythmia in a procedure that Dr. Ferns describes as "touch and go."

"I knew there was such a high risk of heart block, I was trying my best not to go off path," recalls Dr. Ferns.

She felt the case was a success, but only time would tell if the tissue was permanently destroyed or if it would regenerate and cause recurrent SVT. A post-operative visit with Dr. Loehr four weeks later confirmed what everyone hoped: Sam's surgery was a success.

Mom, Susan, beams when she talks of how much stamina Sam has now that his heart function is normal. For his 15th birthday in January, she got him a basketball hoop and enjoys watching Sam and his friends play pickup games out in the cul de sac in front of their house.

Sam, too, has noticed a big difference in how he feels. He is no longer missing school and is considering following in Dr. Ferns footsteps by one day pursuing a career in cardiology.

"Dr. Ferns is my hero," says Sam with a big smile. "She saved my life!"

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