Heart surgery defuses 'time bomb'

McClatchy Newspapers (MCT) - Norma Maynard, a 59-year-old Hialeah, Fla., grandmother, died twice in the last six weeks.

Last week, she returned to the University of Miami Hospital to extol her new life.

"I want people to be aware of this new procedure that saved my life. Maybe it'll save some other people's lives," Maynard said. "I feel 45!"

Her daughter Charmane Soto shot her a smile: "Now she's nonstop energy. We have to tell her to relax."

Quite a contrast. A couple weeks ago, a team of doctors couldn't figure out why Maynard's heart kept failing and why she'd gone into shock.

Maynard suffered from a rare condition called cardiac sarcoidosis _ an inflammation of the heart that causes arrhythmias, or rapid heartbeats, which can be fatal.

Signs include fatigue, shortness of breath and heart pain. In Maynard's case, the inflammation and arrhythmia led to cardiac arrest.

"The heart failure she had was disproportionate relative to the amount of disease in the arteries of her heart," said Dr. Pascal Goldschmidt, the dean of the UM School of Medicine.

Maynard's condition was unusual _ only about 20 in 100,000 suffer from cardiac sarcoidosis. Many doctors fail to diagnose the problem until it is too late. Comedian Bernie Mac, 50, died of sarcoidosis in August. (The condition is more prevalent among blacks; Maynard is Mexican-American.)

Maynard's condition was even rarer _ about 1 in 100,000, Goldschmidt estimates _ because the circuit problem occurred on the outside of her heart.

The standard treatment for sarcoidosis would be to insert an implantable defibrillator device, which shocks the heart whenever it gets out of rhythm. But in a patient with Maynard's level of daily tachycardia, or irregular heartbeats, the shocks would have been unbearable.

A new approach began developing in Brazil in the late 1990s, called cardiac ablation. In this procedure, cardiologists burn off the tissue that is causing the electric circuit to misfire in the heart in the first place. They then insert the defibrillator.

Enter the UM team: Dr. Andre d'Avila, who learned of some refinements of ablation while in Brazil a decade ago. Dr. Gervasio Lamas, who diagnosed her case as cardiac sarcoidosis. "The first case I diagnosed," he said. Dr. Vivek Reddy, an electrophysiology cardiologist, who performed the cardiac ablation to burn away the affected tissue.

An ablation is typically done using catheters that go inside the heart. However, Maynard's circuit problem also involved tissues on the outside of her heart. Until a few years ago, there was no solution for a tachycardia _ or rapid heartbeat _ that stems from tissue outside of the heart. In Brazil, d'Avila learned to conduct the procedure by puncturing the chest with a needle to find the abnormal heart tissue.

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Reddy had to ablate from the outside, an especially rare procedure done in about 15 other medical centers nationwide, d'Avila says. (d'Avila cites centers in California, New York, Alabama, New England and Philadelphia).

"My doctor Lamas said I was a walking time bomb, my electricity was going round and round instead of normally," Maynard said.

After the ablation, Reddy implanted the defibrillator.

"The difference between a pacemaker and a defibrillator is that most of the time a defibrillator does nothing, it sits there and watches the heart _ like having an ambulance inside your chest," Reddy said. "But if suddenly the heart should go fast, it shocks the heart back into a regular rhythm. The problem with her is she had so much tachycardia a rapid heartbeat, we didn't want her to get a lot of shocks."

These life-saving shocks can be painful and, if too frequent, can wear out the defibrillator's battery, like an overused iPhone, Goldschmidt notes.

Experts say there is no known preventive measure to avoid cardiac sarcoidosis.

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© 2008, The Miami Herald.