Math professor counts on UI for innovative cardiac procedure

Roseanne Wolf is well-schooled on how the heart works. The 31-year-old earned a PhD in applied mathematics at the University of Iowa in 2012, and her doctoral research focused on the mathematical modeling of cardiomyocytes—the cells that make up heart muscle.

Despite her academic background and knowledge, Roseanne could not have guessed that cardiac function would one day affect her on much more personal level.

In fall 2013, Roseanne suddenly, and without warning, lost consciousness at her home in Dubuque, Iowa. She had never passed out before.

Fortunately, Roseanne’s parents were visiting that weekend, and they drove her to the emergency room in Dubuque. Since Roseanne had no warning signs prior to her fall, doctors performed an electrocardiogram (EKG)—a recording of her heart rate and rhythm—to rule out an abnormal heart rhythm or decrease in blood pressure that could have caused her to lose consciousness.

Roseanne’s EKG result looked normal, so she was sent home.

“The doctors thought I passed out because of dehydration,” Roseanne says, “but I knew something wasn’t right.”

Roseanne decided to take matters into her own hands. She called one of the cardiologists she knew from her research at Iowa, who encouraged her to come to University of Iowa Hospitals & Clinics for additional testing.

Following a series of heart-related tests, UI doctors determined that Roseanne had neurocardiogenic syncope (also known as vasovagal syncope), which is a sudden drop in heart rate and blood pressure that can cause the heart to stop beating. A number of factors—changes in blood levels of certain body chemicals, or stressful triggers such as long periods of standing or heat exposure, for example—can cause neurocardiogenic syncope. UI cardiologists do not know what triggered Roseanne’s condition.

In some cases, neurocardiogenic syncope can be “self-treated,” meaning patients can avoid what triggers their fainting spells. Doctors also may decide to take a wait-and-see approach. With Roseanne, the hope was that this was a fluke event that would not occur again.

Things seemed normal for Roseanne—no fainting episodes at all—until late December 2014, when she collapsed at her parents’ home in Varina, Iowa. It was especially frightening because she actually lost consciousness repeatedly over a short period of time. After a trip to the ER in nearby Storm Lake, Roseanne requested a transfer to UI Hospitals & Clinics.

This time, doctors decided it would be best for Roseanne to have an implanted LINQTM cardiac monitor, which works as a continuous monitoring device to measure and record the heart’s rhythm.

Michael Giudici, MD, director of UI Heart and Vascular Center’s Electrophysiology Program, performed Roseanne’s procedure, which involves inserting the double AA battery-sized device just under the skin in the patient’s chest wall. No stitches were needed.

After three months of wearing the implanted monitor, no unusual heart rhythms were detected, and Roseanne had not fainted again. However, Guidici knew that Roseanne’s neurocardiogenic syncope was triggering a reflex in her brain, which intermittently caused a steep slowing of her heart rhythm and a significant drop in her blood pressure. With the uncertainty and possible danger surrounding Roseanne losing consciousness in the future, Giudici suggested a pacemaker.

“I gave Roseanne a special pacemaker with a feature that responds to a decrease in blood returning to the heart,” Giudici says, “This goes a long way toward keeping the slowing reflex from occurring and preventing Roseanne from passing out.”

Giudici reassured Roseanne that he would do his best to hide the scar from the procedure with his unique submammary approach.

“Young women tend to have excessive scar formation due to skin tension in the upper chest. The usual location for [pacemakers] in the upper chest can be irritated by purse straps, bra straps, and car restraints,” Giudici says.

The submammary approach is an alternative to the standard pacemaker implant procedure. It involves two small incisions—one in the armpit and one under the breast—to place the device between the chest muscle and ribs.

Giudici is one of the few electrophysiologists in the United States to perform this innovative technique to implant devices such as Roseanne’s pacemaker.

“We have performed submammary implants of devices for more than a dozen years with few significant complications and with a very high level of satisfaction reported by patients,” Giudici says.

Roseanne says she feels better now than she has in years. She’s back to running, one of her favorite forms of exercise. In fact, she has completed her first 5K since receiving her pacemaker.

One “take-home message” in Roseanne’s case is that loss of consciousness should never be ignored, according to Giudici.

“Even if the reason for the blood pressure drop isn’t a life-threatening condition, you could suffer significant trauma or potentially have a car accident if you lose consciousness,” he says.

— Emily Elliott
Spring/Summer 2016