CHOC Patient Benefits from World’s Smallest Pacemaker

Sofia Rodriguez and CHOC Children’s cardiologist Dr. Anthony McCanta are making medical history. The petite 12-year-old recently became the smallest and youngest patient to receive the Micra® Transcatheter Pacing System (TPS). The innovative physician, who specializes in pediatric electrophysiology, joins an elite group of doctors in the world who have implanted the device, and is likely the first to do so in a child.

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The Micra® Transcatheter Pacing System is about the size of a vitamin.

About the size of a vitamin, Micra TPS, which was approved by the Food and Drug Administration last year, provides the most advanced pacing technology at one-tenth the size of a traditional pacemaker. And unlike traditional pacemakers, the device does not have cardiac leads, which are the wires that carry electricity from the pacemaker to the heart and the other way around. This activity occurs between 100,000 to 200,000 times in most children, eventually putting a strain on the leads. The leads can then break or stop working properly, requiring a new device to be implanted.

In addition to being leadless, the Micra TPS is small enough to be delivered through a catheter and implanted directly into the heart instead of a surgical “pocket” under the skin. This offers patients a safe alternative to conventional pacemakers without the complications associated with leads — all while being cosmetically invisible.

Sofia’s story

Diagnosed shortly after birth with a particularly complex form of tetralogy of fallot, a rare and serious heart condition, Sofia had her first open-heart surgery before turning 1 month old and a second, to implant a traditional pacemaker, when she was 6 months old. Abdominal surgery followed, as did a diagnosis of DiGeorge syndrome, a chromosomal disorder that affects the development of several body systems.

Sofia tackled each health challenge with a fierce determination to survive and, more than that, to enjoy her childhood. Her parents and the team at the CHOC Children’s Heart Institute supported her every step of the way, equally committed to her quality of life.

When the pre-teen needed a new pacing system (the cardiac leads from the first device had broken), Dr. McCanta advocated for the Micra TPS. He knew the benefits it would bring to Sofia, and other CHOC patients.

“The immediate benefit to Sofia is that she does not have another scar on her upper chest. The long-term benefit is she has no cardiac lead in her vein that could break, become infected or cause a blood clot,” explains Dr. McCanta. “When you consider the course of her entire life, the benefit of reducing complications of pacing is almost immeasurable.”

Sofia’s parents are proud of the part she played in the medical milestone. “She’s always been special, and here’s just one more thing that demonstrates how special she truly is,” says Sofia’s dad, Edgar. “We are thankful for people like Dr. McCanta and so impressed with the new technology. We feel truly blessed.”

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Sofia and her dog, Yoda

When she’s not on her computer, Sofia loves watching videos and listening to Latin music. She’s outgoing with lots of friends and a bright future ahead of her.

Learn more about the electrophysiology program at CHOC

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Electrophysiology Advances Restore Patient’s Quality of Life

A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist.

Lauren Flotman, 15, had experienced irregular heartbeats for years before Dr. Francesca Byrne, a pediatric cardiology specialist, diagnosed her with supraventricular tachycardia, or SVT, and Dr. Tony McCanta, a pediatric heart rhythm specialist, repaired the condition through radiofrequency ablation.

The episodes first surfaced when Lauren was about 8 years old and they began increasing in frequency as she aged. They’d occur without warning or pattern.

For Lauren and her family, the sudden attacks caused great concern. Not only was she drained and tired after an episode, but Lauren dreaded them happening, especially during a pep squad routine when her teammates were depending on her.

Lauren was elated to finally have a name for her condition.

“It was a huge relief for sure to have a diagnosis,” she says. “I always had to just describe the feeling because I didn’t have a name. Now I can say I have SVT.”

Lauren’s diagnosis was reached after a Holter monitor captured her heart racing at 220 beats per minute. Dr. Byrne referred Lauren to Dr. McCanta to discuss treatment options, which included anti-arrhythmic medications or an ablation procedure.  After reviewing their options carefully, the Flotmans decided to pursue ablation.

For Lauren’s ablation, Dr. McCanta used a new technology called an intracardiac echocardiogram, or ICE, to create a three-dimensional map of the inside of her heart without using fluoroscopy (X-Ray radiation), enabling a catheter to apply radiofrequency energy to the precise location in her heart causing her SVT.

ICE technology involves a tiny ultrasound probe imbedded into a catheter that is advanced through the vein directly into the heart, allowing for very clear, accurate image quality. These ultrasound images then integrate with a three-dimensional electroanatomical mapping system, which acts like a GPS (global positioning system) for the catheters within patients’ hearts, to provide an accurate real-time shell of the inside of the patient’s heart. This allows the doctor to safely move catheters inside the beating heart without using radiation.

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Dr. McCanta and the electrophysiology team at CHOC were among the first in the world to routinely utilize intracardiac echocardiography in pediatric and adolescent patients.

While radiofrequency ablation has become a safe and common treatment for SVT in children and adolescents since the mid-2000s, intracardiac echocardiography (ICE) has not traditionally been used in pediatrics due to the large-sized catheters. But when a smaller catheter was created, which was more suitable for the size of young patients, Dr. McCanta and the electrophysiology team from the CHOC Children’s Heart Institute were among the first in the world to routinely utilize the new technology in pediatric and adolescent patients.

“For a young, healthy patient like Lauren, increasing safety and minimizing the use of radiation are extremely important, while still being able to provide a cure for her arrhythmia with ablation” says Dr. McCanta.

After a few days of taking it easy following the procedure, Lauren felt back to her usual self – only without the constant fear her heart would suddenly begin racing.

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Lauren’s longtime arrhythmia has been repaired and her quality of life has dramatically improved, thanks to the electrophysiology team at CHOC.

“Our team loves utilizing advanced technologies like ICE and three-dimensional mapping to help children, adolescents, and young adults with heart rhythm problems,” says Dr. McCanta, “Seeing patients like Lauren get back to all of the things they love doing is why we do this!”

Since the procedure, Lauren has been vocal at church to educate her peers about being conscious and vocal about their health.


Get the facts about CHOC's advanced electrophysiology program



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Patient Returns to School Symptom-Free

Jaden picWhen Jaden Rascon started fourth grade earlier this week, she didn’t have to worry any longer about her heartbeat suddenly racing – thanks to an innovative procedure at CHOC Children’s.

“I feel good,” the 9-year-old says. “Before, when my heart would speed up, it was very hard to breathe, and it would give me headaches. But now it’s all gone because I got the procedure.”

Jaden recently underwent an outpatient electrophysiology procedure at CHOC to cure her arrhythmia. The experience was short, non-invasive and – even better – required no radiation.

Her procedure is a landmark achievement that signals a new direction for electrophysiology, a field that has already dramatically changed cardiology.  And now, an electrophysiology procedure with no radiation marks an even safer and less invasive cure for a common ailment.

A three-dimensional image of a heart created by cardio-mapping equipment at CHOC Children's.
A three-dimensional image of a heart created by cardio-mapping equipment at CHOC Children’s.

The successful radiation-free electrophysiology procedure is a credit to the skill and expertise of Dr. Anjan Batra, medical director of electrophysiology at the CHOC Children’s Heart Institute, as well as the state-of-the-art cardio mapping equipment inside the hospital’s new Bill Holmes Tower.

“This has really changed our field,” Dr. Batra said. “We can do so much more, and do it better and safer. It’s great to be in a field where we not only treat, but also cure. It’s great to help a patient so that they don’t have to see a doctor for the condition again.”

Dr. Batra performed the procedure using a three-dimensional cardio mapping system. The device uses catheters with locator sensors that transmit signals from inside the heart. This allowed Dr. Batra to visualize the beating heart by using these magnetic sources as reference points, rather than relying on fluoroscopy – an imaging technique that uses X-rays to obtain images of internal organs while they’re in motion – to reveal the catheters’ positions.

Just weeks after her procedure, Jaden’s quality of life has already improved.

Last November, Jaden began complaining of a rapid heartbeat, says her mother, Vera.  A normal resting heart rate for children ages 7 to 9 is between 70 and 110 beats per minute, but Jaden experienced a heart rate of 225 beats per minute during one emergency department visit. She was then referred to CHOC, and was subsequently determined to be a good candidate for an electrophysiology procedure.

“I was nervous at first,” Jaden says, “but then I knew that they were studying the heart for a long time so nothing would go wrong.”

Typically, up to three patients are diagnosed with arrhythmias each day at CHOC, Dr. Batra says.  About 25 years ago, the only cure for these conditions was open heart surgery, and many patients simply tolerated the condition or relied on medication.

Now, the hospital has used electrophysiology procedures to cure more than 100 children with arrhythmias each year, and that figure is expected to increase as awareness grows among parents and the medical community, says Dr. Batra, one of about 200 pediatric electrophysiologists worldwide.

Learn more about CHOC’s electrophysiology services.

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