Cornell University Hospital for Animals

 

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Vet College now one of only two schools to offer 'ablation' to cure dogs' racing hearts

Dr. N. Sydney Moise

Taking advantage of a feat that synthesized human and veterinary medical procedures and united cardiologists from two continents and four medical institutions, a 2-year-old Brittany spaniel has a new outlook on life, renewed energy and an insatiable appetite.

Jay, the spaniel, arrived at Cornell's Hospital for Animals (CUHA) as an emergency patient with a heart rate of 380 beats per minute. His medical history revealed an ongoing battle with cardiac arrhythmias (abnormal heart beats) and symptoms that suggested congestive heart failure. Freddy Brewer, a cardiology veterinary resident, slowed Jay's heart rate to a normal sinus rhythm with medication and released him the following morning with a note of caution: Jay's type of arrhythmia could be difficult to control. A week later, Jay returned to Cornell.

"The medical treatment was going to have limited success in treating this arrhythmia, known as a bypass-tract tachycardia," said N. Sydney Moise, chief of cardiology at CUHA. "We suggested to the owners a procedure that could potentially cure the life-threatening arrhythmia."

In the proposed procedure, called an ablation, which had never been done at CUHA, the cardiologist would use a special catheter to deliver energy that creates controlled lesions on the heart and ultimately focal scar tissue. This eliminates the abnormal pathway of electrical conduction and permits only the normal conduction. The specific abnormal pathway that caused Jay's heart to beat too fast had never been successfully ablated before.

Jay's only chance, according to Moise, was a team approach -- an all-hands-on-deck spirit -- and equipment that was pieced together and borrowed from a Katrina-flooded hospital, Weill Cornell Medical College and corporate partners.

"We divided the labor, with each of us having a designated role," said Moise, indicating that this is now a jointly offered service at Cornell and Louisiana State University (LSU) , the only university veterinary hospitals to provide the service. "None of us could have done it alone."

The team included:

  • Pramod Deshmukh, a cardiologist who practices in Sayre, Pa., and has spent his career using insights from the study of dogs to heal humans. Deshmukh assisted during the electrophysiologic testing and ablation;
  • Roberto Santilli, a veterinary cardiologist in Samarate, Varese, Italy, with experience performing this procedure in dogs in Europe, who mapped Jay's heart with a catheter, millimeter by millimeter, to find the area that needed to be ablated;
  • Romain Pariaut of LSU's School of Veterinary Medicine and a former veterinary resident in cardiology at Cornell, who provided LSU equipment and operated the stimulator to test the heart during the procedure;
  • Moise, who orchestrated the team effort and guided Brewer in the catheter placement during the procedure;
  • Bruce Kornreich, a Cornell veterinary cardiologist and electrophysiologist, who worked with Jason Cole from BioPac to ensure that the diagnostic intracardiac recordings were pristine during the procedure;
  • Robin Gleed and Monique Pare, veterinary anesthesiologists, who kept Jay safely anesthetized and monitored vital signs during the procedure;
  • Cornell veterinary cardiology technicians Shari Hemsley and Sarah Miller, who ensured that the details of catheters and supplies were ready at a moment's notice.

Now active and alert, Jay has gained three pounds and his beating heart is no longer racing.

"It takes a lot of energy for a heart to beat as fast as Jay's was," said Moise. "Every morsel of food he ate was going toward that end. Now, when he eats, he's nourishing his body. This is one of the very special procedures we do in that it's novel and curative. Jay came to us as a very young dog. I fully expect that he'll live a long and healthy life."


When nature needs a little help...

For nearly six years, Buddy was an active, healthy ferret. But when the ultimate power outage occurred – the natural electrical system in his heart stopped functioning properly – his heart rate became too low, a potentially life threatening condition. With the natural rhythm gone awry, owner Tara Fish looked to experts at the Cornell University Hospital for Animals for a man-made cadence.

Drs. Jamie Morrisey and Ricardo DeMatos, from the Exotics Service, and Dr. Marc Kraus from the Cardiology team, diagnosed the three-pound family pet with a third-degree heart block. Considered to be a complete obstruction, Buddy’s failing heart was responsible for the once spry ferret’s current difficulty completing simple tasks, like walking and breathing. Effectively, Buddy’s heart was beating at only 30 percent of what it usually would, making it difficult for Buddy’s brain and organs to get the blood and oxygen needed for optimal functioning.

“It happened so suddenly,” said Fish, who is a lab technician with the USDA. “He was playing as he usually did, and collapsed without warning. He was breathing very fast, so I knew something was wrong.”

With the initial diagnosis, medical and surgical treatment options were discussed with the owner. Considering the high risk of pacemaker implantation and novelty of the procedure in the species, the team and Fish decided to treat medically, administering medicine and observing. For a few months, Buddy’s heart rate was manageable and he was holding his own, according to Fish, but then, just as unexpectedly, the sable bundle of fur took a turn for the worse and surgery was scheduled. A team of veterinarians, including exotics specialists, cardiologists, and surgeons worked together to implant a pacemaker that was originally designed for a human and is the size of a silver dollar.

“The first 24 hours after the surgery were a bit rough, but Buddy is a fighter,” said Fish, who was able to visit him in the recovery area and took him home to his sister, Bella, two days later. “There were definite risks involved, and I knew it could have gone either way.” Buddy loves his life, so I decided to give him that chance. Who wouldn’t do that for someone they love?”

Fish has seen the wire from the pacemaker that is directly linked to Buddy’s heart and the generator in his belly on the x-rays. Listening to his heart beat with her stethoscope – something she does regularly – is the ultimate reassurance, though.

“I’m thankful that there are people who realize life-saving surgeries and treatments should not just be for people,” said Fish. “I will continue to do whatever I can for both of my ferrets. They’re my babies”

Indeed, this wasn’t Buddy’s first surgery with Cornell. In July of 2010, he had an adrenal gland and his spleen removed. Currently, Buddy’s sister is undergoing chemotherapy treatment for intestinal lymphoma. Bella was first diagnosed in June of this year, after emergency surgery for an intestinal rupture and peritonitis. So far she is doing quite well.

“It’s been quite an emotional roller coaster over the last year or so, and I have had to make some very difficult decisions for Buddy and Bella, but I am so thankful for the caring, and professional staff at the Cornell University Hospital for Animals, especially the Exotics department; they been very helpful, for sure,” said Fish.

Some people might ask: Why ferrets? The answer comes easily to Fish: “They have taught me so much, and they bring a level of quality and joy to my life. Their heartwarming personalities are amazing. It doesn’t matter what kind of day I’m having, as soon as I see their curious, bright eyed, little faces, it makes me smile. They really do leave tiny pawprints on your heart.”