Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Early one morning, in the house he built with his own hands by a sparkling lake in northern New York, 77-year-old David Fayette awoke to some disturbing symptoms.
First, he noticed that his legs were swollen, and when he lay down, his heart rate would slow to a crawl. "I thought I was going to flatline right there," he says. "It was terrifying."
He called his primary care physician, who recommended that he go to the Emergency Department at Canton-Potsdam Hospital, an affiliate of Fletcher Allen.
Tests there showed that David had an ejection fraction – the percentage of blood pumped out of the heart’s ventricle with each heartbeat – of 30 percent. Normal is 60 percent. He also had an atrial flutter and a very slow heart rate, just 30 beats per minute.
Alexandru Stoian, M.D., Cardiology Medical Director at Canton-Potsdam, recommended that David go to Fletcher Allen.
With his wife, Mary, and daughter, Marilyn, following behind, David was taken by ambulance to Fletcher Allen. Soon after his arrival, he met Fletcher Allen Cardiac Electrophysiologist Robert Lobel, M.D.
Before Dr. Lobel could restore David’s normal heart rhythm, he needed to rule out the possibility of a blood clot in the upper chambers of David’s heart. Fletcher Allen Cardiologist Peter VanBuren, M.D., performed a transesophageal echocardiogram (TEE) test, a procedure in which an ultrasound transducer, which produces high-frequency sound waves, provides pictures of the heart’s valves and chambers. The TEE showed that there were no blood clots.
Dr. Lobel then performed a DC cardioversion, which involved giving the heart an electric shock while David was sedated. This terminated David’s atrial flutter, and restored his normal heart rhythm.
Following the cardioversion, Dr. Lobel determined that David had significant conduction disease in the atrioventricular node, a part of the heart that coordinates heart rate. Because David had a reduced ejection fraction, he was a candidate for a defibrillator to protect him against sudden cardiac death.
Dr. Lobel performed an innovative procedure that involved combining the defibrillator with a special type of pacemaker, known as a His-bundle pacemaker, in order to bypass David’s diseased conduction system. The combined device preserves David’s normal conduction pattern, protects him from sudden cardiac death, and allows him to take medications for his heart disease without dangerously slowing the heart rate.
David was impressed by Dr. Lobel’s skill and down-to-earth manner – and the way every staff person made an effort to make him feel comfortable. "They all explained what was happening in terms that I could understand," he says. "It was very comforting."
Today, David feels great. He will continue to be checked by Dr. Lobel and physicians at Canton-Potsdam Hospital and Alice Hyde Medical Center, to ensure that he remains symptom-free and his pacemaker defibrillator is working well.
"Everyone at Fletcher Allen did a superb job," he says. "No question about it – I knew I was in good hands."
Fletcher Allen is at the forefront of developing a new method using an old device. In some patients, traditional pacemakers can aggravate a problem such as the lack of synchronized contraction of the heart muscle. Restoring synchronized contraction can allow the heart to work more efficiently. Cardiac Electrophysiologists Daniel Lustgarten, M.D., and Robert Lobel, M.D., developed a technique to deliver an electrical current to the normal conduction system. This approach – used by Dr. Lobel in this story – has a reduced risk of complications and is available at only a handful of health care organizations around the country. Dr. Lustgarten and Dr. Lobel are beginning a trial to test whether this new approach is better than the traditional approach in cases like David Fayette’s.