Lewis LentschLewis Lentsch was a happy, healthy 4-year-old until a routine check-up by his pediatrician uncovered a potentially serious heart problem. Except for the occasional cold or flu, Lewis had no health issues beyond the normal illnesses of an active child with two older siblings. Last spring, after three rounds of antibiotics to wipe out a first-time bout of strep throat, Lewis’ pediatrician listened to his heart and could hear it was not beating the way it should.

“His pediatrician said he had good news and bad. The good news was that there was no more strep; then he asked if I knew Lewis had an irregular heartbeat,” says his mother, Kelly. Lewis was scheduled right away for an electrocardiogram (EKG), a non-invasive test that charts the heart’s electrical activity.

A life-threatening condition

Within a few minutes of completing the test, Lewis and his mother were in the office of Dr. John S. Lozier, of Pediatric Cardiology PC, Des Moines. The EKG showed that Lewis had ventricular tachycardia, causing an abnormal heart rhythm in the bottom chambers of the heart. Lewis had no symptoms, but this type of arrhythmia is potentially life-threatening.

Ventricular tachycardia isn’t a common condition in children, especially at Lewis’ young age.

“Lewis has an exaggerated form, at the extreme end of the spectrum. His case is very exceptional,” says Lozier.

A call for specialized care

Lozier immediately started Lewis on medication designed to stop the irregular beats and for the first 24 hours he wore a portable monitor to track the heart’s activity. In addition, he called Dr. Ian Law, of the University of Iowa Stead Family Children’s Hospital’s renowned pediatric cardiac electrophysiology program. Dr. Law also staffs a Des Moines outreach clinic in the Pediatric Cardiology offices.

“They are a fantastic resource for extreme-type cases. It’s extremely important to have their expertise. I never hesitate to call on them,” Lozier says.

Medication failed to completely stop the irregular heartbeats, and by the fall, Dr. Law examined Lewis at the outreach clinic. It was clear they were familiar with his case and “right away made us feel at ease,” says Kelly.

The physicians suggested Kelly and husband Michael bring Lewis to Iowa City for a procedure where they make a 3-D map to study the heart’s electrical “misfirings” and, once the trouble site is pinpointed, use radiofrequency ablation to cure the abnormal heartbeat.

A trip to Iowa City

Coming to Iowa City “was a little overwhelming,” says Kelly, “but once we met with our nurse and the doctor everything was fine.”

The mapping and ablation procedure are done in the cardiac catheterization lab where the patient is given a sleeping drug. Doctors insert catheters in the vein at the top of the leg and snake them through the patient’s veins up to the heart. Once in place, the catheters map the heart’s electrical firings to determine exactly where the arrhythmia is located. Doctors use radiofrequency energy (heat) to stop the misfiring electrical impulse in that part of the heart.

The procedure, which took about three-and-a-half hours, went smoothly and Kelly and Michael got regular updates throughout. Lewis came through the procedure with flying colors and went home the next morning.

Lewis has had no recurrence of the arrhythmia.

Younger than most

Lewis was younger than most of the patients we treat here in the electrophysiology lab. After the medication failed to stop the arrhythmia, it was important to treat it directly. The procedure itself has few risks and Lewis returned to his normal activities quickly.

The UI physicians performed more than 200 electrophysiology procedures last year, including more than 120 pediatric cardiac ablation with 3-D mapping procedures.

“Every aspect of our care from these doctors has been amazing,” says Kelly. Today, Lewis is a happy-go-lucky kindergartener who wants to be a zookeeper when he grows up.

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