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Trinity Ashton - “New Lead”

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Little Pumpkin - Five-Year-Old is first in Michigan to receive “Thin” Heart Lead via Catheter Delivery.

Trinity Ashton is a bit of a daredevil. She loves to get a running start, jump on a swing and land on her tummy.Ashton

No big deal for most kids. However, when Trinity was just a baby, her upper abdomen was fitted with a pacemaker because she was born with a congenital heart block. And the last time Trinity landed on her stomach, she broke the lead (an electrical wire) connecting the pacemaker’s battery to her heart.

Not good!

Congenital heart block is caused by an embryological defect. It is a condition in which the electrical system of the heart is improperly formed. Children with the condition have a heart rate that is abnormally low – 20 to 30 beats per minute. So when the lead to Trinity’s heart broke loose, her pacemaker stopped reminding her heart when to contract, and she began to experience fatigue, dizziness and fainting spells.

That’s where Children’s Hospital and Dr. Peter Karpawich, a pediatric cardiologist who started the Electrophysiology Program at Children’s, stepped in.

Dr. Karpawich (click here for bio)
But first, Dr. Karpawich had to make a crucial decision: Either open Trinity’s chest in a major surgery to attach a new lead to the outside of her heart, or place a new pacemaker under her collarbone, employ a new catheter delivery system, recently approved by the FDA, and send the lead through a vein into the heart.

Dr. Karpawich chose the second option – a procedure requiring just a one-and-a-half-inch incision made to look like a skin crease near Trinity’s armpit.

During research he had conducted on growing hearts, Dr. Karpawich discovered that pacing the heart with a lead placed at a less than optimal location in the muscle can cause the heart to deteriorate over time. So after consulting with Dr. Karpawich, manufacturers in the medical device industry took major steps to advance the technology.

First, Medtronic, Inc., created a thinner lead – just one millimeter in diameter, decreasing the probability of obstruction in the vein. Then it developed a catheter delivery system for more precise positioning of the lead in the heart muscle.

The FDA approved the system in August of 2005. A month later, Trinity became the first child ever to receive the new, thin lead via catheter delivery.

“Because the lead is so thin it’s like a piece of limp spaghetti,” says Dr. Karpawich. “However, placement in the catheter provides resiliency during surgery. So after making the small incision near Trinity’s collar bone and running the catheter through a vein to her heart, I was able to turn a control attached to the catheter and precisely angle the lead in place. There’s a corkscrew tip at the end of the lead. I secured it into the heart and then removed the catheter,” said Karpawich.

The entire procedure – from preparation in the catheterization laboratory to the closing of Trinity’s incision – took about one hour. The process was greatly facilitated through the use of fluoroscopy, an online x-ray with minimal radiation that allowed the doctor to see the heart moving on a screen.

“Today, Trinity is back to running around, doing the things kids do,” says Dr. Karpawich. “She is such an inspiration, and she’s as cute as a pumpkin. Trinity will probably have to come back to Children’s in seven to ten years when the battery for her pacemaker drains. But we’ll put in a new one and she should be able to go home the same day.”

Chamile Ashton, Trinity’s mom, couldn’t be more complimentary of the care her daughter received at Children’s Hospital.

“All of a sudden you feel so helpless, so thrown into the situation, but oh goodness, the doctors and nurses at Children’s were wonderful. They constantly kept us informed, and I felt as though I could call them any time to get answers to my questions.

“And Dr. Karpawich, he was just great about explaining how Trinity’s pacemaker and cord would be replaced. I loved him and everyone at Children’s because they loved Trinity.”

When last seen, Trinity was racing her puppy, Trapper, across the front lawn at home in Detroit.

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