Treating SVT: The Kid’s Got Rhythm

November 12, 2019

With his brown hair, gray eyes and ever-present smile, 7-month-old Charles Caravella Jr. is a lot like other babies his age, laughing at the antics of his siblings and beginning to crawl. But his robust nature belies the life-threatening heart crisis Charles faced just after birth at Jersey Shore University Medical Center.

Charles was days old and in the neonatal intensive care unit (NICU) at Jersey Shore in April 2019 when machines “started going crazy” that indicated the infant’s heart rate was climbing dangerously high, says his dad, Charles Caravella Sr. While around 140 beats per minute is normal for a newborn, Charles’ heart was beating about 300 times per minute—a condition known as supraventricular tachycardia (SVT), the most common abnormal heart rhythm diagnosed in children.

By the time Charles Sr. arrived at the NICU from his job nearby, more than 20 physicians and nurses had surrounded the baby and were hurriedly treating him. The baby’s mother, Christin Andriola, had been feeding Charles when his condition went awry. For both parents, it was a Code Blue moment they recall with terror.

“I was really scared out of my mind because I did not know what was going to happen,” says Christin, who lives in Toms River, New Jersey. “It was a very crazy day, and I was a crying, emotional mess. It still seems not real in a way.”

Adds Charles Sr., a resident of Barnegat, New Jersey, “ A lot went through my mind. I didn’t want to lose my kid. I didn’t know what to think or what to say. I was hoping for the best and preparing for the worst. But he was being helped by one of the best children’s heart doctors in the whole country, so I put a lot of faith in him.”

Tense Moments

The esteemed heart doctor Charles Sr. was referring to is K. Hovnanian Children’s Hospital pediatric cardiologist Mitchel Alpert, M.D., who led Charles Jr.’s care in those frantic first moments after the baby’s heart rhythm abruptly went haywire. Striking as many as one in 250 infants in the U.S., SVT produces an extremely fast heart rate from the heart’s upper chambers, though the severity varies among patients, according to the National Institutes of Health.

But Charles Jr.’s case was the worst Dr. Alpert has seen in a baby in his more than three-decade career. He and his team methodically tried an array of standard therapies for SVT, including so-called “vagal maneuvers” that stimulate the vagus nerve running from the brain to the abdomen to slow the heart. When those didn’t work, they administered a variety of medications that regulate heart rate, upping the doses as Charles Jr.’s vital signs continued to worsen.

Finally, when Charles Jr. began looking cold and clammy, and his blood pressure started to drop, Dr. Alpert came to a startling conclusion: The team would need to perform cardioversion, which uses electrodes on the chest connected to a defibrillator to shock the heart into a normal rhythm.

“On a six-pound baby, that’s a very rare thing,” he explains. “We cardiovert people all the time, but you don’t see it much in babies.”

Even that extraordinary option didn’t work until the second try, when Dr. Alpert and the team doubled the voltage. “We were all concerned—at least for a few minutes—that this baby was not going to make it,” Dr. Alpert recalls. “When that first shock didn’t work, you could feel it in the room.”

Rosy Expectations

To the immense relief of his parents and the Jersey Shore team, Charles Jr.’s heart rate returned to a normal rhythm after the second cardioversion. A post-crisis electrocardiogram Dr. Alpert performed to closely analyze the baby’s heart rate, rhythm and electrical activity revealed he was born with Wolff-Parkinson-White syndrome, an extra electrical pathway between the heart’s upper and lower chambers that causes rapid heartbeat.

For many, the syndrome causes no significant problems, and it’s unclear whether Charles Jr. will ever suffer another resulting episode of SVT, Dr. Alpert says. But the baby is being monitored by his parents and doctors, and taking daily medication to promote a normal heartbeat. If he doesn’t outgrow the problem, eventually Charles could undergo a procedure known as radiofrequency catheter ablation, which uses tiny pulses to create scar tissue within the heart to block abnormal electrical signals.

“It’s a really good story with a really happy ending,” Dr. Alpert says. “A baby with a life-threatening heart rhythm was essentially cured in the hospital, and he was fortunate to be born at Jersey Shore, where we have a team in place who’s had more experience with cardioversion.”

Learn more about the life-saving cardiac care provided at K. Hovnanian Children’s Hospital at Jersey Shore.

Dr. Alpert is a pediatric cardiologist who practices in Neptune, Middletown and Brick. To make an appointment, call 732-458-9666.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

Source:

National Institutes of Health