Seven days after delivering of a new baby girl, 32 year old Antiganee Cain-Francis and her husband were adjusting well to the new lifestyle.
She was recovering from her C-section and working on breastfeeding. "Everything was going on fine with a newborn. "We were just getting used to our routine and her habits." - She said. But that weekend, everything "started to change,"
All she could remember is relaxing while watching TV before getting up to check on her New born. Then, suddenly, she noticed a "static feeling" and wasn't able to see or hear.
While she doesn't remember what happened after that, her husband, Shaquelle, later told her that he heard her screaming his name. He called her OB-GYN, who urged them to go to the emergency room.
The event set off about three weeks of hospital stays and medical detective work to find and finally treat the exceedingly rare cause of life-threatening symptoms.
The medical team was able to resuscitate her, and Dr. Sirish Vullaganti, director of heart failure at Lenox Hill Hospital, decided to put her on a ventilator and extracorporeal membrane oxygenation (ECMO), a machine that supports the heart and lungs and ensures the patient gets enough oxygenated blood.
Once stabilized again, Vullaganti transferred Cain-Francis to North Shore University Hospital on Long Island where she met with electrophysiology specialist Dr. Ramanak Mitra.
After three days on ECMO, Her heart rhythm was "completely normal. So, at that point, the team made the decision to start her on some medications and remove the ventilator so that they could communicate with her.
"She seemed to be doing well," Mitra says, "but within about 24 hours, she started to have a few of these extra beats." During an EKG procedure to try to map out the abnormal beats, Cain-Francis "again went into rapid, sustained arrhythmia," he says. She went into cardiac arrest again and was resuscitated for the second time.
But the team was able to capture the beats on their monitoring system, which gave Mitra more clues about what might be going on.Cain-Francis had no warning signs before her first episode, no family history of heart disease or sudden death and no genetic markers to point doctors in a particular direction.
The team at Lennox Hill Hospital had already ruled out a coronary artery dissection, a heart condition that's more common among younger women. They'd also ruled out peripartum cardiomyopathy, a type of muscle weakness in the heart that can arise around the time of delivery.
But when Mitra's team looked at the electrical tracings of her heart rhythm that was captured on the monitor, they noticed a similar pattern before every episode. That suggested Cain-Francis had a primary rhythm problem caused by an electrical issue within the heart.
The pattern of heartbeats Mitra saw before each of Cain-Francis' episodes led him to suspect that she had a type of arrhythmia called triggered ventricular fibrillation.
In people with this condition, "there's one particular site in the heart muscle," he explains, "and when it fires, it basically puts the heart into a tailspin."
In Cain-Francis' case, the condition is idiopathic, meaning doctors don't know why it developed. That's especially rare in patients as young as Cain-Francis, Mitra says.
While experts don't know exactly what causes triggered ventricular fibrillation happens, the condition is thought to originate in the heart's Purkinje fibers, which are responsible for sending specialized electrical signals that control the heart's pumping muscles.
To treat the condition, Mitra needed to perform a procedure called catheter ablation. During this procedure, the part of the heart that's causing these irregular beats gets cauterized through a tiny catheter.
"The challenge there is that you have to be having these beats in order for us to know where to find them," Mitra says. “If they’re not having these beats and we can’t provoke them, then we don’t have any target of where to ablate."
Sometimes, if the patient is otherwise stable, doctors can stimulate the irregular beats and find them. But because Cain-Francis was still on ECMO, that wouldn't be possible for her.
Instead, Mitra performed a procedure called pace mapping, which allowed him to replicate and pinpoint the source of Cain-Francis' abnormal heartbeats.
"After that, it's a matter of hope," Mitra says. "You've got a theory, but the only way to tell is just to wait and see."
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