Clever cardiologists crack confounding case

All heart: Dolores Martins is alive and well, thanks to innovative thinking by North Shore University Hospital doctors Mitchell Weinberg (left) and Apoor Patel.

A Mineola grandmother is alive – and doing well – thanks to an innovative cardiac procedure devised by clever Northwell Health physicians.

On April 18, Dolores Martins became the first person in the United States to have a micro-pacemaker implanted using an angioplasty technique – a procedure typically used to widen narrowed or obstructed arteries or veins, but in this case used to get the tiny pacemaker past severe clots and implants from previous procedures.

Doctors at North Shore University Hospital came up with the unprecedented solution after being confounded by Martins’ unique physical condition.

The 65-year-old mother and grandmother has struggled with a host of medical issues over the past three decades: She’s been in dialysis since 1989 and has undergone several surgeries, including two failed kidney transplants, multiple procedures to counter thyroid cancer and an open-heart surgery, among others.

But her doctors were truly perplexed by her recent diagnosis of atrial fibrillation, an irregular and often rapid heart rate that increases risk of stroke and heart failure.

Such cases are routinely treated with a beta-blocker, a class of medications used to manage cardiac arrhythmias and protect the heart from a second heart attack after a first.

But in Martins’ case, the traditional treatment was causing her heart to stop for up to 12 seconds at a time.

Her only hope was a pacemaker – NSUH cardiac experts opted for a new, wireless mini-pacemaker commercialized by Irish medtech giant Medtronic – but the veins in her chest and arms were too clotted by years of dialysis to properly insert the device.

Further, a vascular filter inserted during a previous procedure also blocked the way.

“The miniature pacemaker is guided into the heart through a vein in the leg,” noted Apoor Patel, a cardiac physiologist at NSUH. “Then, it is directly implanted into the heart’s muscle, thereby avoiding the need to pass wires through the veins in the chest.

“But we realized early on that this, too, would be difficult because of the presence of an old filter situated within the inferior vena cava,” the doctor added. “In other words, the filter was so dense that it was blocking passage of the pacemaker.”

In concert with vascular interventionalist Mitchell Weinberg, NSUH’s director of peripheral intervention, Patel got inventive. The duo used catheters, balloons and wires to create a temporary hole in the filter, through which they were able to pass the pacemaker and implant it in Martins’ heart.

“Fortunately, this does not affect the function of the filter and the procedure was able to move forward,” Weinberg noted.

The groundbreaking procedure lasted only two hours, according to Northwell Health, and Martins returned home to her family – including her husband, two adult daughters and six grandchildren – within days.

This week, she returned to NSUH to thank the life-saving innovators.

“Now that it’s over, I can tell you that I can’t believe I’m still here,” Martins said. “All I can say is ‘thank you.’

“I hope I’m around for a long, long time.”