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25 April 2016

First paediatric cardiac centre in the UK to install integrated system

Young patients requiring therapeutic catheter ablation at Bristol Royal Hospital for Children will benefit from a new integrated system recently installed in the hospital's catheterization laboratory.

Bristol children's hospital has become the first paediatric cardiac centre in the UK, and the second paediatric centre in Europe, Middle East and Africa to install the Biosense WebsterCartoUnivusystem. When treating abnormal heart rhythms, it is necessary to direct a catheter to the location that is causing the abnormal heart rhythm. This has conventionally been done using x-ray guidance; however this involves exposing the patient to small doses of radiation. The newer CARTO, 3D mapping systems does not require x-rays and works by using a magnetic catheter to create a three-dimensional shell of the heart. The new CartoUnivusystem works by combining these two features, so we get the benefit of seeing an x-ray picture superimposed on a 3D picture of the heart, without exposing the patient to radiation.

Mark Walsh, congenital cardiology consultant at Bristol children's hospital said: "UniVu has really transformed how we manage our electrophysiology cases. It permits better visualisation of the heart by combining x-ray and the latest 3-D mapping technology. This means that we can dramatically reduce the dose of x-ray that a patient is exposed to.

"Another advantage with UniVu is that it provides us with an advantage for difficult cases, for instance, especially when it comes to imaging small blood vessel attached to the heart that sometimes contains areas where the heart rhythm is abnormal."

Since the installation of the CartoUnivu model in January 2016, Bristol children's hospital has successfully treated 25 paediatric patients. The system has enabled cardiologists at the hospital to treat conditions such Wolff-Parkinson-White syndrome which is a common condition which has the potential to cause dangerous fast heart rhythms and cardiac arrest in young children.

Rio Davies, age seven, was treated using the new integrated system earlier this year. Rio's mother, Marcelle Davies said: "When I was told Rio had suffered an out of hospital cardiac arrest in France, I was shocked because what happened at the service station had appeared similar to the seizure he had a few years ago.  I did not have any complaints earlier in the day from him about him feeling unwell or uncomfortable.

"Despite doctor's best efforts at University Hospital Amiens in France, to burn off the dangerous connection in Rio's heart, the treatment was not successful and we flew back to the UK four weeks later where he was treated by the paediatric cardiac team at Bristol children's hospital. Rio immediately underwent an ablation and made a quick recovery, returning to school and becoming his usual energetic self. We then returned to the hospital earlier this year, where Rio required a third procedure when Mr Walsh had identified the connection had come back.

"With thanks to Mr Walsh and the team, Rio was successfully operated on using the new equipment installed. Rio continues to be seen routinely by the team and I am confident if the problem were to occur again, Mr Walsh and the cardiac team will continue to provide exceptional care."  

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Seven year old boy survives a cardiac arrest, and is successfully treated with an emergency procedure at the Bristol Royal Hospital for Children

Rio Davies, aged seven, was on his way home from Disneyland Paris when he suffered an out of hospital cardiac arrest.

His mother, Marcelle Davies recalls the moment her son stopped breathing: "We were getting on the coach following a stop at a service station in France, on the way back from our holiday to Disneyland Paris. As we got back on the bus Rio complained of a belly ache and within moments of reaching our seats collapsed on the floor. His body was rigid and he started fitting so I turned him over and carried him off. It was following a second seizure that he then stopped breathing in the car park.

"It was by chance that a man who replenishes the first aid boxes at the services was there to give CPR. My friend was with me but I was advised to move away from him when paramedics came. It took three attempts with a defibrillator to get him back, after 10 minutes of not breathing."

Both Rio and Marcelle were taken to University Hospital Amiens in France, where they both received treatment.

"I had collapsed from shock at the thought of losing my son," says Marcelle. "An ambulance took me to the emergency department for treatment whilst Rio was taken by helicopter. Due to the language barrier, the staff didn't realise I was with Rio, but within an hour took me to ITU where he was being cared for."

Rio was diagnosed with a condition called Wolff-Parkinson-White (WPW) syndrome; a relatively common condition in children. This condition causes the heart to beat abnormally fast for periods of time, caused by an extra bit of muscle that connects the top and the bottom chambers of the heart. Rio had experienced a very rare complication from WPW; a cardiac arrest. At eight years of age patients are assessed to see whether they are at risk of this complication. However, Rio had not undergone diagnostic testing as he was only seven years of age at the time.

When Rio was stabilised he underwent a catheter ablation at University Hospital Amiens. The procedure involves clinicians placing small wires inside the heart and burning dangerous connections with electricity.

Marcelle explains: "Following the ablation the team had experienced some difficulties, but there was some initial success. I couldn't fault the care Rio had received in France, they did all they could but his condition did not improve so I requested we were transferred to England. They agreed to move him, so that I could get back to my other children and he could continue to receive care for his condition closer to home. A private plane was organised to fly us back to Bristol, with two doctors on board. He was transferred by ambulance to Bristol children's hospital where he was put into the care of the cardiac team.

"Mr Walsh carried out another cardiac ablation on the left side of Rio's heart, weeks following his cardiac arrest in France. We were in Bristol for four days before coming home to Merthyr Tydfil.

"Rio continued to live life normally, returning to school.  We returned to Bristol children's hospital in January of this year for a check-up, four months on from Rio's operation in August.  When asked how he was doing by Mr Walsh I responded positively, expressing that Rio was his usual energetic self.  Despite him making good progress, his ECG showed a change so Mr Walsh requested Rio stay in hospital to undergo a third ablation.  This time the team used a special three-Dimensional mapping system which has proven successful.  He was transferred back to the hospital ward straight after the procedure and discharged a couple of days later.

"It came as a surprise that Rio needed a third procedure but we were fortunate Mr Walsh picked this up, and as a precaution we now attend clinic every eight weeks.

"The care at Bristol children's hospital has been brilliant. I'm aware Rio may need another procedure if this was to come back, but I'm confident Mr Walsh and the cardiac team will continue to provide exceptional care for him."

Further information on Wolff-Parkinson-White (WPW) syndrome can be found here


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