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Strange anatomy

Rare heart structure presents challenge during pacemaker surgery.

Article Author: Kristi Tucker

Article Date:

photo of wife and husband, Susan and Jim Taylor, sitting together in a restaurant, smiling
Susan and Jim Taylor.

"Not everyone is born with the anatomy seen in textbooks."

That's how Matthew McKillop, MD, medical director of the Electrophysiology Program with Baptist Heart Specialists, describes the challenge he faced when Jim Taylor, 74, came to Baptist Health to get an upgrade for his pacemaker.

A pacemaker uses electrodes (leads) to generate electrical impulses that cause the heart chambers to contract and pump blood. It replaces and/or regulates the system that controls the heartbeat.

Taylor, a Jacksonville-based retired truck driver, sought help after his pacemaker and defibrillator began failing. He was falling a lot due to lightheadedness caused by his arrhythmia, and his defibrillator was shocking him more often because his heart was going out of rhythm. Doctors determined that a third lead (as opposed to two) would help his heart function as it should.

Unfortunately, two attempts to implant the additional lead failed because Taylor's heart had an anatomic rarity. The coronary sinus (CS) is a group of veins forming a large vessel that collects blood from the heart muscle and delivers less-oxygenated blood to the right atrium. In Taylor's case, a CS abnormality was preventing easy access from the right atrium.

Dr. McKillop told Taylor and his wife, Susan, he had another option.

Friends in high places

Dr. McKillop had two secret weapons: experience (he co-authored a paper that addressed this rare anomaly), and a collaborative friendship with Seth Worley, MD, an electrophysiologist at a Washington, D.C., health care system. Dr. Worley is a pioneer in the study of this issue who has spent his career developing and fine-tuning the catheter system and wires that deliver the lead to the heart. He agreed to consult during the procedure.

'A ticking time bomb'

After Taylor's defibrillator shocked him seven times during a camping trip with his wife, he asked Dr. McKillop to do the surgery sooner rather than later.

Taylor remembered, "It felt like a mule kicking me in the chest. I didn't want that anymore. I needed that third lead."

His wife added, "He was a ticking time bomb. We were in a much more urgent situation."

With Dr. McKillop leading and Dr. Worley consulting, as well as three doctors observing and a video crew filming for teaching purposes, the procedure was successfully completed by the Baptist Heart Hospital team.

Back on the road

Today, the Taylors are back to doing the things they love: riding their motorcycle, camping and spending time with their adult children, grandchild and dog.

"Jim is a walking testament to what Baptist Health can do," said Susan Taylor. "They were so responsive to our urgent need."

Jim Taylor agreed, simply saying, "Baptist has the best doctors."

Dr. McKillop replied, "His anatomical variation was configured in a way that most implanting physicians would not or could not attempt lead placement. Fortunately, we had the skill, knowledge and equipment to make it possible."

Baptist Health has a team of medical caregivers specializing in the diagnosis and treatment of all heart rhythm disorders. To learn more about Baptist Heart Specialists, click here or call 904.720.0799.

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