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On Sept. 8, 2017, Candice Pesotini passed out in her home. Without prior intervention by Lehigh Valley Health Network’s (LVHN) Heart and Pregnancy Program, the mother of four may not have seen Sept. 9.
“My fiancé would have come home and found me dead,” says Pesotini, of East Stroudsburg, who was born with long QT syndrome, a congenital heart rhythm condition that can cause rapid, chaotic heartbeats. The condition became particularly concerning during her 2017 pregnancy. At 20 weeks, her obstetrician referred her to an LVHN program that is unique to the region.
Heart and pregnancy care
“We meet with patients and discuss options, using our nine years of program experience, to form a prenatal and postpartum care plan that’s best for mother and baby,” says maternal fetal medicine specialist Joanne Quinones, MD, with LVPG Maternal Fetal Medicine, who manages the Heart and Pregnancy Program with Lehigh Valley Heart and Vascular Institute cardiologist Amy Ahnert, MD.
The specialists quickly realized Pesotini needed intervention. Her pacemaker, implanted at age 14, wouldn’t address their concerns. They recommended an automated implant- able cardioverter defibrillator (AICD), a device that sends shocks to correct heart-threatening arrhythmias.
“It’s rare to have such a procedure during pregnancy,” Ahnert says. “But Candice’s EKG (electrocardiogram) showed a clear danger of a heart-threatening episode.”
Lifesaving device implant
They enlisted electrophysiologist Talha Nazir, MD, with LVPG Cardiology, for the procedure. Traditionally an AICD is implanted below the collarbone and connected to wires filtered through the veins to the heart, guided by X-ray. To avoid putting the fetus at risk from X-ray, Nazir opted for a recently developed procedure where the AICD is implanted below the armpit and attached to an electrode that’s run along the breastbone.
“It’s the first time the procedure was performed at LVHN,” Nazir says.
AICD goes into action
A month after Maverick Shay’s birth, he was home alone with his mother when she passed out. The AICD shocked her heart, she regained consciousness and called 911. She received seven more shocks while hospitalized, but quickly recovered. Maverick has inherited his mother’s long QT syndrome, as have sister Madison Lanfrank, 15, and brothers Kaleb Pesotini, 7, and Parker Shay, 4.
“There’s a lot we don’t know about this syndrome, such as why Candice experienced no problems during her earlier pregnancies,” Ahnert says. “But today she’s leading a normal, healthy life. That’s the ideal outcome.”