Saving Sammi

When a rare heart condition debilitated registered nurse and active young mother, Sammi Wetch, to the point of despair, Monument Health Heart and Vascular Institute in Rapid City implemented a cutting-edge care plan. Two years after a groundbreaking procedure where two cardiology surgeons worked in tandem to restore a more normal rhythm for her heart, Sammi knows her trust in her cardiac care team has realized powerful dividends for herself and her family.

Beginning in 2017 through sometime in 2023, the Wetch family was in survival mode. Sammi, mother of two with a full-time nursing career, was constantly exhausted. She could barely get up and get ready in the morning. She felt lightheaded and dizzy frequently. She avoided stairs and any extra physical activity. Eventually she began to avoid just about everything outside of the absolute bare minimum in her day-to-day life. Her heart was constantly beating fast. Something was wrong with her heart and she and her husband Rich knew it.

“I couldn’t keep up with my kids,” Sammi said. “I felt like I couldn’t function like a healthy person in their 30’s should be able to do. I didn’t understand why I was so tired all the time.”

Sammi was referred by her primary care physician to the Heart and Vascular Institute (HVI), where an extensive evaluative process led to a diagnosis of inappropriate sinus tachycardia (IST). Many patients with IST have success managing their arrhythmia with lifestyle changes and medication, but Sammi’s case was particularly difficult to treat. Despite being younger than many IST patients and otherwise healthy, she did not respond to a medication approach and continued to have severe symptoms that degraded her quality of life. While the average heart rate for adult women is 78-82 beats per minute, Sammi had been living in the 130-160 range. At work one day feeling awful, she even recorded a range in the 190s prior to seeking medical attention.

Cardiac Electrophysiologist Ethan Levine, D.O., FHRS, is no stranger to arrhythmia problems. Dr. Levine and his colleagues at HVI have built one of the busiest and most esteemed atrial fibrillation (AFib) clinics in the nation, and he set out to treat Sammi by first discovering where in her heart the inappropriate rhythm was coming from.

“Her case was concerning because her symptoms had been going on for a while and her other health markers were good,” Dr. Levine said. “With IST the group of cells which govern heart rate are overactive and it makes everything you do feel like running a marathon. It can be very frustrating for patients because they can’t do anything, so they continue to get more de-conditioned and depressed, and these things compound.”

Unfortunately for Sammi, discovery of the location of her triggers put her IST case on the severe end of the spectrum. Some of her problems were with the sinus node of the atrium, which is often referred to as the heart’s natural pacemaker. Potential complications of performing an ablation—a procedure that affects abnormal heart tissue that causes arrhythmias—to Sammi’s sinus node could mean she might need a pacemaker for the duration of her life. At her young age, that was an outcome she and Dr. Levine were hoping to avoid. Sammi and Rich had long been scared about everything and were getting desperate for something to help.

Convergent: A New Hope

“Dr. Levine said he had heard of a new procedure that could maybe work for me, and if I could hold off, he could possibly arrange for it to happen,” Sammi said. “He said, ‘Let me talk to Dr. Mungara. Let’s see what we can do for you.’”

Dr. Levine was referring to a new approach where an electrophysiologist and a cardiothoracic surgeon would work in tandem to perform a hybrid thoracoscopic ablation in one procedure, rather than mapping the heart and then treating with ablation in separate procedures 30 days or more apart. A European firm, AtriCure, had recently completed a trial which aimed to demonstrate safety of the Hybrid Convergent procedure for the treatment of symptomatic persistent and long-standing persistent AFib caused by IST. After consulting with Charan Mungara, M.D., a Cardiothoracic Surgeon at Monument Health, Dr. Levine and the HVI team began the process of arranging the case. One major hurdle was moving the Electrophysiology (EP) lab from its normal home in Rapid City Hospital into an operating room large enough to accommodate the considerable technical footprint needed for the surgery. Planning and executing this move from a logistical and infrastructural standpoint meant it took several months to come together.

“Moving all the mapping systems and the entire EP lab into the operating room and doing this case collaboratively with Dr. Levine was very rewarding,” Dr. Mungara said. “It was a very highly complex operation that has never been done in this institution, and it took true collaboration of the EP and the surgical teams to be able to do it.”

Eventually the EP lab was moved and AtriCure brought a team over from Belgium to consult on the case. It was one of the first such cases to be performed in the United States. While all this was happening, from the time planning began to the day of the surgery, Sammi had to wait nine long months. During this time her general condition continued to deteriorate and her resolve was tested, but Sammi believed in her HVI team’s commitment to making sure her case could be done right.

“There was a lot going on behind the scenes; probably more than I knew,” Sammi said. “But in the meantime, in those nine months, I just kept getting worse. I had to knock down my hours at work. I had nothing to give and I had to be so strategic about everything I did. Dr. Levine and Dr. Mungara were committed to helping me, and I believed in both of them and trusted both of them so fiercely that I was willing to wait until we could get it done here. I wanted the two of them to be the ones to do it.”

Using the relatively new OCTARAY™ Mapping Catheter  device, of which Monument Health was the first hospital in South Dakota to have, Dr. Levine mapped the patient’s heart to create a three-dimensional electron atomic map, a computer model of the heart that plots the electrical signal in tens of thousands of places throughout the chambers of the heart.

“It’s kind of like a GPS, and after we get that model made we project it on a screen and then we can turn to the surgeons and say, ‘That’s where we want to be.’ It’s like taking your EKG from 5,000 different spots,” Dr. Levine said.

That is when Dr. Mungara and his team took the reins of the procedure. Dr. Mungara used catheters to reach the heart with a camera and his tools for performing acute actions to affect the sinus nerve. Once Dr. Mungara’s work was complete, Dr. Levine resumed mapping and recording rhythms, which would inform the team of immediate results.

“I think it’s truly a testament to Monument Health as an organization and to Sammi and her family’s trust for us to do this and take excellent care of her,” Dr. Mungara said. “I think it’s a milestone in HVI’s history. Better rhythm means a better life. Dr. Levine lives and breathes helping patients with their heart rhythms, so it’s a privilege to collaborate with him.”

Following acute recovery, Sammi still had a long road of physical therapy to regain a healthy lifestyle. Her body had been so used to operating with an elevated heart rate, it took some adjusting to her new normal.

“We realized very quickly that I was going to need a lot of rehab afterwards, because I lived like that for so long,” Sammi said. “I was not able to exercise, was not able to go out and enjoy life in any capacity, really, so we had to slowly build my stamina back up again and get me to a good point.”

Advanced Practice Provider Jason Nies, working with Dr. Mungara, helped Sammi with a recovery plan that was carried out by Orthopedic & Specialty Hospital Outpatient Physical Therapist Codi Grable, PT, CLT, as they did PT three times a week for nearly nine months.

“Codi was incredible. We started very slowly. She just built me back up to where I was running a mile on a treadmill and feeling amazing,” Sammi said. “I don’t think I had run a mile since I was 16 years old. It was a total high for me to feel, ‘This is what normal people feel like. This is what a normal 35 year old should feel like.’”

The successful convergent procedure was a huge win for Sammi in her journey with IST, but managing symptoms remains a persistent presence in her life. She was able to abstain from heart medications for nearly a year, but now she’s back on some meds. Because the procedure she received is on the bleeding edge of cardiac knowledge and technology, advancements to how it’s now done have happened even in the two years since.

“There are some spots they are ablating now that Dr. Levine and I discussed going back into the EP lab and touching up,” she said.

Out of the Darkness

There are a lot of good days in the Wetch house these days. Sammi’s improved condition has been a rising tide that has lifted all ships in their lives. Their gratitude for her care is rooted in some somber and lonely times when IST was a dark cloud over their lives. Are things perfect now? Certainly not, and Sammi still struggles to manage IST, but the difference since the surgery has been marked.

“There was a lot of emptiness; nights where you’re sitting at home wondering what tomorrow would bring,” Rich said. “Are we going to be better? Are we going to be worse? Are we going to be an inpatient in the hospital?”

Rich and Sammi have been married 18 years, but he says sometimes it feels like 13 because “we nearly lost her there for those years she was so sick.” They both admit that mental health struggles and guilt were factors during their journey to find a medical solution that helped her.

“This procedure put a whole new perspective on her life, where she’s able to do what she’s able to do today, and it’s just been a godsend,” Rich said. “Being here in Rapid City for Sammi’s care was our priority and they paid that off by moving mountains; all for her.”

Two years since the groundbreaking surgery, Sammi is grateful that her trust in the process and her care team finally led to a remediation of her suffering.

“Now we know we have the best care in the world right here (at Monument Health),” she said. “You don’t have to go anywhere else, and I will stand by that from personal experience for the rest of my life.”

Story and Photos: Bob Slocum