When a pacemaker doesn’t keep pace

Modern medicine is full of life saving technology, like pacemakers, which help patients live normal lives after experiencing heart failure. These devices normally last throughout a person’s lifetime but in rare cases they can unexpectedly fail. In those instances, time is critical. When Jack Kitchen’s pacemaker began to fail, he was almost 60 miles away from a doctor who could help him. Quick thinking, coordination and even faster actions from Jack’s care team got him the care he needed in time to save his life. “I was at the Hot Springs VA and I got sick. I didn’t think I was that sick, but the VA called the Rapid City heart doctors and they wanted me in Rapid City fast.”

Jack did get there fast. An ambulance transported him to Monument Health Rapid City Hospital from Hot Springs in under 45 minutes. Kelly Brandsted, CNP, and Samantha Speed, DNP, at the Monument Health Heart and Vascular Institute, were on the team that treated Jack. Kelly received the call from the VA Hospital in Hot Springs. She said, “They called and said Jack was experiencing episodes of lightheadedness and dizziness. They thought he was having pauses on his heart telemetry.” Pauses on heart telemetry sounded unusual because Jack had a pacemaker. Kelly asked to see the telemetry and it confirmed that his pacemaker wasn’t working. They needed to see him right away, and the team was ready when he arrived. “We were pretty much at the door to greet him when he arrived. This was at the end of the day too. I called Dr. Barbera back in when Jack was on his way, and kudos to the electrophysiology (EP) lab, they stayed to help get everything ready.”

Saverio Barbera, M.D., is a Cardiac Electrophysiologist at Monument Health Heart and Vascular Institute in Rapid City. He was quick to get Jack into the operating room. Dr. Barbera said, “The emergency room wasn’t going to be able to do much at this point, so we fast-tracked him. He was blacking out periodically right in front of us and we wanted to take over the pacing of his heart as soon as possible. He continued, “We knew what we had to do. We got him prepped, cleaned his chest as fast as we could, and gave him a local anesthetic. He was wide awake; he could tell what we were doing. He knew his life was in danger and worked with us so we could save him. It was about five minutes of hell for all of us.” The rush was not lost on Jack, who noticed how quickly everything was moving. “They got me right into the surgery room. I asked, ‘What’s the big hurry?’” Jack maintained a sense of humor throughout the ordeal. Jack said, “I told the doctor to ‘just put on a glove and pull that sumbitch out,’ and he did it. He got it done.”

According to Samantha things moved very quickly. She said, “By the time we got him to the lab he was blacking out every 8 to 12 seconds. We had to get his new device in as quickly as we could. The time from the EP labs to getting his new device in was around ten minutes, it was really fast.” Dr. Barbera agreed with that, but said time seemed to move slowly. “It takes about seven seconds or so to lose consciousness when there is no pulse, and every time we saw a flat line on that screen we knew we had to move. Every second seemed like ten minutes at that point. We were moving as fast as we could, but it feels like you never have enough time when you’re rushing to save someone’s life.”

The operation was a success. As soon as they were finished, Dr. Barbera said the improvement in Jack’s condition was like night and day. “It was amazing. It was like the lights had been intermittently flickering and now they were back on, and everything was fine.” Kelly agreed and was glad to see Jack recovering and more like the patient they had come to know. “Jack is always joking and laughing, so seeing him like this was scary and awful. It was a huge relief to see him being his normal self.” Jack was released that weekend and said he was quickly able to go back to his normal life “After I got out, I went down to the Dairy Queen, got a hamburger and fries and strawberry malt and drove home.” He said the care didn’t stop after he was released, “They called me when I got home and made sure I was okay and helped get my monitor setup.” He keeps a close eye on his monitor now and hasn’t had any problems with his new pacemaker.