Stopping Preventable Sudden Cardiac Deaths
Xavier Hendrix and Rafe Maccarone played competitive high school sports in Brevard County.
Although they never met, and their athletic aspirations had different endings, the two shared more than competitive drive.
Each had serious heart defects that went undetected as children.
Sports activity can trigger sudden cardiac arrest in some young athletes with underlying heart problems. Families often don’t know their children have those problems despite physical exams.
“A lot of these athletic physicals whether high school, youth league or colleges are a little superficial,” said Drew Watson, director of athletics at Southeastern University, which began providing EKGs for its athletes in fall 2017.
That decision may have saved Hendrix’s life.
Hendrix had two goals when he came to SEU in 2017:
Earn a college degree.
Play football for the Fire.
The electrocardiogram he got there changed that second goal.
It disclosed an extra electrical pathway between the upper and lower chambers of his heart, a condition called Wolff-Parkinson-White syndrome. That extra pathway can cause rapid heartbeat or worse.
The exertion of competitive sports sends a high level of adrenaline circulating through the body. That’s the danger for young athletes with Wolff-Parkinson-White, said Dr. William Miles, adult electrophysiologist and program director of clinical cardiac electrophysiology at the University of Florida College of Medicine.
Increased adrenaline and that extra electrical pathway can lead to ventricular tachycardia, a rhythm disturbance in which the heart beats dangerously fast. Sudden cardiac death can occur.
Symptoms of WPW syndrome include shortness of breath, heart palpitations, dizziness, fainting and fatigue.
Xavier Hendrix hadn’t experienced any of them. The diagnosis came as a shock.
“I didn’t really believe it,” said Hendrix, who turned 20 in November.
“I thought they must have mixed me up with someone else.”
He played football from the time he was 6 and never had symptoms, said his mother, Marianne Hendrix.
Who We Play For
Marianne Hendrix praised Southeastern for working with a nonprofit organization, Who We Play For, to provide EKGs for its athletes.
“We thank God every day for Southeastern and Who We Play For,” she said. “They ran the heart test. Otherwise, he could have been a statistic.”
Who We Play For was created in honor of Maccarone, the other Brevard student.
Maccarone never made it to college.
He went into sudden cardiac arrest on a soccer field and died Dec. 1, 2007, at the age of 15. Later, it was discovered he apparently had hypertrophic cardiomyopathy, which causes thickening of the heart muscle.
Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in student athletes, Miles said.
Maccarone’s death inspired friends and former teammates, many of whom went to Florida State University, to hold regular fundraisers, donate automated external defibrillators and establish Who We Play For.
WWPF, begun in Tallahassee, promotes and provides low-cost electrocardiograms to student athletes. Volunteer physicians read and interpret the EKG results.
Its goal is to eliminate preventable sudden cardiac death in young people through affordable heart screenings. There have been at least 90 lives saved and 113,586 hearts screened, its website said in mid-December.
An SEU video, “Xavier’s Story,” is on that website, www.whoweplayfor.org.
The organization also does EKGs for Webber International University in East Polk. It began with Webber before Southeastern and spotted abnormalities in several Webber athletes, said Evan Ernst, executive director and one of the founders.
Who We Play For contacted Jem Sirrine, an SEU athletic trainer, in early 2017. Watson wasn’t sure they could afford screening that year until, in June 2017, he encountered Ernst at an athletic directors’ conference.
“It’s different when you hear someone directly affected, when his friend dies or collapses in the middle of something that’s supposed to be fun,” Watson said.
“I thought ‘We’re going to find a way to do this.’”
They did. Just in time for Xavier.
Xavier’s resistant pathway
Ablation (destruction) of the extra electrical pathway, done by an electrophysiologist, is typical treatment to resolve Wolff-Parkinson-White syndrome. Xavier Hendrix’s turned out to be more challenging than usual.
After a first attempt at ablation, done locally, didn’t destroy the pathway in October 2017, he was referred to Miles.
“This was a tough ablation in a very tough spot,” Miles said. “We had to do it twice.”
The extra “short circuit, the accessory pathway” was traveling up veins behind the heart on the outside surface.
The pathway was close to his coronary arteries and burning them with radio frequency could have caused a small heart attack, Miles said.
Because of that, cryoablation — freezing the pathway — was used in Hendrix’s first procedure at UF in the spring. That method was safer, in view of the pathway’s location, but it isn’t as durable, Miles said.
Sure enough, the pathway reappeared the next morning.
The third attempt to destroy his extra electrical pathway took place during Thanksgiving break.
“We had to ablate him very carefully with low energy-radiofrequency ... to destroy it but not destroy the coronary arteries,” Miles said.
His breathing was stopped 15 seconds to 20 seconds to keep him motionless while energy was delivered.
This time, the pathway didn’t reappear.
Should screening be universal?
Xavier Hendrix hasn’t returned to the football field. He’s working on a pre-med degree and interested in becoming a heart doctor.
He and his mother have become avid supporters of EKG screening for student athletes and public speakers for Who We Play For.
“Every athletic department, in my opinion, should be doing this,” Southeastern’s Watson said.
Miles said he and most cardiologists consider EKG screening of athletes useful, although some controversy surrounds it.
There are concerns, for example, about test results showing variations that aren’t dangerous but may get used to keep students from playing.
The heart enlargement developed in some well-trained athletes isn’t the same as the thickening from hypertrophic cardiomyopathy, Miles said, mentioning that UF screens with both EKGs and echocardiograms for better diagnoses.
“EKGs have to be looked at by someone expert in athletes, athletics and EKGs,” Miles said.
The American Heart Association and American College of Cardiology haven’t recommended routine EKG screening, he said, but they have suggestions regarding screening if it’s done.
Story Credit: https://www.theledger.com/news/20190107/stopping-preventable-sudden-cardiac-deaths
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