Story by: Joe Hall on January 3, 2024
Submit request or call to make an appointment.
Aubrie Chandler loves volleyball. A hitter on her championship team last year, Aubrie, 12, has always wanted to play as the libero, a defensive player in the back row who receives lots of spikes and hard-hit balls.
Due to a heart condition and having an abdominal pacemaker, Aubrie has refrained from playing her favorite position for risk of a hard hit to her abdomen and damaging the pacemaker system. But thanks to a new type of device, Aubrie is now able to play her favorite sport — and others — without restrictions.
At 15 months old, Aubrie was diagnosed with congenital complete atrioventricular block. The condition happens when there is an interruption in electrical communication between the top and bottom chambers of the heart, and electrical impulses originating in the top chamber fail to make it to the bottom chamber. This often leads to a significantly slow heart rate which may be life-altering or even life-threatening in some cases, and all patients ultimately require a permanent pacemaker.
Aubrie’s mom, Derby, recalled the diagnosis.
“We were at a restaurant, and Aubrie broke out into a rash and fever, then her heart rate dropped,” Derby said. “I couldn’t believe it was happening.”
Aubrie was transported to Norton Children’s Hospital for emergency surgery. Christopher L. Johnsrude, M.D., and the team at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, installed a pacemaker to help Aubrie’s heart communicate and function. However, given her age and small size, this required open-chest surgery to implant the system, which is quite different than the more traditional location for adults, which is in the upper chest.
“Without her pacemaker, Aubrie’s heart rate would be dangerously low,” Dr. Johnsrude said.
Young children with complete AV block require a pacemaker for the rest of their lives. The device helped Aubrie’s heart but had a few downsides. First, the procedure to install the pacemaker required opening her chest to implant leads on the outside of the heart, connected to a pacemaker generator implanted in the abdomen. Second, because the pacemaker generator was placed in the abdomen, it was more easily exposed to external bumping and significant trauma when being active and playful. Therefore, Aubrie had to be cautious while playing contact sports to reduce the risk of damaging the pacemaker.
“She’s felt restricted,” Derby said. “There were things she wanted to do as a normal kid that were just too risky.”
“It made me feel different because I couldn’t do what most of my friends were doing,” Aubrie said. “There were times I hated life and having my heart issue.”
The battery life of a pacemaker may vary from five to 10 years, depending on the type of pacemaker and the electrical characteristics of the wires attached to the heart. Aubrie’s first abdominal pacemaker battery had to be replaced in 2017. In late 2023, she was due for another replacement.
When children with AV block grow to near-adult size, different types of pacemaker upgrades might be a better idea rather than simply using the original leads implanted in infancy. Dr. Johnsrude and Soham Dasgupta, M.D., cardiologist with Norton Children’s Heart Institute, discussed various options. That’s when Derby learned about the Medtronic Micra, a relatively newer type of pacemaker.
The Micra contains the generator and pacing leads all in one small package, the size of a quarter. The device eliminates the need for additional wires and is implanted inside the heart so there are no components near the body surface where they could be more easily damaged. In addition, the procedure to install the system is minimally invasive, since it can be inserted into the heart through a catheter placed in a vein in one leg. No chest incision is needed, which means the recovery period is shorter.
Cardiologists at Norton Heart & Vascular Institute have implanted many Micra devices in adults, but when Aubrie got hers, no child in Kentucky had received the device.
“We thought this could improve Aubrie’s quality of life,” Derby said. “She wouldn’t have to worry about damaging the device while being active.”
After pre-testing and several consultations, Dr. Johnsrude approved Aubrie for the device.
“We determined Aubrie would be a good candidate,” Dr. Johnsrude said. “Based on how active Aubrie is, we believed this approach would enhance her quality of life.”
In early December, Dr. Dasgupta implanted the device through a vein in Aubrie’s leg. The procedure took about an hour, and Aubrie was up and walking that night.
“Because we don’t have to make any large incision to implant the device, the recovery is a lot quicker and less painful,” Dr. Dasgupta said. “Patients also are less likely to develop complications than they might with other, more standard pacemakers.”
After a month of recovery, Aubrie is getting back into volleyball and plans to give libero a try. She may also explore other sports she couldn’t play before getting her new device.
“This is such a great option for active kids,” Derby said. “It’s going to change her lifestyle dramatically for the better.”
Another benefit is that the battery life of a Micra is about 15 years, so it should require fewer procedures over Aubrie’s lifetime. When that time comes, a new device can be inserted into the heart without having to remove the old one.
In the meantime, Aubrie is looking forward to a more active life. “I’m so grateful for the care I’ve gotten,” she said. “Now I can go and do everything.”