Thirteen-year-old Macy Roberts was going to lunch with her mom, Molly, when she became dizzy and complained about tightening chest pains. 

They were visiting Indianapolis, where her traveling softball team had just won a big tournament game. Macy thought it was just adrenaline. But it was actually her heart. 

“I was crying a lot because of how bad it hurt,” said Macy. “It felt like it was compressing my chest.”  

Immediately, Molly drove her daughter to the nearest urgent care / emergency room. There, they registered Macy’s heartbeat at 237 beats per minute (bpm), far higher than the normal heartbeat rate of 60 to 100 bpm for adolescents in Macy’s age range (between 12 and 18 years old).

“They thought at first maybe it was a heart attack,” said Molly. 

Thankfully it was not a heart attack. But Macy did require three rounds of medication to reduce her rapid heart rate before she could leave the ER and return home to Owensboro, Kentucky.

Finding “One of the Best in the Nation” at Cincinnati Children’s

Unsure where to take Macy for further evaluation and treatment, her father, Gavin, sought advice from a close friend, a cardiologist in Owensboro, who recommended the family travel to Cincinnati Children’s. 

“Our friend said if it were his child, he would go to Cincinnati Children’s,” said Molly. “He described it as ‘one of the best in the nation.’ We didn’t need convincing. We knew we would take her there to get the best possible care.” 

But as it turned out, they didn’t need to travel to Cincinnati to receive Cincinnati Children’s expert heart care.  

It began with a phone call to pediatric cardiologist Bradley B. Keller, MD., who set up an appointment for them at Cincinnati Children’s Elizabethtown, Kentucky location. During the call, he prescribed a medication to reduce the frequency and duration of Macy’s rapid heart rate episodes. 

A week later, they drove to nearby Elizabethtown and met with Keller, the medical director of Cincinnati Children’s Heart Institute – Greater Louisville and Western Kentucky practices. 

“We were really excited not to have to drive three and a half or four hours to see Dr. Keller [in Cincinnati],” said Molly. 

Keller splits his time in Kentucky, seeing patients in Louisville, Elizabethtown, Bardstown, Ashland and now Owensboro. The practice also offers locations in La Grange, Shelbyville and Danville, Kentucky and Madison, Indiana. 

It’s very convenient, Molly adds. “I can text Dr. Keller, and he responds in minutes. I’ve never had access to a doctor like that before. It just makes everything so much better.” 

The Cause of Macy’s Rapid Heart Rate: An Extra Conducting Pathway

During the initial appointment in September 2020, Keller used electrocardiogram (ECG) and echocardiogram tests to confirm Macy’s first episode as supraventricular tachycardia. With this condition, the heart suddenly beats much faster than usual. 

“I then used a diagram to discuss the typical causes of rapid heart rate in children [with the family]. In Macy’s case, her ECG suggested an extra conducting pathway that allowed electrical activity to travel in rapid circles within the heart,” said Keller. 

Extra conducting pathways are present as the normal heart develops, but they usually disappear before birth, explained Keller. But for Macy, the extra electrical pathway remained, causing accelerated heartbeats. It led to her dizzy spell, a trip to urgent care and the potential for greater risks if left untreated.   

Keller recommended a cardiac catheterization procedure to shut down the pathway. He referred the family to pediatric cardiologist Tim Knilans, MD, director of the Congenital Arrhythmia Service, for consultation and cardiac mapping and ablation. 

Explaining and Performing the Cardiac Mapping and Ablation Procedure

During a telehealth consultation, Knilans set a date for and explained the cardiac mapping and ablation procedure in detail to Macy and her family. Together they discussed when the family could expect updates and the typical timeline – so they could anticipate how the day of the procedure would go.

Usually, the procedure would take three to four hours. However, Macy’s case was more complex and took nearly nine hours. Knilans and the team used cryothermal ablation to kill the tissue by “frostbite.” But they needed multiple access points (first in her leg and eventually through the neck vein) to shut down the pathway completely and finalize the procedure. 

“I know the last thing any patient or family wants to do is go through the process again,” said Knilans. “So, I will persist until we are successful or to a point where, in my judgment, continuing with the procedure poses an increased risk to the patient.” 

And Knilans’ judgment and experience serve him well. He began doing cardiac mapping and ablations over 30 years ago. 

“Technology has advanced so much to improve the precision of the procedure, and decades of experience has taught us different approaches that we can use for the more difficult and complex cases – as we did in Macy’s case,” said Knilans. 

Macy Returns to the Field Following Successful Procedure

Other than some migraine-like symptoms days and weeks after the procedure, Macy recovered comfortably but sat on the sidelines for two months. 

When given the go-ahead from doctors, Macy slowly resumed her regular workout routine in preparation for her return to the softball field. 

“It was like starting from the beginning again,” said Macy.

She lifted weights, did squats and practiced her hitting and running. She wanted to get back to the field and her teammates. But first, Macy had to admit the experience had a traumatic effect on her. 

She was not traumatized by the fear of having another episode of rapid heart rate. The Cincinnati Children’s team explained what signs to watch out for and what triggers to avoid. Instead, Macy had to overcome the trauma of being far away from most of her family when it occurred.  

“When I was playing out of town and not close to my family, I didn’t know if I was safe,” said Macy. “But when I’m playing closer to home, it’s different. I feel like I’m more able to do stuff.” 

And for Molly and Gavin, they feel better knowing the experts at Cincinnati Children’s aren’t far away either. Cincinnati Children’s and Kentucky Children’s Hospital have since collaborated with Owensboro Health to make advanced heart care more accessible as part of the Joint Heart Program. This collaboration allows Macy, and other heart patients like her, to see Keller and the Cincinnati Children’s team in her own town. Three cardiologists from the Joint Heart Program are now seeing patients once a week at the Owensboro Health Pleasant Valley Medical Office Building, saving local patients countless hours of travel time.

Cincinnati Children’s offers outpatient heart care in more than 25 locations throughout Kentucky, Ohio and Indiana. They also created the Joint Heart Program in conjunction with Kentucky Children’s Hospital in 2017 to provide world-class access to heart care, even closer to home.

(Published December 2021)