B ut on August 2, an undiagnosed heart condition nearly cost Fohs his life. He awoke early that morning with his heart beating irregularly—a feeling he had never experienced before. “I didn’t know what was going on,” he recalls. “I decided I would try to take a shower and relax for a few minutes to see if that helped. Fifteen minutes went by and I still didn’t feel right, so I told my wife I was going to drive to the hospital and get checked out.” Grabbing his car keys for the two-mile drive to the hospital, Fohs made it as far as his front door before collapsing. His wife, Amanda, found him unresponsive on the floor, in cardiac arrest, and called 911. When the emergency medical service arrived, they performed CPR, shocked him with a defibrillator, and transported him to the Emergency Department at Robert Wood Johnson University Hospital (RWJ). It was there that Fohs’s EKG revealed a “pre-excitation” pattern, often called a WolffParkinson-White (WPW) pattern. This suggests that an individual has an extra electrical connection between the upper and lower chambers of the heart, says William J. Kostis, PhD, MD ’07, a cardiac electrophysiologist and assistant professor of medicine at Robert Wood Johnson Medical School. “This extra connection, or accessory pathway, may lead to abnormal heart rhythms and, in turn, to symptoms in patients with the so-called WPW syndrome,” Dr. Kostis explains. The WPW pattern is relatively uncommon, with only a couple of people per thousand having it, and the syndrome is even less common, he says. In Fohs’s case, he had an additional abnormal heart rhythm, paroxysmal atrial fibrillation (AF), in which the upper chambers of the heart have rapid, disorganized electrical activity. And while AF alone can mean an increased risk for stroke and a decline in the heart’s ability to effectively move blood through the body, it can have especially dire results in people like Fohs who have an accessory pathway, Dr. Kostis says. JAMIE MEILE PHOTOGRAPHY “If these individuals go into AF, the electrical signals may conduct rapidly through that accessory pathway, which can subsequently cause ventricular fibrillation [VF],” he explains. “In VF, the ventricles quiver in an uncoordinated pattern instead of contracting properly, which means blood is not being pumped from the heart. It’s a life-threatening condition that typically results in sudden cardiac death.” When testing revealed evidence that this had occurred with Fohs, RWJ specialists started him on medication to stabilize the condition and immediately took steps to prepare to rectify the issue. Within a few days, he was in RWJ’s Cardiac Catheterization Laboratory, where Dr. Kostis performed a catheter ablation. In this procedure, a series of thin, flexible tubes—known as catheters—is inserted into blood vessels and guided to the heart. Three-dimensional mapping techniques are used to find the precise location of the accessory pathway. A special machine then delivers energy— in this case, radiofrequency energy—through one of the catheters. This targeted energy creates a small scar in the heart tissue where the extra pathway is located, thus destroying it, explains Dr. Kostis. After recovering overnight in the hospital, Fohs was monitored for a few weeks using an ambulatory monitor to help ensure that the procedure had been successful and that there were no other signs the extra pathway had returned, Dr. Kostis says. “All in all, although it’s an uncommon condition to have, we were able to get the problem solved,” he adds. Fohs is pleased with the result, noting that he returned quickly to his normal activities and has been doing well. “After the procedure, I was sore for a few days, but it wasn’t anything significant. No real pain,” he says. “Overall it was a positive experience, and all of the doctors went out of their way to explain what had happened and the procedure that would be performed.” Regaining his active lifestyle has been important for this young father and former racing enthusiast. Although he’s JOHN O'BOYLE VISUALS 30 Robert Wood Johnson I MEDICINE