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Putting His Heart Into Life Jowyn Alapai , 17, is a big kid with a big heart, but it was just about broken when he learned he would have to leave the Damien High School football team. The problem was that the high school senior’s heart was beating too fast. He was born with a condition known as Wolff-Parkinson-White syndrome (WPW). WPW causes the heart to beat rapidly because of abnormal, extra electrical pathways between the heart’s upper and lower chambers. Jowyn’s heart was fine until he turned 15, which is when he began experiencing the symptoms of WPW. Like many boys his age, Jowyn had a full plate of extracurricular activities. So his first response was to keep quiet about it. Speaking up “One day, a couple years ago, he finally told me he was feeling sick,” says Jowyn’s mother, Jorene. “We were sitting on the porch, and I said, ‘What do you mean you’re feeling sick?’ He said, ‘I feel like my heart is racing — beating really fast — and I feel dizzy. Then sometimes, for a couple of seconds, things go black.’” For about the past four months, he told his mother, he had been experiencing these symptoms. He then confessed that when playing football and making contact with other players, he would sometimes have to leave the field and rest. “He told me the same thing was happening in his classes,” she adds. “He said he would just be sitting there and suddenly have to hang onto a friend or lean against the wall. When my son mentioned his heart, I got scared.” The next day, Jorene set up an appointment with the pediatrician. When electrocardiogram results revealed an abnormal heart rhythm, pediatric cardiologist James Sim, M.D., ordered further tests, including a Holter monitor to measure how often the episodes were occurring. Because the monitor tracks a person’s regular daily activities for 24 hours, it is much more likely to detect an abnormality compared with an electrocardiogram, which monitors less than a minute of heart activity. Weighing his options For several months after his diagnosis, Jowyn and the Alapai family weighed the consequences of having Jowyn’s condition corrected. He had never wanted to use his heart problem as an excuse to miss out on school activities. He played baseball and football, and he also played tuba in Damien High School’s marching band. When one of his dizzy spells caused him to fall to the ground on the pitching mound, Jowyn was forced to give up his positions at first base and as a pitcher. While he was limited to the role of designated hitter, he still managed to shine and was an ILH All-Star in 2006. “The doctors were monitoring Jowyn and taught him what to do when he felt an episode coming on,” says his mother. “He had to bear down and stop whatever he was doing; he could not exert himself. His attacks would occur if he got worked up about something. One time, another student made their teacher cry, and Jowyn got upset and found himself gasping for air, unable to breathe. “Then the episodes started coming more often, and he began to black out. The first time he completely blacked out, he was walking in the hallway at home. Next thing I knew, I saw him bobble and slide right down to the ground. Another time, he went to take a shower, and we heard him fall in the bathroom. We took him to the emergency room. That’s when the doctor said he couldn’t play football anymore,” recalls his mother. Dr. Sim advised the family that the blackouts could become life-threatening if they continued. Taking action Thankfully, electrophysiologist George Van Hare, M.D., of Stanford had earlier joined Kapi‘olani’s Pediatric Cardiac team for Heart Week (see sidebar). An electro-physiologist is a heart rhythm specialist. Dr. Sim referred Jowyn to Dr. Van Hare for a consultation, and he recommended that Jowyn undergo a nonsurgical procedure, known as electrophysiologic study and radiofrequency ablation, to tame his rapid heartbeat. It is a minimally invasive procedure that calls for threading thin, flexible tubes, known as catheters, through the patient’s blood vessels to reach the abnormal heart tissue. The doctor then uses the heat of radiofrequency energy to burn the unwanted tissue and restore the heart to its normal rhythm. When Dr. Van Hare learned of Jowyn’s blackouts, he insisted that they perform the procedure right away. Last November, the night before Dr. Van Hare performed a catheter ablation, Jowyn marched with his fellow band members at the Rainbow Classic at Aloha Stadium. He had an attack during the show, but he continued on and finished because, he said, it was the last show of his senior year. Getting back in the game In the months since the corrective procedure, Jowyn’s heart has returned to a normal rhythm. Although it is uncertain whether the arrhythmia will recur, the success rate of ablations performed by experienced programs, like the Pediatric Cardiac Program at Kapi‘olani Medical Center for Women & Children, approaches 98 percent. “This procedure has allowed him to return to his normal activities. I encourage kids like Jowyn to play sports and be active. They know their own bodies and know when to stop,” says Dr. Sim. Jowyn has resumed his activities; he is trying out for baseball and already has made the soccer team. Although he’s never played soccer before, he successfully stopped three goals in one of his first games. He also is looking forward to playing the tuba again. An all-state band is going to Europe this summer, and Jowyn doesn’t want to miss a beat. Kapi‘olani Pediatric Cardiac Program Jowyn was able to take advantage of the Pediatric Cardiac Program at Kapi‘olani Medical Center for Women & Children, which was founded in 1995 to treat children with heart disease. Before the program began, families had to travel to the Mainland for treatment. Today Kapi‘olani, in partnership with its sister hospital Straub Clinic & Hospital, performs some of the most technologically advanced pediatric heart procedures available — including open-heart and minimally invasive techniques and electrophysiology for treatment of moderately complex heart disease — with results comparable to those at the best centers on the Mainland. James Sim, M.D. The Center teams with leading specialists from San Diego Children’s Hospital, University of California, San Diego, UCLA and Stanford in what are known as Heart Weeks. During Heart Weeks, which are held about five times a year, cardiac surgeons and specialists from these institutions visit to perform procedures. The result is the best possible care for infants, children and teens without imposing the additional stress on families of being away from home. Since the start of Heart Weeks in 1995, the number of cases has grown steadily.