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Care from the Heart for the Heart

By: Ashley Berke Date: Feb 10, 2015

Jake Biros, the BoxerThe first pacemaker was placed in a dog in 1967, right here at Penn Vet, by veterinary cardiologist Dr. James Buchanan. Almost 50 years later in the same hospital, this procedure saved the life of a 10-year-old Boxer named Jake.

Arriving home one day in early December, Dan Biros noticed Jake was unusually lethargic. He didn’t greet Biros by hopping on him when he walked in the door, their usual routine. “When he looked up at me, his eyes looked very tired,” Biros said. When Jake stopped eating the next day, Biros grew even more concerned.

He brought Jake to his primary care veterinarian at Quakertown Veterinary Clinic, where she discovered his heart rate was only 30 beats per minute. A normal heart rate for a dog is between 60 and 150 beats per minute. Biros was told to see a cardiologist as soon as possible.

Jake at Ryan HospitalAn electrocardiogram taken at Veterinary Specialty & Emergency Center in Levittown revealed that Jake had third-degree atrioventricular block (AVB), meaning the signal for the heart to pump was not getting through from the top part of the heart to the bottom.

“I was told that if we did nothing, congestive heart failure would eventually take Jake’s life,” Biros explained, “or we could have a pacemaker placed at Penn Vet.”

Following His Heart

Dr. Danielle Laughlin and Dr. Mark Oyama check the power output on Jake's pacemaker.Biros and Jake got back in the car to make the trip to Penn Vet’s Ryan Hospital – their third trip to a veterinary hospital in one day. During the ride to Philadelphia, Biros contemplated whether or not to proceed with the procedure.

“I realized I wasn’t ready to put him down,” Biros said. “Jake was perfectly healthy otherwise.” Another deciding factor: Laila, Jake’s six-year-old Boxer buddy back at home. “It’s always been Jake and Laila,” Biros said. “I just couldn’t imagine not having them together.”

Jake having the power output of his pacemaker tested.Upon arrival at Ryan Hospital, Biros met with Dr. Danielle Laughlin, Resident in the Cardiology Service. “She answered all of my questions, which made me feel even more comfortable with my decision,” Biros said.

Before placing the pacemaker, Laughlin ordered an echocardiogram, which did not reveal any cardiac dysfunction or abnormalities, other than the slow heart rate. This was good news for Jake, making him an ideal candidate for pacemaker placement.

AVB can be caused by serious structural heart disease or degenerative changes in the heart, Laughlin explained. When structural disease is not an issue, as in Jake’s case, a pacemaker can remedy the problem.

The incision site at Jake's jugular.Jake also was taken for chest X-rays to rule out any signs of metastatic disease. In addition, an atropine response test confirmed that Jake’s heart could not respond to stimulation by the central nervous system, meaning his condition could not be managed only with heart medications.

Given these results, Jake was taken to surgery for a pacemaker. Laughlin made a small incision in his right jugular vein and placed a permanent pacemaker lead in his right ventricle. The procedure lasted two hours and successfully paced Jake’s heart.

Without Missing a Beat

By the next day, Jake was ready to go home. “I could tell he was feeling great because he was pulling me down the hallway, ready to go home,” Laughlin said.

“In cardiology, we treat a lot of things, we manage long-term heart disease, and we can often improve an abnormal valve with surgery,” she commented. “But with pacemakers, we can truly fix the problem. Jake went home with a normal heart rate.”

Dan Biros with Laila and Jake

Of Jake’s progress, Biros said, “It was night and day.”

Jake can no longer wear a leash around his neck, so he sports a harness now. And he visits Ryan Hospital for periodic pacemaker checks. Otherwise, his life has returned to normal. Jake enjoys running around with Laila and hopping on his beloved owner when he walks in the door – a daily occurrence that warms Biros’ heart.

“Dr. Laughlin not only saved Jake’s life, but she also kept two other hearts from breaking,” Biros said.

The Heart of the Matter

In 1967, Dr. James Buchanan (r) examines the first dog to receive a pacemaker.Less than ten years after the first pacemaker was implanted in a person, Penn Vet cardiologist Dr. Buchanan placed the first pacemaker in a dog. Like Jake, the dog was a 10-year-old male, a Basenji with recurrent congestive heart failure due to complete heart block.

Since pacemakers weren’t specially made for animals at the time, Buchanan used one that had been removed from a human patient who had died. Despite the fact that the remaining battery life was estimated to be 18 months, the pacemaker functioned normally for more than five years, with the dog still in good physical condition at 15 years of age.

Top, an x-ray showing the original pacemaker placed in 1967. Bottom, size comparison between the original pacemaker (r) and the modern version that Jake recieved (l).When the battery finally corroded after five years and four months, Buchanan performed surgery to replace the pacemaker. The new pacemaker functioned normally for the remaining six months of the dog’s life, before the 16-year-old was euthanized due to an abdominal mass. As is the case for many dogs with pacemakers, they often maintain good cardiac health for the remainder of their lives and end up dying from other health conditions.

Buchanan still imparts wisdom as Professor Emeritus of Cardiology at Penn Vet. He is one of several pioneers who helped make the Cardiology Service – established in 1958 – one of the preeminent of its kind. Today, the Service continues in this tradition of excellence by offering state-of-the-art diagnostic and treatment services to improve the health and well-being of animals.