Rare Condition: Woman Undergoes Pacemaker Implant With Her Heart on the Right Side

A 70-year-old woman from Safed suffered for weeks from weakness, dizziness and shortness of breath until an ECG revealed a conduction disorder in her heart that required a pacemaker implant. Doctors at Ziv Medical Center then had to deal with a rare case in which the heart is located on the right side.

Yaffe, 70, from Safed, has spent years teaching at-risk youth and maintains an active lifestyle that includes daily walks and Pilates classes. In recent weeks, however, she began to feel that something was wrong. “Every time I climbed two or three stairs, I started to pant,” she says. “I felt that something bad was happening to me.” She says that for more than a month she suffered from weakness, dizziness and sensations of almost fainting. As a result, Yaffe turned to community doctors and underwent various tests, but according to her, no one understood the source of the problem. “They did tests and said it might be related to my spine, maybe diabetes or even stress because of the war.”

Last week Yaffe went to her family doctor after feeling her condition was worsening. “He did an ECG and then said I had to go to the hospital immediately.”

She arrived at Ziv Medical Center in Safed for further evaluation and treatment, and told the staff that since childhood she has known her heart is on the right side. When doctors performed an X-ray to confirm the heart’s location, it turned out that not only the heart was on the opposite side, but also the liver and spleen. The findings confirmed that Yaffe lives with a rare condition of complete organ reversal, a phenomenon in which the body’s organs are arranged as a mirror image of the normal anatomical structure.

Dr. Musa Saad, senior cardiologist and head of the electrophysiology department at Ziv Medical Center, explained that she was suffering from advanced atrioventricular conduction block that required a pacemaker implant. “We knew in advance that this was a patient with complete organ reversal, dextrocardia, so careful planning was needed before the procedure,” he said.

According to him, the team performed a special CT scan to map the chest. “In such cases there may also be changes in the anatomy of the major blood vessels and their connection to the heart, so it is important to understand the anatomy precisely before proceeding. We wanted to make sure there were no surprises along the way.”

Dr. Saad explained that doctors performing pacemaker implants are used to working when the heart is on the left side of the body. “All the accumulated experience over the years is based on a certain anatomy. In this case you have to make a switch in your head and understand that everything is reversed. I like to compare it to a situation where, as a left-handed person, you have to write and read in Hebrew from left to right. It may not sound very complex, but when it comes to entering blood vessels and reaching the heart chambers, this is a real challenge.”

He said the condition is extremely rare. “Complete organ reversal occurs in about one in 15,000 people, but the need for a pacemaker implant in such a patient is even rarer. Even during a year and a half of training at a large medical center in Toronto, I did not encounter a similar case, and senior, experienced doctors who have worked in the field for many years said they had never encountered such a case before.” The procedure, he said, ended successfully and the patient is already recovering at home.