Pediatric arrhythmias

What are pediatric arrhythmias?

An arrhythmia can mean the heart beats too quickly (tachycardia), too slowly (bradycardia) or it skips a beat. All arrhythmias are caused by abnormal electrical signals in the heart. These may happen because of a heart defect or because of outside factors like illness, exercise, trauma or a reaction to allergens or medicines.

Usually, the abnormal heartbeat lasts a short time and returns to normal. It may occur frequently or only once in a while. Some arrhythmias are dangerous, but many times they aren’t and can be managed with little or no treatment.

What are the different types of pediatric arrhythmias?

• Sinus tachycardia is when the heartbeat starts from the correct location (sinus node) but is faster than normal for a child’s age.

• Premature atrial contractions (PACs) are extra heartbeats coming from the upper chambers beating early.

• Atrial ectopic tachycardia (AET) occurs when there are continuous extra heartbeats from the upper chamber.

• Supraventricular tachycardia (SVT) is a rapid heart rate, caused by an extra electrical connection that allows the electric signal to go in a circle from the upper to lower chambers of the heart.

• Wolff-Parkinson-White syndrome is a special type of SVT where the extra electrical connection causes an abnormal appearance to the electrocardiogram (EKG).

• Atrial flutter occurs when an electrical signal goes around in a circle only in the upper chambers.

• Atrial fibrillation is a rapid heart rate that is not regular and may cause blood clots.

• Premature ventricular contractions (PVCs) are extra heartbeats coming from the lower heart chambers beating early.

• Ventricular tachycardia (V-tach or VT) is a heartbeat caused by irregular electrical signals in the lower part of the heart. It can be life-threatening if the heartbeat stays elevated for a long time.

• Ventricular fibrillation is a heartbeat that is very fast and shallow, almost like a quiver. This is the most serious of the arrhythmias and is life-threatening, because the heart doesn’t pump deeply enough to circulate blood.

• Heart block occurs when the electrical signal can’t go from the upper chambers (atria) to the lower chambers (ventricles).

• Sinus bradycardia is a slow heartbeat that can be irregular and is caused by problems in the normal pacemaker for the heart.

What are the signs and symptoms of pediatric arrhythmias?

Some arrhythmias aren’t noticeable at all. In other cases, a child might feel their heart beating differently, but it doesn’t affect them in other ways. But some arrhythmias cause more serious discomfort and risks.

These include:

• Difficulty or lack of interest in eating (especially with newborns in the first 28 days)

• Fainting

• Chest pain

• Pale coloring

• Weakness

• Lack of energy (also called lethargy)

• Shortness of breath

• Sweating

• Irritability

How are pediatric arrhythmias diagnosed?

We diagnose arrhythmias by getting an electrical recording of the heart. Specifically, we need to record the irregular heartbeat while it happens. We may be able to do this during an office visit with a test called an EKG. Or your child may wear a monitor for a week or more. The monitor is taped to the outside of their chest and records data on an ongoing basis.

What causes pediatric arrhythmias?

Most arrhythmias are caused by tiny defects in the heart that formed when a baby was developing. Sometimes something external like an infection can cause inflammation in the heart that can lead to an arrhythmia. In rare cases, a child inherits an arrhythmia from a parent.

How are pediatric arrhythmias treated?

Sometimes the arrhythmia isn’t a problem, and all we do is watch for symptoms. For patients bothered by symptoms of fast heart rates, many get better using breathing techniques and specific body movements that help. We might also prescribe medicine that prevents irregular heartbeats by modifying the heart’s electrical activity. Different medications are designed for different types of arrhythmia.

Some arrhythmias require advanced care from experts like the ones in our Pediatric Electrophysiology Program. This may include a treatment called ablation, where we use a special tool to eliminate the exact spot in the heart that allows the arrhythmia to start. The ablation kills a tiny area of the tissue and stops it from allowing irregular beats.

Other conditions may require an implant to keep the heartbeat from going too fast. For example, patients with ventricular fibrillation or ventricular tachycardia can benefit from an implantable cardioverter-defibrillator (ICD). This device keeps track of the heart rate and, if it gets too high, uses electrical pulses to restore it to normal.

For hearts rates that are too slow, we may need to implant a pacemaker. This device makes sure the heart rate is never to slow.