Arrhythmias in Children
An arrhythmia is an abnormal heart
rhythm. When a child has an arrhythmia, abnormal electrical signals sent through the
heart muscle may cause the heart to beat too fast (tachycardia), too slow (bradycardia),
or in an irregular way. When the heart doesn't beat normally, it may be unable to
blood to the body efficiently. That means the brain, lungs, and other organs may not
enough blood. The organs then can't work as well and may become damaged over time.
Arrhythmias in children include:
Long-Q-T syndrome (LQTS). This is a condition that is
typically passed from parents to children (inherited), but not always. Many children
have no symptoms. But fainting is common in those who do. It may also cause cardiac
arrest and sudden death.
Premature atrial contraction (PAC) and premature ventricular
PACs or PVCs are abnormal beats that start in the upper
chambers of the heart (
atria) or the lower
chambers of the heart (ventricles). They are often viewed as completely normal and
Sinus tachycardia. This is a fast heart rate (greater than
100 beats per minute) that occurs with fever, excitement, and exercise. It is
Supraventricular tachycardia (SVT). This is the most
common type of tachycardia in children. An abnormal electric circuit or focal site
the atria can cause rapid heart rates. Treatment may be needed if it happens often
lasts long. SVT is also called PAT (paroxysmal atrial tachycardia) and PSVT
(paroxysmal supraventricular tachycardia).
Wolff-Parkinson-White (WPW) syndrome. Normally, the
electrical pathway from the top chambers of the heart to the bottom chambers passes
through the AV node. This is a group of tissues that serves as a bridge between the
chambers. In WPW, an additional electrical pathway exists between the top and bottom
chambers. This allows electricity to pass outside of the normal pathway. It's present
since birth. A fast heart rate is a common symptom. Many children don't have
symptoms. In rare cases, sudden cardiac death may occur.
Ventricular tachycardia (VT). This is a
potentially life-threatening arrhythmia. It's marked by very fast electrical signals
that start in the ventricles, rather than the atria. It may be caused by heart
disease, may occur following heart surgeries, or may be caused by a genetic
condition. A child may feel weak, tired, dizzy, or may faint (syncope). They may also
feel their heart beat (palpitations).
Sick sinus syndrome. In this condition, the heart's
natural pacemaker (sinus node) doesn't work as it should. This causes slow heart
rates. It is rare in children. But it may occur in children who have had open heart
surgery. A child may not have symptoms. A child with symptoms may be tired or dizzy,
or may faint.
Complete heart block. This occurs when the electrical
signal from the upper to lower chambers is blocked. With this condition the heart
often beats much more slowly. It's possible to be born with this condition. Or a
child may develop the condition following surgery, heart disease, or an infection.
Symptoms may include low energy, weakness, or fainting.
The cause of an arrhythmia may be unknown. Some known causes in children include:
- Heart problem that is present at birth
- Heart problem that is inherited
- Abnormal levels of certain chemicals
in the blood
- Normal reaction to exercise, fever, or
- Changes in the structure of the
- Electrical conduction abnormality
- As a result of heart surgery
A child with an arrhythmia may not have any symptoms. For those who do, these are
the most common symptoms:
- Feeling weak
- Feeling tired
- Feeling like the heart is fluttering (heart palpitations)
- Low blood pressure
- Feeling dizzy
- Fainting (syncope)
- Not feeding or eating well
The symptoms of an arrhythmia may
look like other health conditions or heart problems. Make sure your child sees their
healthcare provider for a diagnosis.
Your child's healthcare provider
will ask about your child's health history and family history. They will look for
and symptoms of an arrhythmia. The provider will give your child an exam focusing
heart. Your child may need to see a pediatric cardiologist. This is a doctor with
special training to treat children with heart problems. Your child may need tests,
Electrocardiogram (ECG). This simple
test measures the electrical activity of the heart. An ECG may show an arrhythmia.
The test may be a:
Resting ECG. Your child will
lie down while electrodes are connected to the ECG machine by wires. The ECG
records the heart's electrical activity for a minute or so.
Stress test (exercise ECG). Your child is attached
to the ECG machine as described above. They will walk on a treadmill or pedal a
stationary bike while the ECG is recorded. This test is done to check the heart
Holter monitoring. Your child will
have their heart rhythm checked .over 24 to 48 hours. A small portable monitor is
worn while your child goes about their normal activities.
Electrophysiologic study (EPS). For
this test, the doctor puts a small, thin tube (catheter) into a large blood vessel
a leg or arm. The doctor moves the catheter to your child's heart. This test can find
out the type of electrical signal causing the problem, and where the signal is.
Tilt table test. This test may be
done if your child faints often. The test checks your child's heart rate and blood
pressure as they change position.
Echocardiography (echo). This test
uses sound waves to make detailed pictures of your child's heart structure and
Implanted loop recorder. This heart
monitoring device may be used when the doctor thinks your child is at high risk for
arrhythmia and other testing has not given a straightforward result. This test may
only be used in children who are high risk. The device is put under the skin and is
used for long-term monitoring.
MRI. May be used to assess for an
abnormal structure of the heart that may be a focus for abnormal electrical activity.
Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
condition is. Some children don't need treatment. If your child needs treatment, they
will likely be cared for by a pediatric cardiologist. Treatment may include:
Medicines. Medicines can ease
symptoms or suppress arrhythmias.
Radiofrequency ablation. This
procedure uses a special catheter to destroy the tissue causing the abnormal
Surgery. Surgery can stop an abnormal
Pacemaker. An artificial pacemaker
may be needed for an abnormally slow heart rate. The pacemaker is a small device that
is put inside the belly (abdomen) or chest. It gives a small amount of electricity
the heart to keep it beating regularly.
Implantable cardioverter defibrillator
This device is put in the chest or abdomen. It automatically sends a
shock to stop an abnormal and dangerous rhythm. Some ICDs also work as
During this procedure, an electric shock is given. This
briefly stops the abnormal electrical action in the heart. It "resets" the heart's
normal pacemaker. The heart can then restart in a normal rhythm.
Complications can happen, depending on the type of arrhythmia and how serious it is.
Complications may include:
- Damage to the brain, kidneys, lungs, liver, or other organs
- Heart failure
- Blood clots. A blood clot in the brain
may cause a stroke.
- Sudden cardiac death
Some arrhythmias don't cause any
problems. Some are more serious. A child with a serious arrhythmia will need frequent
Talk with your child's healthcare provider about managing your child's arrhythmia.
Your child may need regular tests. Or your child may not be able to take part in some
sports or activities.
When to Call a Healthcare Provider
Call your child's healthcare provider if your child has symptoms of an arrhythmia.
- Feeling weak or tired
- Having heart palpitations
- Feeling dizzy
- Fainting (syncope)
- Not feeding or eating well
- An arrhythmia is an abnormal heart
rhythm. It may be a heart rate that is too fast, too slow, or irregular.
- The cause may not be known. In some cases it is caused by a
problem that's present at birth, a problem that's inherited, or an infection.
- There may not be any symptoms. Or a
child may have moderate to very serious symptoms.
- Your child may need to see a pediatric heart doctor
(cardiologist) for a diagnosis. Your child may also need tests.
- Some children don't need treatment. If
treatment is given, your child may need medicine, radiofrequency ablation, a device,
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.