6 questions about heart arrhythmias – answered
February 16, 2022
6 questions about heart arrhythmias – answered

    When the heart is working as it should, it beats with a regular, even rhythm. An irregular heart rate – fast, slow or with an uneven cadence – is called an arrhythmia. While many arrhythmias are not cause for concern, others can be quite serious.

    Pediatric cardiologist and electrophysiologist Dr. John Phillips explains heart arrhythmias in kids and when to be concerned

    1.  What’s happening in the heart during an arrhythmia?

    Almost every cell within the heart can beat by itself, but we need the cells to beat together as a team to push blood through the heart. This is accomplished by a collection of cells in the right collecting chamber (named the SA node) that controls the heart rate at a regular pace. Once the upper chambers beat, electricity is passed (through the AV node) to the lower chambers that beat next. An arrhythmia occurs when this process is interrupted, or individual heart cells beat on their own in competition with the normal electrical circuit.

    2. What causes a heart arrhythmia?

    The regular electrical circuit can be interrupted, and lead to a heart arrhythmia, for a variety of reasons. Some are based on temporary circumstances, while others are related to a more permanent illness or issue with the heart itself.

    Causes of heart arrhythmias can include:

    • Abnormality of the heart muscle or heart conduction system
    • Congenital heart defects
    • Infection and/or fever
    • Inflammation of the heart (myocarditis)
    • Inherited genetic arrhythmia syndromes
    • Medication/caffeine
    • Reaction to exercise, fever or emotions

    3. What are the symptoms of a heart arrhythmia?

    Talk to your pediatrician if your infant, child or teen is experiencing any of the following arrhythmia symptoms:

    • A racing or pounding heart
    • Chest pain
    • Difficulty feeding (in infants)
    • Dizziness
    • Fainting
    • Fatigue
    • Paleness
    • Shortness of breath

    If it becomes an ongoing concern, the pediatrician may recommend testing for an arrhythmia.

    4. How is a heart arrhythmia diagnosed?

    Heart arrhythmias are usually diagnosed by a cardiologist and/or electrophysiologist. Following a physical exam and discussion of symptoms, we typically do one or more tests.

    An electrocardiogram, or ECG, is a noninvasive test that records the electrical signals of the heart and can help diagnose many common heart problems including arrhythmias. For this test, small, sticky patches called electrodes are placed at specific locations on the skin and attached to wires and a recording machine. This test takes only a few seconds.

    Because arrhythmias can come and go, symptoms may not be present at the time of the ECG in the doctor’s office. In this case, we may recommend a Holter monitor or Event monitor, small noninvasive devices that keep track of the heart rhythm over time. A Holter monitor is worn for shorter durations and records all beats, and event monitors only record when your child is having symptoms or an arrhythmia. Exercise stress tests are another method for evaluating heart rhythms particularly if symptoms are exercise related.

    When we want to track heart rhythms over a longer period of time, we’ll use an implantable loop recorder – a small device that’s surgically placed just under the skin to continuously monitor and record the heart rhythm for up to three years.

    5. Can a heart arrhythmia be treated?

    Yes, most pediatric arrhythmias respond very well to treatment. The approach to treatment depends on the type of arrhythmia and the risks and benefits of each option. We always involve families in the decision process and usually try the least invasive treatments first.

    Medications are often the first step to control arrhythmias. They are low risk, which is good, but can become less effective over time. If kids start to experience symptoms while on medication, we then must decide if we try a second-line medication or another option. This next level of medication usually comes with some additional risks.

    Ablation is another option for arrhythmia treatment. In an ablation procedure, small flexible tubes called catheters are inserted through the veins in the legs and advanced to the heart. Using heat or cold, scar tissue is created to block the abnormal electrical signals and correct the arrhythmia. The major benefit of ablation is that, in most pediatric arrhythmias, it’s effective 97% of the time and offers a permanent cure.

    For kids and teens with abnormally slow heart rhythms, a surgically implanted pacemaker is an option to regulate the heart rhythm. A pacemaker is a device that uses low energy electrical pulses to prompt the heart to beat whenever a pause in the rhythm is detected. They can help to coordinate electrical signals between the upper and lower chambers so they will beat in a coordinated fashion. Pacemakers can help speed up a slow heart rate.

    An implantable cardioverter defibrillator, also placed in surgery, can be helpful in children with dangerous rapid heart rhythms of the lower chamber. An implantable cardioverter defibrillator is a special type of cardiac device that can recognize abnormal heart rhythms in the bottom part of the heart and deliver therapy if needed to restore the heart to a normal rhythm.

    6. What is the long-term prognosis of a child with a heart arrhythmia?

    If a heart arrhythmia is not identified and addressed, the consequences can be very serious, including sudden cardiac death. Thankfully, most kids treated for arrhythmias through medication, ablation or implantable devices live healthy, active lives without long-term complications.

    Read Faith’s story of overcoming arrhythmia through ablation.

    Discover more about Dr. Phillips, the only pediatric-trained electrophysiologist in Central Virginia, and his arrhythmia care at CHoR.

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