Children's Emergency Department is now located in Children's Tower: 1001 E. Marshall Street.

Learn more
View alerts close

Treating heart arrhythmias with our specialized electrophysiology program

Learning that your child’s heartbeat is irregular, either beating too fast or slow, can be scary for families. Our pediatric electrophysiologist is here to help. Our pediatric arrhythmia team will diagnose and treat your child’s condition so they can spend more time just being a kid.

Why choose CHoR?

  • We’re trained in the art and science of caring for kids: Our electrophysiology services are specific to children, adolescents and young adults. Dr. John Phillips is the only pediatric-trained electrophysiologist in the Richmond area. His training, bedside manner and years of experience caring for children puts families at ease. Adult cardiologists do not have the level of training needed to gain a unique understanding of your child’s heart.
  • The region’s most advanced imaging and treatment options: Imaging and diagnostic testing is often the key to a clear diagnosis and successful treatment plan. We offer the region’s most advanced imaging and testing services for children with heart abnormalities.  Our tailored treatment programs are designed to meet your child’s unique needs.
  • We treat the whole child, not just the disease: Our team provides care across a range of specialties so we can achieve the best outcomes for both simple and complex cases. Arrhythmias often exists with other medical conditions, like cardiomyopathy and congenital heart disease. From our fetal cardiologists and child life specialists – to our dedicated nurse educators and navigators – were here with your family every step of the way.  

What is electrophysiology?

Electrophysiology (EP) is the study of the electrical properties of the heart which helps diagnose and treat arrhythmias (heart beats too fast or slow).

For abnormally fast heart rhythms, an EP study can be performed to assess the electrical activity in your child’s heart, determine if there are abnormalities, and, in some disorders, fix what is wrong.

For abnormally slow heart rhythms, pediatric electrophysiologists use sophisticated devices called pacemakers that can be implanted to support a child’s slow heart rate.

How is an EP study performed?

The procedure is performed similarly to cardiac catheterization. In an EP study, catheters (small wires) are placed in the veins in the groin and passed up into the heart. Once in the heart, the catheters are positioned to evaluate the course of electricity through the heart. From, this information, electrical abnormalities can be determined and even repaired.

Diagnosis and treatment

The most common reasons our pediatric electrophysiologists perform an EP study include:

  • Supraventricular tachycardia, a type of abnormally fast arrhythmia of the collecting chambers (atria)
  • Ventricular tachycardia, a type of abnormally fast arrhythmia of the pumping chambers (ventricles)
  • Inherited genetic syndromes, like Long QT syndrome to determine the likelihood of a patient having ventricular tachycardia
  • Arrhythmias associated with pediatric and adult congenital heart disease

What to expect during an EP study

  • All tests are performed with sedation by an anesthesiologist, so your child is asleep and does not feel anything.
  • Your child will lie on a special exam table with a large camera and several television monitors overhead.
  • Wire electrodes are placed on their chest. The electrodes are painless, and they will feel like sticky patches with lightweight wires attached. The electrodes are attached to an electrocardiogram (EKG) machine that will chart your child’s heart's electrical activity.
  • Electrophysiology catheters (flexible, narrow wires) are inserted through the veins in the groin and up into the heart. These catheters transmit data to specialized electrical mapping machines that show the electrophysiologist a 3-dimensional representation of the patient’s electrical activity.  
  • The procedure generally takes about one to four hours.
  • After completing the procedure, your child will be observed for 4-5 hours and discharged home the same day.

Treatment options

Treatment options vary depending on the exact type of arrhythmia your child suffers.

It is important to note that most pediatric arrhythmias are treatable and don’t typically lead to sudden death. Additionally, most children with arrhythmias do not require exercise restrictions and should be treated like any other child.

Treatment options can include:

  • Medications to control arrhythmias
  • Electrophysiology studies: This is an outpatient procedure. Patients are typically discharged the same day. After three days of convalescence, your child can return to normal activities.
  • Ablation: Ablation is part of an EP study where a catheter is used to create small areas of a scar by burning or freezing the spot the arrhythmia comes from. This eliminates the electrical signals causing the arrhythmia, which then prevents it from happening in the future. Our program offers all options for ablation therapy including radiofrequency ablation and cryoablation. Our electrophysiologist will choose the safest and most effective options for your child after the mechanism of arrhythmia is determined.
  • Pacemakers: 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. They are typically implanted through a vein under the collar bone. The procedure is performed by the pediatric electrophysiologist with anesthesiology sedating the patient. The patient is admitted overnight for IV antibiotics and post-operative care.
  • Internal cardioverter-defibrillators (ICD): An ICD 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. Like a pacemaker, they are typically implanted through a vein under the collar bone. The procedure is performed by the pediatric electrophysiologist with anesthesiology sedating the patient. The patient is admitted overnight for IV antibiotics and post-operative care.
  • Prevention of sudden cardiac death: CHoR is the Project ADAM affiliate for central Virginia. Dr. Phillips is the Medical Director of the program. Project ADAM affiliates strive to assist schools and communities in establishing an emergency plan to place into action in the incidence of a sudden cardiac arrest. It’s not enough simply to have AEDs in the building. Lives are saved when schools are prepared not only with a documented plan but also with a cardiac response team, in addition to being well trained and practiced on how to respond in the event of a cardiac emergency.

Educating families about living with heart conditions such as arrhythmias

Dr. Phillips’ philosophy is that he treats all his patients as if they were his own. His approach to a child or young adult is patience and education. He likes to spend time with the patient and family to explain the mechanism of their disease. This helps families be confident in recognizing signs of both small problems, as well as potentially larger issues, such as sudden cardiac arrest.


Meet the team

View all providers
John R Phillips, MD
John Phillips MD Cardiology
Read more
Christopher Snyder, MD
Christopher Snyder MD Cardiology
Congenital heart disease
Read more


View all locations