Arrhythmias

Arrhythmias are caused by abnormal electrical signals in the heart. These cause the heart to beat too fast, too slow, or in an irregular pattern. This abnormal rhythm means that the heart isn’t able to pump blood to the brain, lungs and other organs efficiently, so they may not get enough oxygen to function properly.

Arrhythmias are categorized by whether they start in the atria (upper chambers of the heart) or ventricles (lower chambers of the heart). There are many types of arrhythmias; they can involve tachycardia (heart beats too fast), bradycardia (heart beats too slow, or fibrillation (irregular pattern).

Types of arrhythmias in children include:

• Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C): This is a rare heart condition that runs in families and can cause abnormal heart rhythms. It is generally diagnosed in adulthood but can also affect children.
• Atrial fibrillation (AFib). Rare in children, AFib is an irregular, often rapid heartbeat. It occurs when electrical signals firing in the heart cause the atria to beat erratically and becomes out of sync with the ventricles.
• Atrial flutter. A very fast heartbeat caused when the muscles in the atria contract quickly.
• Brugada syndrome: A genetic disorder that can cause a dangerous irregular heartbeat.
• Catecholaminergic polymorphic ventricular tachycardia (CPVT). This rare inherited condition that causes sudden abnormal heart rhythms, often brought on by high adrenaline levels, such as during exercise or when experiencing strong emotions.
• Complete heart block. This condition occurs when the electrical signal from the atria to the ventricles is blocked, causing the heart to beat more slowly.
• Long QT syndrome: This condition causes a fast erratic heartbeat when the ventricles take too long to contract and release.
• Premature ventricular contractions (PVC)/premature atrial contractions (PAC): These conditions cause an extra or premature heartbeat to occur in the atria or ventricles.
• Short QT syndrome: In this rare genetic disorder, the length of time between the heart contracting, relaxing and contracting again is shorter than normal.
• Sick sinus syndrome: Though rare in children, this condition can occur in children who have had open-heart surgery. It occurs when the sinus node in the heart – which helps the heart keep a steady beat – doesn’t function properly.
• Sinus tachycardia: An increase in the heart rate often brought on by exercise or excitement, which can be common in children.
• Supraventricular tachycardia (SVT): The most common type of tachycardia (fast heartbeat) in children, triggered by abnormal electrical signals in the atria.
• Ventricular tachycardia (VT): A rare but serious rapid heart rate that involves very fast electrical signals in the ventricles. It is often caused by other serious heart conditions in children.
• Wolff-Parkinson-White (WPW) syndrome: A child is usually born with this condition, which involves an abnormal electrical connection between the atria and ventricles that can cause a rapid heartrate.

What are Symptoms of Arrhythmia in Children?

Symptoms and signs of arrhythmia will vary depending on the type and severity of the condition. Some children may not experience any symptoms with arrhythmia, and the condition will only be detected during a doctor’s exam. Common signs and symptoms can include:

• Heart palpitations, fluttering or racing heart
• Chest pain
• Difficulty exercising
• Dizziness
• Fainting
• Fatigue

With severe arrhythmia, potential complications can include:

• Damage to internal organs such as the brain, kidneys, lungs or liver
• Heart failure
• Blood clots
• Stroke
• Sudden cardiac death

Diagnosing Arrhythmias

If your child experiences symptoms of arrhythmia, you should have them checked out by their primary care provider. If they detect an irregular heartbeat, they may refer you to a pediatric heart specialist in UH Rainbow’s Pediatric Electrophysiology Center. There are several tests that can be used to diagnose arrhythmias in children. These include:

Treating Arrhythmia in Children

Treatment will depend on your child’s symptoms, age and general health, as well as the severity of the condition. There are many different treatment options available, ranging from lifestyle changes and medications, to implantable devices, cardiac ablation procedures and surgery.

Treatments include:

• Implantable device therapy: Devices implanted in the chest or abdomen can be used to help control the electrical signals in your child’s heart. They can include loop recorders, pacemakers and cardioverter defibrillators.
• Catheter ablation: With this minimally invasive procedure, a pediatric electrophysiologist inserts a small tube through a vein and into the heart. They then use radiofrequency (heat) ablation or cryo-ablation (cold) energy to help correct the abnormal heartbeat.
• Surgery: In rare cases, surgery may be used for children with severe arrhythmias that have not responded to other treatments.
• Lifestyle modifications: Our pediatric heart specialists will work with your family to devise strategies to avoid or limit potential triggers (such as stress or caffeine) that can make arrhythmia symptoms worse.
• Medication: Antiarrhythmic drugs can be prescribed in some cases to help regulate your child’s heartbeat.
• Cardioneuroablation: Uses a catheter ablation technique to rebalance the cardiac autonomic nervous system.

Follow-Up Care

While some arrhythmias may not cause any symptoms or issues, others may require frequent follow-up care with a pediatric electrophysiologist and periodic tests. Depending on the severity and type of arrhythmia, you child’s provider will work with you to help you understand and manage your child’s condition.