Pediatric arrhythmias diagnosis and management in children

Indumathi

Critical Ward Nursing Incharge, Kauvery Heartcity, Trichy, Tamil Nadu

Background

Definition: Abnormalities in cardiac rhythm ranging from benign to life-threatening conditions.

Importance: Early recognition and management are crucial to prevent complications such as sudden cardiac arrest or heart failure.

Types of Pediatric Arrhythmias

  • Supraventricular Tachycardia (SVT)
  • Ventricular Tachycardia (VT)
  • Ventricular Fibrillation (VF)
  • Bradycardia
  • Long QT Syndrome
  • Premature Beats (PACs/PVCs)

 

Supraventricular Tachycardia (SVT)

Most common in infants and children.

Symptoms

  • Chest discomfort
  • Palpitations
  • Dizziness
  • Fainting

Management

  • Vagal maneuvers
  • Adenosine administration or
  • Cardioversion.

Ventricular Tachycardia (VT)/Fibrillation (VF)

Can be life threatening, often related to genetic cardiac mutation or congenital heart disease.

Symptoms

  • Chest pain
  • Palpitations
  • Syncope

Management

  • Anti-arrhythmic medications
  • Defibrillation

Bradycardia

Slow heart rate, commonly seen in conditions like drug toxicity, electrolyte abnormalities, sick sinus syndrome, AV block.

Symptoms

  • Fatigue
  • Syncope
  • Giddiness
  • Exercise intolerance

Management

Pacemaker implantation if chronotropic incompetent and refractory to medications.

Long QT Syndrome: Can lead to fatal arrhythmias.

Symptoms

  • Syncope
  • Seizures

Management

To treat underlying cause, Beta-blockers, implantable defibrillator (ICD) in high-risk cases.

Premature Beats (PACs/PVCs): Early beats arising from atrial or ventricular tissue.

Symptoms: Usually asymptomatic, but may be felt as palpitations.

Management: Typically, benign, but treatment may be required if symptomatic and high burden PVC on holter monitoring.

Diagnosis of Pediatric Arrhythmias

  • Clinical Assessment: Detailed history (family history of arrhythmias or sudden death, exercise history, symptoms).
  •  Electrocardiogram (ECG): important diagnostic tool. Determines the type, duration, and origin of the arrhythmia.
  • Holter Monitor: Continuous monitoring of the heart’s electrical activity over 24–72 hr.
  • Exercise Stress Test: Identifies ischemia, arrhythmias induced by physical exertion.
  • Echocardiogram: Assesses structural heart defects, wall motion abnormality and valve lesions.
  • Electrophysiological Study: Invasive technique used to locate the origin of certain arrhythmias and to map the electrical pathways.

Management of Pediatric Arrhythmias

Non-Pharmacologic Approaches

  • Vagal Maneuvers (for SVT)
  • Carotid sinus massage
  • Ice-water immersion
  • Valsalva technique.

Cardioversion: For unstable tachyarrhythmias or refractory to medications.

Pacemaker/ICD: In cases of high-grade AV block or high-risk ventricular arrhythmias.

Pharmacologic Treatment

Antiarrhythmic Medications

SVT

  • Adenosine
  • Beta-blockers
  • Calcium channel blockers

Ventricular Tachycardia

  • Amiodarone
  • Lignocaine

Long QT Syndrome

  • Quinidine

Parenteral Education

  1. Limit high-risk activities (e.g., competitive sports in certain cases).
  2. Regular follow-up
  3. Home monitoring may include checking the child’s pulse regularly and looking for any signs of distress.
  4. Provide pamphlets, videos, or online resources that explain arrhythmias in a simple, understandable way.

 

Special Considerations in Pediatric Arrhythmias

Congenital Heart Disease

Many pediatric arrhythmias are associated with congenital heart conditions such as atrial or ventricular septal defects or hypertrophic cardiomyopathy.

Genetic Syndromes

Disorders like Long QT syndrome, Brugada syndrome, and Wolff-Parkinson-White syndrome predisposes to arrhythmias.

Age-related Factors

Neonates and infants have different arrhythmic profiles than older children due to immature conduction systems.

Emergency Management of Life-Threatening Arrhythmias

  • For Tachyarrhythmia’s: Medications followed by synchronized cardioversion if persistent unstable SVT or VT.
  • For Brady arrhythmias: Atropine for acute symptomatic bradycardia, cardiac pacing if required.
  • Defibrillation: For ventricular fibrillation or pulseless VT.

Prognosis

  • Short-Term: With appropriate intervention, many arrhythmias in children can be effectively managed.
  • Long-Term: Prognosis depends on the underlying cause (e.g., congenital heart disease, genetic arrhythmia syndromes).
  • Recurrent Arrhythmias: May require long-term monitoring and interventions.

Conclusion

Timely diagnosis and treatment of pediatric arrhythmias are critical to prevent cardiac and systemic complications. With appropriate management, most children with arrhythmias can live normal lifestyle.

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