Arrhythmias in Children

What Is an Arrhythmia?
When a child’s heart beats too fast, too slowly, or irregularly, it’s called an arrhythmia. An arrhythmia could indicate that there is a problem with the body’s electrical signals that tell the heart muscle when and how to beat.

Why Do Arrhythmias Occur?
Arrhythmias can develop in children before birth, but most begin after birth. They can occur in infants, young children, or teenagers. There are many causes of arrhythmias, including imbalances of electrolytes in the blood, certain medications, abnormal electrical pathways in the heart muscle, congenital heart defects, a heart muscle disease called cardiomyopathy, or genetic heart cell problems (such as long QT syndrome) that can occur in families. Arrhythmias may also occur following heart surgery.

When Should My Child See a Pediatric Cardiologist?
Arrhythmias can range from harmless to life-threatening. It’s important for your child to see a pediatric cardiologist if you or your child notices symptoms like an abnormally fast or slow heartbeat, palpitations, dizziness, feeling weak or tired often, or shortness of breath. Fainting may be a sign of a heart rhythm issue, or it could have another cause -- for example, a problem with the autonomic nervous system (the part of the nervous system that controls involuntary body functions, such as heartbeat and breathing).

If your child is diagnosed with an arrhythmia, you can rely on Duke Children’s for comprehensive, expert heart care. Our team will recommend the most appropriate treatment. In addition to a pediatric cardiologist, your child's care team may include:

• A pediatric electrophysiologist who has completed additional training in diagnosing and treating heart rhythm disorders in children. All of our pediatric electrophysiologists have years of experience performing advanced procedures to treat problems with electrical signals in the heart.
• A dedicated pediatric procedure team -- including anesthesiologists and nurse anesthetists -- all of whom are certified specialists with specific training in providing care for children’s hearts.

Medication
Your doctor may prescribe medications to treat irregular heart rhythms. Your child may need ongoing monitoring to check for any side effects.

Electrophysiology (EP) Study
While your child is sedated or under anesthesia, a doctor inserts a catheter (a narrow tube) into a vein or artery and guides it toward the heart. Using electrodes attached to the catheter, the doctor can test the heart’s electrical signals. This study helps identify what’s causing abnormal heart rhythms and what types of treatment might be most effective.

Radiofrequency Ablation
A electrophysiologist uses a special catheter that sends radiofrequency energy to heat up and destroy abnormal heart tissue that is causing irregular heart rhythms. This treatment can be performed during an EP study or in a separate catheterization procedure.

Cryoablation
This treatment is similar to radiofrequency ablation, except that it uses extreme cold (instead of extreme heat) to destroy the abnormal heart tissue.

Pacemaker and Defibrillator Implantation
A pacemaker uses electrical impulses to help control the speed and rhythm of your child’s heartbeat. An implantable cardioverter defibrillator (ICD) monitors your child’s heartbeat and can deliver an electric shock to “reset” the heart when it detects a dangerous heart rhythm. Most ICDs also function as pacemakers. These devices can usually be implanted in an outpatient procedure.

Laser Lead Extraction
Duke is a leader in providing laser lead extraction. If pacemaker or defibrillator wires placed inside the heart become damaged or blocked due to scar tissue or infection, our doctors can remove them through a small incision during this operating-room procedure.

At Duke Children’s, your child will benefit from the most advanced treatments available, delivered in a compassionate and family-focused environment.

Dedicated Pediatric Cardiac Catheterization and Electrophysiology Labs
Our two fully equipped pediatric cardiac catheterization and electrophysiology labs have the latest 3-D anatomy mapping systems, allowing the greatest precision for procedures on the smallest, most delicate hearts.

Minimized Radiation Exposure
We perform procedures with the lowest possible radiation dose to minimize any future health risks to your child.

Remote Monitoring
If your child has a pacemaker or defibrillator, we can keep track of heart rhythms between visits with remote monitoring. A monitoring station in your home sends data from your child’s device to the care team. They evaluate the information and determine if and when a clinic visit is needed.

Fetal Cardiology Specialists
If your child’s heart problem is diagnosed before birth, our fetal cardiology team ensures your child gets appropriate care -- including having a pacemaker implanted, if needed -- as soon as possible after delivery.

Specialists in Genetic Heart Disease
Duke’s pediatric cardiologists and geneticists are experts in evaluating whether your child has a genetic disease that causes arrhythmia or could increase the risk of sudden cardiac arrest or death. We partner with similar experts in adult genetic heart disease to evaluate adult family members who may also have inherited the condition.