Arrhythmias in Children

What Is an Arrhythmia?
When a child’s heart beats irregularly, too fast (tachycardia) or too slow (bradycardia), it’s called an arrhythmia. An arrhythmia could signal that a problem exists with the body’s electrical signals that tell the heart muscle when and how to beat.

What Causes Arrhythmias?
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 electrolyte imbalances in the blood, certain medications, abnormal electrical pathways in the heart muscle, congenital heart defects, a heart muscle disease called cardiomyopathy, or a genetic problem (such as long QT syndrome) that can occur in families. Arrhythmias may also occur following heart surgery.

Our team of pediatric heart experts work together to ensure your child gets the care they need. Every week, our specialists meet to discuss patients who require surgery or whose arrhythmias are complex. This means your child benefits from the expertise of the entire group. 

Pediatric cardiologists usually care for children with non-life-threatening arrhythmias that can be treated with medications or other noninvasive treatments.

Pediatric electrophysiologists have completed additional training in diagnosing and treating pediatric heart rhythm disorders. They specialize in caring for more severe and life-threatening arrhythmias. Your child should see a pediatric electrophysiologist if:

• Their symptoms are brought on by or get worse with exercise.
• There is a history of a sudden and unexplained death in your family, including an infant who died from sudden infant death syndrome (SIDS).
• They need a procedure like cardiac ablation.

Cardiovascular geneticists evaluate people for genetic causes of arrhythmias, including those that put people at increased risk of cardiac arrest or death. Together with experts in adult genetic heart disease, they can also counsel family members and make recommendations for relatives who could also have the condition. 

Fetal cardiologists help identify and treat your baby’s heart problems during pregnancy. Fetal cardiologists ensure your child gets appropriate heart care -- including having a pacemaker implanted, if needed -- as soon as possible after delivery.

Blood Tests
Standard blood testing can measure levels of chemicals in the blood that contribute to arrhythmias.

Electrocardiogram
Also known as an ECG or EKG, an electrocardiogram records the heart's electrical function through electrodes placed on the chest.

Heart Rhythm Monitors
Portable, wearable heart monitors record heart function and abnormalities over time. 

Cardiac Stress Test
This test monitors your child’s blood pressure and heart function during exercise (for example, running on a treadmill).

Tilt Table Test
Lying on their back, your child will be secured to a table that tilts slowly. This tests for a fainting response and helps determine the cause.

Genetic Testing
To identify arrhythmias that are heritable, meaning they can be inherited from family members, cardiovascular geneticists test blood or saliva samples to look for genetic mutations. For those with heritable arrhythmias that have a known genetic cause, family members can undergo risk-predictive genetic testing to determine who might else be at risk.

Cardiac MRI
This specialized MRI produces detailed images of the heart and surrounding blood vessels.

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 helps identify what’s causing abnormal heart rhythms and the most effective treatments.

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

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

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

Electrical Cardioversion
While your child is sedated, a pediatric electrophysiologist applies specialized pads or paddles to the chest to shock the heart back into a normal rhythm.

Sympathetic Denervation Surgery
This minimally invasive surgical procedure removes a section of the sympathetic nerve, making the heart less responsive to stimuli and reducing future arrhythmias.

Pacemaker and Defibrillator Implantation
A pacemaker uses electrical impulses to help control the speed and rhythm of your child’s heartbeat. A cardioverter defibrillator (ICD) is implanted in your child’s chest during an outpatient surgical procedure. It monitors their heartbeat and delivers an electric shock to “reset” the heart when a dangerous heart rhythm is detected. ICDs can also function as pacemakers. 

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.

Maze Surgery
During this open-heart surgery, pediatric heart surgeons strategically burn the inside of the atria -- the upper chambers of the heart. This prevents irregular heartbeats from traveling to other areas of the heart. This surgery is best for children whose arrhythmias cannot be treated with medication or ablation.

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 3D anatomy mapping systems, which allow doctors to perform precise procedures on the smallest, most delicate hearts.

Minimized Radiation Exposure
We use lowest possible radiation dose to minimize any future health risks to your child.

Team Approach to Care
Our team of pediatric cardiologists and electrophysiologists work with genetic experts, heart disease experts, and specialized surgeons to provide comprehensive care for families with heritable arrhythmias syndromes.

Remote Monitoring and Device Management
If your child has a pacemaker, defibrillator, or implanted heart monitor, we can use remote monitoring to keep track of heart rhythms between visits. A monitoring station in your home sends data from your child’s device to the care team for review. During clinic visits, our team gives your child’s device a full work-up to ensure it functions properly.

Clinical Trials 
As a Duke patient, your child may be eligible to participate in clinical trials or other research programs that are studying new approaches to treat heart rhythm disorders.