Adapting adult heart procedures to help children with arrhythmias

Pediatric cardiologist Kelvin C. Lau, M.D., became interested in the electrical activity of the heart when he realized he could help children with irregular heartbeats, or arrhythmias.

At Norton Children’s Hospital and University of Louisville Physicians, Dr. Lau has been adapting minimally invasive procedures that adult cardiologists first used to address adults’ arrhythmias.

An arrhythmia is a condition that causes the heart to beat too quickly, too slowly or irregularly. Some arrhythmias are life-threatening.

Dr. Lau, who’s also an assistant professor of pediatrics at the University of Louisville, describes a heart with an arrhythmia as something like a perfectly constructed house with lights that flicker or go out.

“An electrophysiologist is an electrician of the heart, and there is a lot we can potentially fix,” he said.

Minimally invasive options to fix irregular heartbeats

For a child who has heart palpitations, dizziness or fainting issues, an arrhythmia could be the cause. A minimally invasive electrophysiology study can identify the arrhythmia, according to Dr. Lau.

A pediatric electrophysiologist can correct the arrhythmia by first threading a catheter to the heart. Then, using hot or cold ablation, the physician gets rid of the tissue causing the faulty electrical signals.

“A surgeon can’t see where the arrhythmia is coming from. In electrophysiology, we use the latest technology to collect EKGs from inside the heart and figure out where the arrhythmia is coming from,” Dr. Lau said. “There is no cutting or suturing involved, just IVs. Kids can even go home the same day or the next day.”

An alternative to an ablation could be medication. Unlike medicine, though, ablations can permanently fix the arrhythmia.

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Another option is open-heart surgery. But this is rarely required, as an electrophysiology study is much more precise, according to Dr. Lau.

Fixing the arrhythmia with heat or cold

Dr. Lau said ablations are usually done on children age 4 and older but can be performed on babies if necessary.

With radiofrequency ablation, a catheter is placed directly over the area of the heart that is causing the arrhythmia. The tip of the catheter is heated, changing the tissue in that spot so the abnormal electrical current will no longer pass through it.

Cryothermal ablation cools the tissue to sub-zero temperatures instead of heating it. Like radiofrequency ablation, the procedure stops the tissue in that spot from conducting abnormal electrical signals.

Implantable defibrillators and pacemakers

Dr. Lau also performs other minimally invasive procedures on children with irregular heartbeats to avoid the long recovery and risks that come with open-heart surgery.

For the past two years, he has implanted lifesaving transvenous implantable cardioverter defibrillator (ICD) or pacemaker devices through a vein near the collarbone.

By adapting techniques and technology first used in adult patients, Dr. Lau can help kids avoid the operating room.

ICDs can prevent cardiac arrest in patients who have life-threatening arrhythmias, which often cannot be treated with an ablation procedure. The battery-powered device monitors the heart and delivers a potentially lifesaving shock if the heart is beating dangerously fast or chaotically.

Life-threatening arrhythmias can occur after a child has had heart surgery for congenital heart disease or if they were born with conditions such as long QT syndrome or hypertrophic cardiomyopathy.

A pacemaker uses electrical pulses to prompt the heart to beat at a normal rate, speeding or slowing the heart as necessary. A pacemaker also can coordinate the chambers of the heart.

A child might need a pacemaker if he or she underwent cardiac surgery and the natural pacemaker was injured as an unavoidable part of the operation. Other children are born with congenital heart disease that results in abnormality of their natural pacemakers.

Shorter hospital stays

Dr. Lau said device implantation is available to children as young as 6 years.

Children usually come into hospital the day of the procedure and spend the night in the hospital, compared with the several nights usually required after open-heart surgery. They usually are able to recover and return to school much more quickly.

“It is very rewarding to be an electrophysiologist here at Norton Children’s,” Dr. Lau said. “We have the techniques and the technology to go beyond medications in taking care of children with abnormal heart rhythms. In the end, it’s about getting kids back to being kids again as quickly as possible.”

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