Arrhythmia in children

Arrhythmia in children is also called an irregular heartbeat in children. Both terms describe an abnormal heart rhythm. Most arrhythmias are caused by an electrical “short circuit” in the heart.

The heart normally beats in a consistent pattern, but an arrhythmia can make it beat too slowly, too quickly or irregularly. This uneven pumping activity can lead to a variety of symptoms, including fatigue, dizziness and chest pain.

Many arrhythmias don’t need medical care, but some can cause health issues and need to be evaluated and treated by a doctor.

At Norton Children’s Heart Institute, affiliated with the University of Louisville, electrophysiologists work closely with specially trained nurses and technicians in the electrophysiology laboratory to fully evaluate, treat and often cure many arrhythmias in children.

What causes arrhythmias?

A unique electrical system in the heart causes it to beat in its regular rhythm. The electrical signals start from a group of cells located in the right atrium. This area is called the sinus node. The sinus node acts as the heart’s natural pacemaker, making sure the heart beats at a steady rate most of the time. The sinus node will speed up the heart rate in response to things like exercise, emotions and stress, and slow the heart rate during sleep.

Sometimes the electrical signals don’t communicate properly with the heart muscle, and the heart can start beating in an abnormal rhythm — this is an arrhythmia.

Arrhythmias also can be caused by:

  • Caffeine
  • Chemical imbalances in the blood
  • Diseases that irritate the heart
  • Infections
  • Injuries to the heart from chest trauma or heart surgery
  • Medicines (prescription, over-the-counter and some herbal remedies)
  • Use of illegal drugs, alcohol or tobacco
  • Stress

Arrhythmias can be temporary or permanent. An arrhythmia can be congenital (present at birth) or develop later in life.

What’s a normal heart rate?

The heart rate is the number of heartbeats per minute. A “normal” heart rate differs depending on age and lifestyle and other factors.

The resting heart rate — how fast the heart beats when a person is not engaged in activity — decreases as children get older. Typical resting heart rate ranges are:

  • Babies (birth to age 3 months): 100 to 150 beats per minute
  • Children ages 1 to 3: 70 to 110 beats per minute
  • Children by age 12: 55 to 85 beats per minute

A doctor can determine whether a heart rate is abnormally fast or slow, depending on a person’s situation. An older child or adult with a slow heart rate, for example, might have symptoms when the heart rate drops below 50 beats per minute. Trained athletes usually have a lower resting heart rate, so a slow heart rate for them isn’t considered abnormal if it doesn’t cause symptoms.

Symptoms of arrhythmia in children

Arrhythmias make the heart beat less effectively, interrupting blood flow to the brain and the rest of the body. When the heart beats too fast, its chambers can’t fill with enough blood. When it beats too slowly or irregularly, it can’t pump enough blood out to the body.

If the body doesn’t get the supply of blood it needs to run smoothly, a person might have:

  • Chest pain
  • Dizziness
  • Fainting
  • Fatigue
  • Lightheadedness
  • Irregular heartbeat or palpitations (a feeling of fluttering or pounding in the chest)
  • Shortness of breath
  • Weakness

Arrhythmias can be constant, but most come and go at random. Some cause no noticeable symptoms. In these cases, the arrhythmia may be found only during a physical examination or heart function test.

Types of arrhythmias

There are several types of arrythmias, including:

  • Bradycardia, an abnormally slow heart rate. Bradycardia can be caused by:
  • Sinus node dysfunction,when the heart’s sinus node isn’t working correctly. It may occur after surgery to correct a congenital heart defect.
  • Heart block,when electrical impulses can’t make their way from the upper to lower chambers of the heart. It’s often caused by a congenital heart defect, but also can be caused by disease, surgery or injury.
  • Premature contractions (atrial or ventricular) are typically minor arrhythmias. Your child may feel a fluttering or pounding in the chest caused by an early or extra beat. These premature contractions are very common, and are what happens when it feels like the heart “skips” a beat. The heart doesn’t actually skip a beat — an extra beat comes sooner than it should. Occasional premature beats are common and considered normal. In some cases, they can be a sign of an underlying medical problem or heart condition.
  • Tachycardia is an abnormally fast heart rate. Tachycardia falls into two major categories — supraventricular and ventricular:
    • Supraventricular tachycardia causes bursts of fast heartbeats that start in the upper chambers of the heart. These can happen suddenly and last anywhere from a few seconds to several days. Treatment usually is recommended if the episodes are long-lasting or happen often.
    • Ventricular tachycardia is a serious but uncommon condition that starts in the lower chambers of the heart and can be dangerous.

Diagnosing arrhythmia in children

Doctors use several tools to diagnose arrhythmias. It’s very important to know a child’s medical history and give this information to the doctor. The doctor will use the medical history and a physical exam to begin the evaluation.

Your doctor may order an electrocardiogram (EKG), a test that measures the heart’s electrical activity. For this painless test, the child will lie down and have electrodes attached to the skin with sticky papers. The electrodes have wires attached to them, which connect to the EKG machine. The EKG records electrical signals from the heart.

These types of EKG tests might be recommended:

  • Resting EKG.This measures resting heart rate and rhythm, and lasts about one minute.
  • Exercise EKG(also called a pediatric stress test). This measures heart rate and rhythm during exercising, like riding a stationary bicycle or walking on a treadmill.
  • Signal-average EKG.This is much like a resting EKG, but monitors the heartbeat for about 15 to 20 minutes.
  • Holter monitor.A continuous EKG lasting 24 hours or more. The child wears the Holter monitor and continues normal daily activities.

Arrhythmia treatment

Many arrhythmias don’t need treatment. For those that do, the electrophysiology laboratory at Norton Children’s Hospital has state-of-the-art technology for our electrophysiology cardiologists to treat arrhythmias. These options might be used:

  • Catheter ablation: Arrhythmias often are caused by microscopic defects in the heart muscle. In this procedure, a long, thin tube called a catheter is guided through a vein in the leg until it gets to the heart. Once the problem area of the heart is pinpointed, the catheter heats or freezes the defective cardiac cells and destroys them.
  • Implantable defibrillator: A defibrillator is a device that senses when the heart has a dangerously fast or irregular rhythm. It sends an electrical signal to restore a normal heartbeat. A small, battery-operated type called an implantable cardioverter defibrillator (ICD) is surgically placed under the skin near around the chest or abdomen.. Wires run from the ICD to the heart and send a signal when needed.
  • Medicines: Doctors may prescribe antiarrhythmic medicines, depending on the type of arrhythmia and other considerations. Sometimes these medications can increase symptoms and cause side effects, so the doctor will inform you what to watch for and closely monitor the patient.
  • Pacemaker: A pacemaker is a small, battery-operated device surgically implanted into the body, similar to an ICD. It is connected to the heart through wires. The pacemaker can detect when the heart rate is too slow and sends electrical signals to speed up the heartbeat.       It can also sense the electrical signal from the upper chamber SA node and send a signal to the ventricles to contract. This is done for the treatment of heart block.
  • Surgery: Surgery may be recommended when other options have failed to treat the arrythmia.

Many arrhythmias are minor and aren’t a significant health threat. But some can indicate a more serious problem. If your child has symptoms of an arrhythmia, call your doctor.

Why Norton Children’s Heart Institute?

Norton Children’s Heart Institute, affiliated with the University of Louisville, is a comprehensive pediatric heart surgery, heart failure and heart transplant program serving Kentucky, Southern Indiana and beyond.

The goal of the full-service Norton Children’s Heart Institute is to provide care for the child and the whole family. Our specialists are prepared to repair even the most complex congenital and acquired heart conditions.

Our heart team includes:

  • Pediatric cardiothoracic surgeons
  • Pediatric transplant surgeons
  • Pediatric cardiologists
    • Fetal cardiologists
    • Adult congenital heart cardiologists
    • Heart failure/heart transplant cardiologists
    • Pediatric electrophysiologists
    • Pediatric cardiac catheterization cardiologists
  • Pediatric cardiovascular anesthesiologists
  • Pediatric intensive care physicians
  • Cardiac critical care nurses
  • Critical care pharmacists
  • Family support team
  • Child life specialists
  • Rehabilitation specialists
  • Social workers
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