Atrial fibrillation

Atrial fibrillation (A-fib) is a type of arrhythmia, an irregular heart rhythm. A-fib causes the heart’s upper chambers (the atria) to beat very fast and irregularly. This condition is rare in children.

The specialists at Norton Children’s Heart Institute — the leading providers of pediatric heart care in Louisville and Southern Indiana — can help your child with atrial fibrillation.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute, affiliated with the University of Louisville, have the skill and experience to provide a pinpoint diagnosis and determine what treatment, if any, is needed for your child’s A-fib.

During atrial fibrillation, many electrical impulses around the atria cause these upper chambers to contract in a fast and hectic fashion that makes them vibrate. The atrioventricular node blocks most of these vibrations from reaching the heart’s lower chambers (the ventricles). So even though the atria are beating very fast, the ventricular heart rate — which causes your pulse — beats at a slower rate, usually less than 180 beats per minute. Sometimes the pulse rate is lower and may even be in the normal range, but it will still be irregular. 

Atrial fibrillation symptoms

Symptoms caused by atrial fibrillation can include:

  • Chest pain
  • Fainting (syncope)
  • Feeling that the heart is racing
  • Lightheadedness
  • Low energy levels
  • Shortness of breath

Sometimes symptoms are mild or there may be no symptoms.

This condition is rare in children, but it can occur in:

  • Children with conditions such as cardiomyopathy and heart failure
  • Children who have had complex heart surgery
  • Children with no other heart issues, although this is very rare

Diagnosing atrial fibrillation

A pediatric cardiologist will perform a physical exam, listen to the heart and lungs, and perform any needed tests to make a diagnosis, including:

  • Electrocardiogram (ECG or EKG): This test records the heart’s electrical activity. It shows abnormal rhythms (arrhythmias or dysrhythmias) and can show heart stress. This may be one of the first tests completed. Children with atrial fibrillation will have a fast, irregular heartbeat and many extra “P” waves from rapid atrial contractions. To diagnose atrial fibrillation, the ECG may need to take place while symptoms are happening.
  • Echocardiogram (echo): This test uses sound waves (ultrasound) to produce images of the heart and blood vessels’ structures on a screen. It can show the structure and function of the heart. Norton Children’s Heart Institute has 28 tele-echo locations throughout Kentucky and Southern Indiana.
  • Heart catheterization: During this procedure, a thin, long tube called a catheter is inserted into a blood vessel at the belly button or groin and guided into the heart. The doctor can see more details about the structure of the heart. An electrophysiologic study may be done during a heart catheterization to diagnose atrial fibrillation.
  • Holter monitor: This portable monitor records the heart’s rhythm for 24 hours period to help diagnose a rhythm issue. If the rhythm issue tends to occur during exercise, your child might also have an exercise test.

Atrial fibrillation treatment

Possible treatments include:

  • Synchronized cardioversion
  • Medications
  • Radiofrequency ablation
  • Pacemaker placement
  • Surgical treatment

Synchronized cardioversion delivers an electrical charge or “shock” to the heart to reset the heart’s rhythm. The shock interrupts the irregular electrical activity of the atria and helps restore a normal rhythm. The child will be sedated during this procedure and won’t feel any pain.

Medications used to treat or control atrial fibrillation may include:

  • Amiodarone
  • Diltiazem
  • Flecainide
  • Propranolol
  • Sotalol
  • Verapamil
  • Digoxin
  • Aspirin, warfarin, heparin, or enoxaparin may be used to prevent blood clots from forming

Radiofrequency ablation is an option for some patients. This type of cardiac catheterization takes place in the electrophysiology lab during an electrophysiologic study:

  • A thin, long tube called a catheter is inserted into a blood vessel at the belly button or groin and guided into the heart. Using the catheter, doctors find the spots in the heart muscle that trigger atrial fibrillation. A special type of catheter delivers radiofrequency energy to the area of the trigger.
  • The energy heats the catheter tip, causing a small burn that damages the spot that is causing the bad electrical impulses in an attempt to eliminate the A-fib.

If the A-fib does not respond to other treatments, a pacemaker may be surgically implanted. A pacemaker is a small device that’s connected to the heart with a thin wire. It sends small, painless amounts of electricity to the heart to make it beat the way it should.

If a patient does not respond to the previous treatments, your pediatric cardiologist may suggest the Maze surgery. This is an open heart surgery where the pediatric cardiothoracic surgeon makes small cuts in the upper part the atrium where the atrial fibrillation originates. The cuts create scar tissue that can stop the electrical atrial fibrillation transmission through the atrium.

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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Norton Children’s Heart Institute

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