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, affiliated with the UofL School of Medicine— 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 have the skills 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 A-fib can include:

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, the pediatric cardiologist may suggest a 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 Choose Norton Children’s Heart Institute

The Adult Congenital Heart Association has recognized Norton Children's Heart Institute for its expertise treating adult congenital heart disease.

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
  • The Adult Congenital Heart Association has accredited Norton Children’s Heart Institute’s Adult Congenital Heart Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
  • More than 5,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
  • Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.
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