Arrhythmia Types in Children

As you may have noticed, there are various types of arrhythmias in adults. What about children? First I will list and then describe the multiple arrhythmias that children can have:

1. Premature Atrial Contraction (PAC) and Premature Ventricular Contraction (PVC)
2. Tachycardia (Fast heart beat)
3. Supraventricular Tachycardia (SVT)
4. Wolff-Parkinson White Syndrome
5. Bradycardia (Slow heart beat)
6. Sick sinus syndrome
7. Complete Heart Block

Until you have a child that has an arrhythmia, you may not be particularly concerned about the differences between the types. But it is important to know their differences so that doctors can treat them appropriately and that you, as a parent, can be prepared for these treatments.

1. Premature Atrial Contraction (PAC) and Premature Ventricular Contraction (PVC)

Has your heart ever felt like it skipped a beat? No, not the I-feel-in-love skip a beat but an actual feeling like it randomly skipped a beat. What has actually happened is the heart beated too early (hence "premature"), causing the beat after the pause to be felt more forcefully. PAC occurs in the upper chamber (atria) and PVC occurs in the lower chamber (ventricles). These are considered arrhythmias but are not major concerns for the most part. There are no special treatments and there is really no specific cause. Your child may want to be seen by a cardiologist to make sure that the heart is ok. It is important to remember that this is VERY common in normal children and teenagers and it may even disappear!

2. Tachycardia (Fast heart beat)

Here, the definition of "fast" depends on the patient's age and physical activity. A normal resting heart rate for a newborn is normally considered tachycardic above 160 beats per minute. For teenagers, it is much lower at around 90 beats per minute that they are considered tachycardic. For any age, an exercising patient will have a lower resting heart rate than one that does not exercise on a regular basis. While exercising, a teenager may have a normal heart rate up to 200 beats per minute.

3. Supraventricular Tachycardia

By far, SVT is THE most common abnormal tachycardia in children. The fast heart rate involves both the upper and lower chambers (atria and ventricles) but is not life-threatenng for most people. Treatment is only considered if the episodes are long or frequent. The heart rate of an infant with an otherwise normal heart may reach up to 220 beats per minute...this may cause the infant to breathe faster than normal and be more lethargic. If this is the case, the situation must be diagnosed and treated to return the heart to a normal rate. Medication can prevent further episodes.

Oftentimes, the SVT is detected while the baby is still in the womb. If this is the case, the mother can take medications to slow the baby's heart rate. For older children, symptoms may include palpitations, dizziness, lightheadedness, chest pain, upset stomach or weakness. Oddly enough, a maneuver called a Valsalva maneuver can be taught to them to slow their own heart rate. This is a maneuver involving "straining", or closing the nose and mouth and trying to breathe out may be successful.

It is unusual for a child to be unable to enjoy normal activities. Older children may need more diagnostic tests and medications but will still have no restrictions on activities. The treatment for SVT involves stopping the current episode and preventing the next episode, which varies with the child's age. In an infant's case, taking them to the hospital may be the best option. For other children, putting ice on the face and/or gagging may be beneficial to stop a fast heart rhythm!

4. Wolff-Parkinson-White Syndrome (WPW)

Remember the electrical conduction pathway mentioned in the last blog? If an abnormal conduction pathway runs between the atria and ventricles, the signal may arrive at the ventricles sooner than normal. Named after the three people who first described it, WPW syndrome is recognized by certain changes on the EKG. Many patients with WPW do not have symptoms but are a risk for cardiac arrest. Often, but certainly not always, medication can help improve the condition but sometimes surgery or removing the irregular pathway via a catheter is necessary.



5. Bradycardia (Slow heart beat)

Again, what is too "slow" for a person depends on their age and physical activity. A newborn should not have less than an 80 beat per minute heart rate. On the other hand, a physically fit teenager may have a resting heart rate of 50 beats per minute.

6. Sick Sinus Syndrome

Ok, stretch all the way back to last week's blog and retrieve the information about the Sinus Node (SA node aka Pacemaker)....ok got it? Good...sometimes it doesn't work right and when it's work is severly disturbed, it is called sick sinus syndrome. The child may not have any regular symptoms of a cardiac patient but may be tired, dizzy or faint. Children with Sick Sinus Syndrome will have episodes of both too fast (tachy) or too slow (brady) heart rates. This is an unusual syndrome in children but a pacemaker would fix the problem in most cases, although medication may also be necessary.

7. Complete Heart Block

Heart block may be present at or even before birth (congenital) or may even be caused by a heart surgery. Heart blocks mean that the heart's electrical signal can't pass normally from the upper to the lower chambers. If the signal is blocked, the slower pacemaker sets in from the lower chambers of the heart. If this pace is not fast enough for the heart, an articial pacemaker is placed in the patient.

So have you realized the importance of the electrical conduction pathway of the heart yet?!? I hope this blog has helped you come to an understanding of the different arrhythmias that children can present. For the most part, careful observance and some TLC is just what they need.