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The heartbeat is the strong, rhythmic action that pumps blood to the body and lungs. It is controlled by electrical signals in the heart. In some cases there is an abnormal change in the rate or pattern of the heartbeat. This is called a cardiac arrhythmia. It can cause the heart to pump blood less efficiently. There are many types of cardiac arrhythmias. Some are fast. These are called tachycardias or tachyarrhythmias. Some are slow. These are called bradycardias or bradyarrhythmias. Many arrhythmias are harmless and do not need treatment. But if an arrhythmia causes discomfort, it can be treated.
The heart has four chambers. Two are called ventricles. The other two are called atria. The heart has an electrical system. It sends signals to trigger the heartbeats. The sinoatrial (SA) node is in the right atrium. This node is the heart’s own pacemaker. It sends the signal that starts a heartbeat. The signal then moves through the atria. This causes them to squeeze. This makes blood move into the ventricles. The signal then goes into the atrioventricular (AV) node. This node sends the signal into paths called bundle branches. These pass the signals to the ventricles. This makes them squeeze and pump blood to the lungs and body. This cycle completes a heartbeat. After each heartbeat, the heart recharges. Then the cycle starts again.
An arrhythmia happens when the electrical action of the heart is changed. This may be due to a problem with the electrical system. There are several causes of this. They can include:
Congenital heart defects (structural heart problems that are present at birth)
Cardiomyopathy (damaged heart muscle)
An isolated heart problem (such as an abnormal additional electrical pathway in the heart)
Postoperative changes following heart surgery
The symptoms can vary. It depends on whether it is a fast or slow rhythm. These can include:
Lightheadedness or syncope (fainting)
Nausea or vomiting
Palpitations (an extra or skipped heartbeat)
Tiring easily during exercise (in older children)
Your child will be seen by a pediatric cardiologist. This is a doctor who treats heart problems in children. Your child may also be seen by an electrophysiologist. This is a doctor who is trained to treat electrical problems of the heart. The following tests may be done:
Electrocardiography (ECG or EKG). During this test, the electrical activity of the heart is recorded. It is checked for abnormal heart rhythms or problems with heart structure. Small pads (electrodes) are placed on the chest, arms, and legs. Wires connect the pads to an ECG machine. The machine records the heart’s electrical signals.
Holter or event monitor. During these tests, the electrical activity of the heart is recorded over time. This is done with a special device to track the heartbeat. A log is kept of your child’s activities and symptoms during the day. This log is then compared with ECG results. With a Holter monitor, the heartbeat is tracked for 24 hours. With an event monitor, a button is pressed to record the heartbeat each time your child has symptoms. It is worn for periods longer than 24 hours.
Exercise stress test. During this test, the electrical activity of the heart is recorded. It is done while your child is on a treadmill or a stationary bike. This is done to check your child’s response to different levels of activity (stress). Electrodes are placed on the chest, arms, and legs.
An arrhythmia may cause few symptoms. It may cause no problems in a child’s normal routine and growth. Your child may not need treatment. But an arrhythmia that causes severe symptoms can lead to serious health problems if untreated. Treatment depends on the type of arrhythmia and may include:
Medications. These may be given to regulate your child’s heart rate.
Catheter ablation. Thin, flexible tubes (catheters) with special wires are guided into the heart. The area(s) that are causing the arrhythmia are then destroyed (ablated).
Electrical cardioversion. An electric shock is given. This briefly stops the abnormal electrical action in the heart. The heart can then restart in a normal rhythm.
Pacemaker. This is a device that is placed in the chest with leads (wires) attached to the heart. It is placed in the abdomen if it’s for a newborn or infant. This device is used to start the electrical signal that makes the heart beat at a regular rate. A pacemaker may be used if the SA or AV node is not working properly.
Implantable cardioverter defibrillator (ICD). This is a device that is placed in the chest. It tracks the heart rate. It sends an electric shock to the heart to stop a dangerous fast heart rhythm when needed.
A child with an arrhythmia can have an active life after treatment. The amount of activity will vary with each child. Check with the doctor about what activities your child can do. Regular visits with a cardiologist may be needed for the rest of your child’s life. This is to make sure that the heart is working right. Your child may have a pacemaker or ICD. If so, the doctor will need to check it regularly.