Pediatric Arrhythmia

Diagnosis begins with a detailed history and physical examination, including questions about symptoms, family history of heart rhythm problems or sudden death, and any prior heart conditions. Further evaluation typically includes:

• Electrocardiogram — records the heart's electrical activity over a short period and is the primary initial test, often identifying the specific type of arrhythmia
• Extended heart rhythm monitoring — using a portable device worn for 24 to 48 hours or longer, since many arrhythmias are intermittent and may not appear during a brief office visit
• Echocardiogram — may be performed to evaluate the heart's structure and rule out an underlying structural cause
• Exercise stress test — in select cases, can help determine whether an arrhythmia is triggered by physical activity
• Genetic testing — may be recommended when an inherited condition, such as long QT syndrome, is suspected

Not every pediatric arrhythmia requires treatment; many, particularly those that cause no symptoms and are not associated with an underlying structural or electrical risk, are simply monitored over time. When treatment is needed, options include:

• Medications — often the first approach, used either to control the heart rate or to suppress the abnormal electrical activity causing the arrhythmia
  
  
• Catheter ablation — a minimally invasive procedure in which a catheter is guided to the heart to precisely destroy the small area of tissue responsible for the abnormal signal, which can provide a long-term or permanent solution for certain types of arrhythmia
  
  
• Pacemaker — for children with an abnormally slow heart rate or a complete block in the heart's electrical conduction, a small device that delivers regular electrical impulses to maintain a steady heartbeat
  
  
• Implantable cardioverter-defibrillator — for children found to be at risk of a life-threatening rhythm, continuously monitors the heart's rhythm and can deliver a corrective shock if a dangerous pattern develops
  
  
• Surgery — in some cases, needed to address an arrhythmia connected to a structural heart problem