Author: Adam Rowden
Arrhythmia is the term for a heartbeat that is too slow, too fast, or irregular. There are a number of different types of arrhythmia. Some types of arrhythmia can affect children.
Arrhythmia is the name for several conditions that affect a person’s heart rate.
Many factors can cause a person to develop an arrhythmia. These include changes to the heart tissue, changes to the heart’s activity, or changes to the electrical signals that control the heart.
Common causes of these changes include damage from disease, injury, or genetic factors.
This article will outline some types of arrhythmia that can affect children and how doctors diagnose and treat arrhythmias.
Below are some types of arrhythmia that can affect children.
Long QT syndrome
Long QT syndrome (LQTS) is a disorder of the heart’s electrical system.
In LQTS, the ventricles, which are the heart’s lower chambers, take too long to contract and release. This can affect a child’s heartbeat by upsetting the careful timing of each beat.
LQTS can trigger dangerous heart rhythms.
A child will often inherit LQTS, meaning they are born with the disorder and live with it for their whole life.
People with LQTS can experience an irregular heartbeat in response to emotional stress, sudden surprise, or exercise.
Children with LQTS may show no symptoms at all. However, some children may experience fainting, an irregular heart rate, and a fluttering sensation in the chest.
Premature contractions, sometimes called extra contractions, can cause a child to have an irregular heart rhythm.
If a contraction in a chamber of the heart happens prematurely, it often causes a pause, which causes the next beat to be more forceful.
A more forceful beat can often feel like the heart has skipped a beat.
Premature beats start in the heart’s upper chambers and are called premature atrial contractions. Premature beats that start in the lower chambers are called premature ventricular contractions.
Premature contractions are common in children and teenagers. There is often no known cause for these contractions, and they usually go away without any treatment.
Tachycardia is the name for a heartbeat that is too fast. There are a variety of different types of tachycardia.
The two main types of tachycardia that affect children are sinus tachycardia and supraventricular tachycardia (SVT).
Sinus tachycardia is a regular increase in a child’s heart rate. It is common in children and usually does not require treatment. Sinus tachycardia commonly occurs alongside a fever, excitement, or exercise.
SVT occurs when electrical signals in the upper chambers, or atria, of the heart fire abnormally. These abnormal electrical signals interfere with the sinoatrial (SA) node’s electrical impulses.
The SA node sets the normal rhythm and rate of the heart. When SVT disrupts the SA node’s impulses, it can cause a child to develop a faster heart rate than normal.
SVT is not life threatening for most children and usually does not require treatment. A child will only require treatment if arrhythmia episodes are long or frequent.
A child may take medication to control their SVT. Some children with SVT also learn ways to slow their heart rate.
Wolff-Parkinson-White syndrome (WPW) is a disorder in which the electrical signals between the atria and the ventricles are abnormal.
WPW involves the atrioventricular (AV) node, a small structure that connects the electrical systems of the atria and ventricles.
If a child has WPW, electrical signals can bypass the AV node, causing them to prematurely reach the ventricles. These premature signals then bounce back to the atria, which can cause a child to develop a very fast heart rate.
Medication can often improve this condition in children. If medication does not work, a child may undergo another treatment such as catheter ablation or a surgical procedure.
Ventricular tachycardia (VT) is the name for a fast heart rate that begins in the ventricles.
If a child has VT, they may experience dizziness, heart palpitations, chest pain, and shortness of breath.
This is a rare condition in children but can be very serious. A child with VT will require immediate medical attention.
Bradycardia is the name for a heart rate that is too slow. It is rare in children.
What doctors consider a low heart rate depends on several factors, such as a child’s age and fitness level. Normal heart rates for children tend to decrease as a child gets older.
According to the American Heart Association (AHA), a newborn should not have a heart rate below 80 beats per minute (bpm). An athletic teenager could have a normal resting heart rate as low as 50 bpm.
If a child has bradycardia, they may experience fatigue, weakness, dizziness, and confusion.
Bradycardia does not always require treatment. However, if there is an underlying cause of a child’s bradycardia, doctors will treat that cause.
Sick sinus syndrome
Sick sinus syndrome occurs when the SA node does not fire its electrical signals effectively, causing a child’s heart rate to slow down or speed up. This can lead a child to develop bradycardia or tachycardia.
If a child has sick sinus syndrome, they may experience no symptoms at all. Some children experience symptoms including dizziness, fatigue, and fainting.
A child may receive treatment for sick sinus syndrome, including medications, an artificial pacemaker, or a combination of both treatments.
Complete heart block
If a child has a complete heart block, their heart’s electrical signals do not pass normally from the atria to the ventricles.
Without receiving electrical impulses from the SA node, the ventricles continue to contract and pump blood. However, complete heart block causes them to pump slower than normal.
Diseases or heart muscle injuries can cause heart block. A congenital heart block can also be present when an unborn baby is in the womb.
A child with a complete heart block may require treatment with an artificial pacemaker.
The main causes of arrhythmia are:
- changes in the heart tissue
- changes in the electrical signals that control the heartbeat
- damage to the heart due to disease or injury
A common cause of arrhythmias in children is open-heart surgery. One 2017 review states that arrhythmias resulting from heart surgery occur in 7.5 to 48% of pediatric cardiac patients.
Different arrhythmias have a variety of differing symptoms. However, common symptoms of arrhythmias include:
- a fluttering sensation in the heart
- a feeling that the heart has skipped a beat
- fatigue and a feeling of weakness
- feeling lightheaded
- a rapid heartbeat and pounding in the chest
- shortness of breath
- chest pain
- pressure in the chest
In more extreme cases of arrhythmia, a child may collapse or experience sudden cardiac arrest, which is a medical emergency.
Arrhythmias can be difficult to diagnose in children as a child may be unable to explain their symptoms.
Often a doctor will diagnose an arrhythmia during a routine wellness exam or through another encounter with the child for a different reason.
If a doctor suspects a child has an arrhythmia, they will investigate further with general health questions. They may ask about the child’s medical history and listen to their heartbeat.
A doctor may ask the child’s caregiver about any prescribed and over-the-counter medications that the child may take. Certain medications can worsen the effects of some arrhythmias.
Doctors will also ask about any other medications that people have at home, as children are at risk of accidentally ingesting them.
A doctor may refer a child to a heart specialist, or cardiologist, for further evaluation and treatment.
A doctor may carry out the following tests to diagnose an arrhythmia:
- Electrocardiogram (ECG or EKG): An ECG is simple and painless. A medical professional attaches electrodes to the child’s chest to measure the heart’s electrical activity.
- Holter monitor: This is a small, portable ECG recorder that the child can wear for a longer period. The Holter monitor monitors the heart’s electrical activity for 24 hours or more to give a medical professional additional data to analyze.
- Transtelephonic monitor: This is a type of monitor that a person can wear for an even longer period to provide a doctor with more data about the heart’s electrical activity. A person can wear a transtelephonic monitor attached to a bracelet, finger clip, or a patch under the arms.
- Echocardiogram: An echocardiogram is an ultrasound of the heart. It is a painless procedure that uses sound waves to create an image of the heart’s size, structure, and motion.
Different types of arrhythmia require different treatments. However, common treatments for arrhythmias in children include:
- Medication: Certain medications can ease symptoms of an arrhythmia.
- Cardiac ablation: This procedure eliminates or scars tissues that may cause abnormal electrical signals in the heart.
- Artificial pacemaker: A doctor may fit a child with an artificial pacemaker. This device uses electricity to keep the heart beating regularly.
- Surgery: In some cases, a child may require surgery to correct an abnormal heartbeat.
If a child’s caregiver believes that their child has an arrhythmia, they should contact a doctor. This is because some symptoms may require immediate treatment.
A child may show signs of arrhythmia if they are experiencing symptoms such as dizziness, feeling faint or lightheaded, a rapid heartbeat, and feeling like their heart has skipped a beat.
A child with an arrhythmia may be able to lead a very fulfilling life. However, some types of arrhythmia are more serious than others, and some increase a person’s risk of heart disease and stroke.
A child’s caregiver and the child must be aware of activities or medications that may cause an arrhythmia. A doctor can explain what activities or medications a child should avoid.
A caregiver should also be able to check the child’s heart rate to monitor if it is particularly high or low.
The AHA recommends that caregivers of children with tachycardia learn how to slow the child’s heart rate if it becomes fast. Coughing or gagging can help slow the heart rate, and holding an ice pack against the child’s face can also work.
The AHA also recommends carrying out the Valsalva maneuver to lower a child’s heart rate. This involves having the child close their nose and mouth before straining to breathe out.
The American Academy of Pediatrics recommends that all caregivers of children receive training in basic life support.
Arrhythmia is the name for several conditions that affect a person’s heart rate. If a person has an arrhythmia, their heart may beat too slowly, too fast, or irregularly.
Some children with arrhythmia may experience no symptoms at all. However, common symptoms include a fluttering sensation in the chest, the feeling that the heart has skipped a beat, fatigue, dizziness, fainting, and shortness of breath.
Many types of arrhythmia may require no treatment at all. However, various treatment options are available for arrhythmias, including medications, an artificial pacemaker, cardiac ablation, and surgery.