Arrhythmias are the conditions of the heart in which the heart's beating or rhythm is irregular. Arrhythmia can affect both adults and children alike. When a child has arrhythmia, it could mean that the heart may be beating too fast, it may be beating too slow, or it can skip a beating. In simpler terms, the beating is not of a regular fashion.
The rhythm of the heart is electrically generated. The heartbeat is generated by the SA (Sinoatrial) node. At the right atrium(top right chamber of the heart) is the SA node of the heart. This node generates electrical impulses responsible for the heart's pumping action. When the heart pumps, the blood moves from the atrium (upper chamber) to the ventricle (lower chamber). There also happens an exchange of ions such as carbon dioxide and oxygen. The oxygenated blood is then pumped into the organs. When the heart's rhythm is improper, any of the above-mentioned steps can be compromised.
What Are the Symptoms of Arrhythmia Is Children?
The following may be the symptoms of arrhythmias in children.
-
The child may complain of pain in the chest. However, it may not be possible for smaller children and infants to convey this. Hence, it is important to look out for other symptoms.
-
It may feel like the heartbeat is very rapid, and the palpitations are visibly felt.
-
The child may present with fatigue and overall tiredness. This tiredness may be reported very frequently.
-
The child can present with breathing difficulties and breathlessness upon exertion. Sometimes, after extreme physical activity, there could be dizziness as well as lightheadedness.
-
Other common symptoms may include fussiness to eat and general irritability. This is seen when the child cannot express his discomfort that is otherwise felt.
-
The most severe symptoms can include - syncope (loss of consciousness), seizures, and sudden cardiac arrest.
What May Be the Causes of Arrhythmias in Children?
Arrhythmias can be caused due to various congenital anomalies of the heart. In some cases, it can also be caused by other factors, such as-
-
Various congenital anomalies of the heart. These anomalies have a genetic predisposition and have been present since birth.
-
Thickening of the cardiac musculature. This condition is otherwise known as cardiomyopathy. This leads to the improper generation of cardiac impulses.
-
Other inherited anomalies include prolonged QT (a condition in which the time between two impulses is very long.
-
Effect of other medications on the heart. Sometimes, the child may be taking medication for other conditions that could present with arrhythmia-like symptoms.
-
Imbalances in the body, such as a chemical imbalance and electrolyte imbalance.
-
Any conditions that can cause fever in the body, such as fever.
-
Bacterial or viral infections in the body.
What Is Electrophysiology Study and Ablation in Arrhythmia?
An electrophysiology study is a diagnosis cum treatment procedure in the treatment of arrhythmia. In this procedure, a small tube is inserted in the vein of the limb. This moves all the way up to the heart to study the source of faulty heart rhythms.
-
Electrophysiology Study: It is a special diagnostic procedure performed to understand the source of the irregularity in the heart impulses. This procedure is performed by specially trained doctors (a pediatric electro-physiologist). For this procedure, the child may be put under general anesthesia or conscious sedation as deemed necessary by the cardiologist of the child. For the EP study, the doctor uses specialized catheters to study the heart’s impulses. These catheters are placed at various locations in the heart and the impulses generated are recorded. The abnormalities are localized to the site based on this test.
-
Ablation: Ablation is a rectifying process that is carried out to ease out the extra impulse or the skipped beat. After the site of the defect or the abnormality is found, a process called ablation or cryoblation may be carried out. In this procedure, catheters with special tips are used. These tips generals small electrical impulses (radiofrequency) that cause the tiny tissue in that region to die. This can re-establish the blood flow in that particular region. It can also rectify the cause of the extra electrical impulse that is being generated. In cryoblation, the tip is cooled and not heated. The effects of both processes are, however, the same. This procedure helps in nullifying the region responsible for causing the rapid heartbeat.
What Happens During This Procedure?
The following may be the steps involved in this procedure:
-
Before the Procedure: Since this is a minimally invasive procedure, a certain set of precautions will be taken before the procedure. After the preliminary investigations, an appointment for the cath procedure will be finalized. There may be certain dietary restrictions as this procedure is usually performed under general anesthesia. Other specific precautions should be taken on the advice of the child’s physician.
-
During the Procedure: This procedure is performed by specialized pediatricians known as the electro-physiologist. This procedure takes place in the catheterization lab of the hospital. After the child has settled, general anesthesia or conscious sedation is administered based on the doctor’s and patient’s needs. After this, the catheter is inserted through the veins of the upper or lower limb. After studying the signals, the procedure is performed.
-
After the Procedure: After the procedure, the child will be shifted to the recovery room for the anesthesia to wean out. The child may be under observation for the remainder of the day.
What Are the Benefits and the Risks of This Procedure?
The advantages of this procedure outweigh the risks and complications. Since this procedure can be very effective in eliminating arrhythmia, it is one of the most preferred treatment modalities. However, some of its complications may include:
-
Perforation of the artery or vein by the catheter.
-
Injury to the heart nodes (SA and AV node).
-
Brachial plexus injury.
Conclusion:
Arrhythmia causes irregular heartbeats in patients. Heart palpitations are one of its major symptoms. In a child, it occurs mostly due to congenital reasons. Electrophysiological study and ablation is a diagnosis-cum-treatment methodology used to treat arrhythmia. It is very effective as it helps in nullifying the extra impulses that are generated.
