Arrhythmias in Children
What is an arrhythmia?
An arrhythmia is any change in the regular, even rhythm of the heartbeat. If your child has an arrhythmia, his or her heart might beat too fast or too slow, or it might skip a beat or have extra beats. An arrhythmia might result from a physical condition — such as a heart defect —or in response to outside factors, such as a fever, infection, and certain medications. Even crying and playing can briefly alter a child’s heart rate.
Most arrhythmias are harmless, but some can be serious and even life-threatening. If your child’s heart beats too fast (a condition known as tachycardia), or too slow (bradycardia), it might affect the heart’s ability to pump blood efficiently to the rest of the body. Irregular blood flow can damage organs, including the kidneys, liver, heart, and brain.
How does an arrhythmia occur?
The pumping action of the heart is powered by an electrical pathway that runs through the nerves in the walls of the heart. With each heartbeat, an electrical signal is generated and travels from the top of the heart to the bottom.
The signal begins in a group of cells in the right atrium (the upper right chamber of the heart) called the sinoatrial node (SA node). From there, the signal travels through special pathways to stimulate the right and left atria, causing them to contract and send blood into the ventricles (the bottom chambers of the heart).
The current continues through its circuit to another group of cells called the atrioventricular node (AV node), which is between the atria and the ventricles. From there, the electric current moves on to another pathway called the bundle of His, where the signal branches out to stimulate the right and left ventricles, causing them to contract and send blood to the lungs and the rest of the body.
When the circuit is working properly, the heart beats at a regular, smooth pace. When something interrupts the circuit, the heartbeat can become irregular, and an arrhythmia occurs.
Types of arrhythmias
There are many types of arrhythmias, which can grouped into three general categories: supraventricular (atrial) arrhythmias, ventricular arrhythmias, and bradyarrhythmias.
Atrial arrhythmias in children include:
- Premature atrial contractions (PACs) — early beats that start in the atria
- Supraventricular tachycardia (SVT) — a rapid, usually regular rhythm, starting from above the ventricles (SVT begins and ends suddenly)
- AV nodal reentrant tachycardia (AVNRT) — a rapid heart rate due to more than one pathway through the AV node
- Atrial fibrillation — a condition in which many impulses begin and spread through the atria, competing for a chance to travel through the AV node
- Atrial flutter — an arrhythmia caused by one or more rapid circuits in the atrium
- Wolff-Parkinson-White syndrome — a condition in which an electrical signal may arrive at the ventricle too quickly due to an extra conduction pathway or a shortcut from the atria to the ventricles
Ventricular arrhythmias in children include:
- Premature ventricular contractions (PVCs) — early extra beats beginning in the ventricles. These occur when the electrical signal starts in the ventricles, causing them to contract before receiving signals from the atria
- Ventricular tachycardia (V-tach) — a life-threatening condition in which electrical signals start from the ventricles in a fast and irregular rate
- Ventricular fibrillation — an irregular, disorganized firing of impulses from the ventricles
- Sinus node dysfunction — a slow heart rhythm due to an abnormal SA node
- Heart block — a delay or complete block of the electrical impulse from the SA node to the ventricles
Symptoms and Causes
What causes arrhythmias in children?
An arrhythmia can occur as a result of internal factors, such as a disease of the heart muscle itself (cardiomyopathy) or a heart defect the child had when he or she was born (congenital heart disease). Other common causes of arrhythmia in children include:
- Chemical imbalances
How will I know if my child has an arrhythmia? What are the symptoms?
Recognizing symptoms of an arrhythmia depends on the age and maturity of your child. Older children can tell you about feeling lightheaded or feeling his or her heart fluttering or "skipping beats." For infants and toddlers, you might notice changes such as paleness of the skin, irritability, and disinterest in eating. Some common symptoms of arrhythmias include:
- Feeling lightheaded or dizzy
- Fainting or near fainting
- Chest pain
- A slow heartbeat
- A fast heartbeat
- Feeling pauses between heartbeats
- Shortness of breath
- Difficulty feeding (infants)
- Irritability in infants
Diagnosis and Tests
How are arrhythmias diagnosed?
The doctor will begin with a thorough history, including a review of symptoms, and a physical exam. He or she might order blood tests to rule out medications and infections as the cause of the arrhythmia. The doctor may do a test called an electrocardiogram (ECG), which records the heartbeat, to see if it is beating regularly. The doctor might consult a pediatric cardiologist, a doctor who specializes in children’s heart disorders.
If your child does not have symptoms of arrhythmia at the time of the ECG, the doctor might order a different type of device to record your child’s heartbeat. These include portable monitors you take home with you that continuously record your child’s heartbeat over a period of days to months. Implantable monitors that can be worn for up to a year or more are also available.
Other tests that might be needed, depending on your child’s situation, include:
- Electrophysiology tests — During this test, a small, thin tube is inserted into a blood vessel in the leg or arm and advanced to the heart. This allows the doctor to find the site of the arrhythmia’s origin within the heart tissue.
- Tilt table test — This test is often used in children who have frequent fainting episodes. A tilt table test shows how the heart rate and blood pressure respond to a change in position, lying down to standing up.
Management and Treatment
How are arrhythmias treated?
Many arrhythmias in children are isolated occurrences and harmless, and do not need treatment. In many cases, arrhythmia is treated by treating the underlying problem, such as fever.
Treatment, when needed, depends on the child’s age and the type and cause of the arrhythmia. Treatment options include:
- Medicine: Many arrhythmias respond to medicine and need no other treatment. However, medicines have side effects and have to be watched closely.
- Radiofrequency ablation: This procedure involves a cardiac catheterization and uses radiofrequency energy applied to the area where the arrhythmia begins, heating it and causing tissue death. This is generally used to cure many forms of tachycardia.
- Cardioversion: This is a procedure in which an electrical shock is delivered to the heart to convert an irregular or fast heart rhythm to a normal rhythm.
- Implantable devices:
- Pacemakers: These are small devices, placed just under the skin, that use electrical pulses to control abnormal heart rhythm.
- Implantable cardioverter defibrillator (ICD): These devices are also placed under the skin. They use electrical pulses or shocks to help control life-threatening arrhythmias.
- Surgery — A procedure called Maze surgery can be used to treat atrial fibrillation. During Maze surgery, the surgeon makes small cuts or burns in the atria to prevent the spread of disorganized signals.
Outlook / Prognosis
What is the prognosis (outlook) for a child with an arrhythmia?
Most arrhythmias in children are harmless and do not lead to significant health problems in the future. Even serious arrhythmias can be successfully treated. Depending on any underlying heart disease, the outlook for children with arrhythmias is positive.
When should I take my child to the doctor?
In many cases, arrhythmias in children are harmless. However, when arrhythmias occur outside of exercise and play, occur often, or last a long time -- especially in combination with any of the symptoms listed above -- you should take your child to a healthcare professional.
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