Cardiac causes of arrhythmia in children include, first of all, congenital heart defects (Ebstein’s anomaly, atrial septal defect, open atrioventricular canal, Fallot’s tetrad), cardiopulmonary bypass surgery, DMPP, etc., acquired heart defects.
All causes leading to arrhythmia in a child can be divided into cardiac (cardiac), extracardiac (non-cardiac) and mixed.
The defeat of the pathways of the heart in children can develop as a result of myocarditis, myocardial dystrophy, dilated and hypertrophic cardiomyopathy, transferred vasculitis and rheumatism.
In some cases, the cause of arrhythmias in children are heart tumors, pericarditis, heart injuries, accompanied by hemorrhage in the area of pathways, intoxication. Serious infections can provoke arrhythmia in children: angina, diphtheria, pneumonia, bronchitis, intestinal infections, sepsis, accompanied by fluid loss and leading to electrolyte disturbances. The iatrogenic causes of arrhythmias in children include mechanical effects when sounding the cardiac cavities and performing angiography.
Children may have congenital rhythm disturbances caused by abnormalities of the conduction system (WPW syndrome), arrhythmogenic right ventricular cardiomyopathy, etc.
Extracardiac arrhythmias in children can be a pathological course of pregnancy and childbirth, prematurity, intrauterine malnutrition of the fetus, leading to the immaturity of the cardiac conduction system and the violation of its innervation. Among non-cardiac arrhythmia mechanisms in children, an important role is played by functional disorders of the nervous system (emotional overstrain, vegetative-vascular dystonia), endocrine disorders (hypothyroidism, thyrotoxicosis), blood diseases (iron deficiency anemia), etc.
They talk about mixed arrhythmias in children if there is a combination of organic heart disease and disorders of the neurohumoral regulation of its activity.
Sinus arrhythmia in children can often be functional, that is, it is a natural reaction of the body to hot weather, inadequate physical exertion, strong emotions, etc.
Child arrhythmia classification
The most common classification of arrhythmias in children is their separation according to myocardial dysfunction (automatism, excitability, conduction, and their combinations). According to this principle, violations of automatism include sinus arrhythmia in children, sinus bradycardia, sinus tachycardia, pacemaker migration, and slow sliding rhythms.
Arrhythmias in children caused by impaired myocardial excitability include extrasystoles, non-paroxysmal and paroxysmal tachycardia, atrial fibrillation (atrial fibrillation and flutter), ventricular fibrillation and flutter.
Disorders of the conduction function are represented by the sinoatrial block, intra-atrial and intraventricular block, and atrioventricular block. Combined arrhythmias in children include WPW syndrome, long QT interval syndrome, sick sinus syndrome.
Based on the clinical significance of arrhythmias in children, they are divided into 2 groups. Clinically insignificant arrhythmias in children include unstable, asymptomatic, not affecting the child’s well-being and prognosis of rhythm (single extrasystoles, migration of a pacemaker during sleep, not manifesting clinically sinus bradycardia and tachycardia, etc.). A group of clinically significant arrhythmias in children consists of persistent arrhythmias that affect the child’s well-being and prognosis (frequent extrasystoles, paroxysmal arrhythmias, SSS, WPW syndrome, etc.).
Symptoms of arrhythmia in a child
About 40% of arrhythmias in children are detected by chance, in the course of a routine medical examination or during the examination of a child after an illness. In other cases, the clinical manifestations of arrhythmia in children are not specific. In infants, arrhythmia should be suspected when paroxysmal dyspnea appears, skin color changes (pallor or cyanosis), restless behavior, refusal to eat or sluggish sucking, poor weight gain, poor sleep, pulsation of the neck vessels.
An arrhythmia in an older child may be accompanied by increased fatigue, poor exercise tolerance, unpleasant sensations in the heart area (interruptions, fading, a strong jolt), hypotension, dizziness and fainting.
Potentially dangerous arrhythmias in children with an increased risk of sudden death include prolonged QT interval, ventricular tachyarrhythmias, accompanied by hypoxic encephalopathy, myocardial ischemia, and acute heart failure.
Diagnosis of arrhythmia in a child
Objectively, in children with arrhythmias, slowing down or an increase in heart rate compared with the age norm, irregularity of heart contractions, and pulse deficit are detected. When assessing the pulse in children should take into account the age norms: for example, in newborns the heart rate is 140 beats. in min.; 1 year – 120 beats. in min.; in 5 years – 100 beats. per minute, at 10 years old – 90 beats. in min.; adolescents – 60-80 beats. in minutes
Electrocardiographic examination of children with arrhythmia includes ECG recording lying, standing, and after insignificant physical exertion. This approach allows us to identify vegetative rhythm disturbances. Daily ECG monitoring does not limit the patient’s free activity and today can be carried out for children of any age, including newborns. With the help of Holter monitoring any forms of arrhythmia in children are detected.
GPCR is used in the examination of older children.
- Studies using stress tests (bicycle ergometry, treadmill test) are indispensable for identifying latent rhythm and conduction disturbances, determining exercise tolerance, and predicting the course of arrhythmias in children. In pediatric cardiology, pharmacological tests (atropine, potassium-obsidan) are used to detect arrhythmias. In order to detect the organic causes of arrhythmias in children, echocardiography is performed.
To determine the relationship of arrhythmias in children with the state of the central nervous system, EEG, rheoencephalography, radiography of the cervical spine, a consultation of a children’s neurologist are performed.
Arrhythmia Treatment in Children
Functional arrhythmias in children do not require treatment; in this case, parents should pay attention to the organization of the child’s day regimen, proper rest, moderate physical activity. In the treatment of clinically significant arrhythmias in children, conservative medical and surgical approaches are used.
In all cases, therapy should begin with the exclusion of factors causing arrhythmia in children: treatment of rheumatism, rehabilitation of chronic foci of infection (adenotomy, tonsillectomy, treatment of caries, etc.), cancellation of drugs that cause rhythm disturbances, etc.
Conservative pharmacotherapy of arrhythmias in children includes three areas: the normalization of the electrolyte balance of the myocardium, the use of anti-arrhythmic drugs, the improvement of cardiac muscle metabolism. By means of normalizing electrolyte balance, are preparations of potassium and magnesium. Antiarrhythmic therapy is carried out with procainamide, propranolol, amiodarone, verapamil, etc. For the purpose of metabolic support of the myocardium, cocarboxylase, riboxin, calcium pangamat are used.
In case of arrhythmias resistant to drug therapy in children, minimally invasive surgical treatment is indicated: radiofrequency ablation or cryoablation of pathological arrhythmogenic zones, implantation of a pacemaker or cardioverter defibrillator.
Prevention of arrhythmia in children
The course of arrhythmias in children is determined by the causes and the possibility of their elimination, as well as the degree of hemodynamic disorders. With functional arrhythmias, the prognosis is favorable. Atrial fibrillation increases the risk of heart failure and thromboembolic complications. The greatest concern about the risk of sudden death is caused by arrhythmias in children, developing on the background of organic heart disease, AV-blockade of the III degree, combined arrhythmias.
Prevention of arrhythmias in children involves the elimination of predisposing factors, the treatment of major diseases, preventive examination of the cardiovascular system. Dispensary observation of children with arrhythmia is performed by a pediatrician, pediatric cardiologist, according to indications, a children’s endocrinologist, a children’s neurologist, a children’s rheumatologist, etc.
Arrhythmia in children is a variety of cardiac abnormalities, manifested in changes in the frequency, consistency, or regularity of heart contractions. Manifestations of arrhythmias in children are usually not specific: weakness, shortness of breath, pallor of the skin, refusal to eat, fatigue, fainting. Diagnosis of arrhythmia in children includes ECG recording, daily heart monitoring, EEG, echocardiography, stress tests. In the treatment of arrhythmias in children, medical and non-drug methods (RFA, cryoablation, implantation of antiarrhythmic devices) are used.
Arrhythmia in children is a variety of cardiac rhythm changes of origin, resulting from dysfunction of automatism, excitability and conduction of the heart. In pediatrics and pediatric cardiology, there are as many heart rhythm disturbances as in adults.
Arrhythmias in children are detected in all age groups, but the periods of greatest risk for the development and manifestation of arrhythmias are the neonatal period, 4-5 years, 7-8 years, and 12-14 years. That is why it is advisable to provide for mandatory consultations of a pediatric cardiologist and ECG screening as part of the clinical examination of children of this age.
Statistical analysis of the prevalence of arrhythmias in children is difficult due to the fact that even in healthy children there are episodes of heart rhythm disturbances: migration of the pacemaker, bradycardia, tachycardia, extrasystole, WPW phenomenon, atrioventricular degree I arrhythmias, etc. therapy and prognosis in children have their own characteristics.