An arrhythmia is a problem with the rate or rhythm of the heart. 

Arrhythmias are classified by the area of the heart where they occur (i.e. the upper chambers (atria) or lower chambers (ventricles). If your child has a cardiac arrhythmia, that means their heart may be beating abnormally fast or abnormally slow.

If a heart isn’t beating normally, it has trouble pumping blood to the rest of the body such as the brain and lungs. This can result in your child complaining of an irregular heartbeat, palpitation, rapid heartbeat, dizziness, shortness of breath and fainting.

It’s important, however, to recognize that children’s normal heart rates are faster than adults, even up to 200 BPM in an infant!  Further, your healthy athletic teenager will often have a normal slow heart rate at rest, as low as 50 BPM. So, not all fast or slow heart rates in your child are abnormal.

Types of arrhythmias

There are many types of causes of arrhythmias in children, including:

• Long-Q-T syndrome (LQTS): Long QT syndrome (LQTS) is a genetic condition that affects the flow of ions into and out of the cells in the heart. This abnormal flow of ions can prolong the patient’s QT interval, which is measured on an ECG. The prolonged QT interval affects how electrical impulses travel through the heart. Electrical activity may be transmitted abnormally through the lower heart chambers (ventricles) leading to potentially life-threatening ventricular arrhythmias. LQTS is usually, but not always, inherited.
• Premature atrial contraction (PAC) and premature ventricular contraction (PVC). PACs or PVCs are when individual cells within the heartbeat out of concert with the normal rhythm resulting in an early, extra heartbeat causing the sensation of a palpitation. Commonly found in children and adolescents, they are usually harmless and exacerbated by caffeine use. 
• Wolff-Parkinson-White Syndrome (WPW). WPW is an abnormality of the heart's electrical conduction system that can be associated with supraventricular tachycardia (SVT). In WPW syndrome, there is an extra electrical pathway (called an "accessory pathway") in the heart that can transmit electrical impulses from the upper chambers (atria) to the lower chambers (ventricles) of the heart. In the normal conduction system, there is only one electrical conduction pathway from the atria to the ventricles. It is called the atrio-ventricular node (AV node). A WPW pathway bypasses the AV node and can transmit electrical signals through the heart faster than through the AV node This can cause SVT or other abnormal heart rhythms.
• Supraventricular tachycardia (SVT), paroxysmal atrial tachycardia (PAT) or paroxysmal supraventricular tachycardia (PSVT). SVT is the most common type of abnormal fast heart rhythm in children. It often involves having an extra electrical wire (in addition to the AV node) between the atria and ventricles that causes electrical impulses to circle (reenter) between the upper and lower chambers causing an abnormally fast heart rate. It is not life-threatening. Treatment is typically needed if the tachycardia occurs often, lasts long or interferes with your child’s normal activities.  
• Sinus bradycardia. The normal biological slow heart rate that occurs with sleep and rest. Sinus bradycardia is a normal decrease in the heart rate but can be caused by heart block, medication or hormone imbalances.
• Sinus tachycardia. The normal biological fast heart rate occurs with fever, pain, excitement and exercise. Sinus tachycardia is a normal increase in the heart rate but can be caused by medication, caffeine or hormone imbalances.
• Sinus node dysfunction (SND). The heart's natural pacemaker, the sinus node, is located in the right atrium and allows the heart rate to increase and decrease in response to the body's activity level. Sinus node dysfunction (SND) can occur in patients with congenital heart disease (CHD), especially those who have had cardiac surgery, causing the heart rate to be slower than expected during activities.
• Ventricular tachycardia (VT). VT is an abnormally fast heartbeat of the ventricles (lower chambers). This rapid heartbeat of the ventricles can be dangerous, particularly in patients with genetic arrhythmia syndrome-like long QT syndrome, and lead to sudden cardiac arrest.  In some children, however, it is a benign arrhythmia that may resolve on its own. 
• Complete heart block. This is when the electrical signals from the upper chambers fail to conduct normally through the AV node to the lower chambers. The heart usually beats considerably slower than normal. Infants can be born with this problem or it may occur after heart surgery.

What are the symptoms?

The symptoms of an arrhythmia may present like other health conditions or heart problems. Some children might not even show symptoms. It is important your child sees an expert pediatric cardiologist for an accurate diagnosis.

Some common symptoms of arrhythmias include:

• A slow heartbeat
• A fast heartbeat 
• Heart palpitations, a sensation that the heart is racing, pounding or skipping a beat
• Feeling lightheaded or dizzy
• Fainting or near fainting (syncope)
• Paleness
• Chest pain
• Shortness of breath
• Tiredness
• Difficulty feeding

What causes arrhythmia?

Arrhythmias can be caused by inherited abnormalities of the heart, congenital heart defects or acquired, for example, by drinking caffeine.

Some known causes in children include:

• A normal reaction to exercise, fever or emotions 
• Abnormalities of the heart muscle (cardiomyopathy) 
• Abnormalities of the heart conduction system (WPW)
• Inflammation/infection of the heart muscle (myocarditis)
• A heart defect that the child is born with (congenital heart disease)
• Inherited genetic arrhythmia syndromes (Long QT syndrome, Brugada syndrome)
• Medications/caffeine/illicit drugs

Diagnosing and treating arrhythmias

Our team of pediatric cardiologists at CHoR can determine if your child is having a heart arrhythmia.   

Tests used to diagnose arrhythmias in children:

• Electrocardiograms
• Holter monitors: heart monitors that will record your child’s heartbeat over a period of time
• Event monitors: heart monitors that will record your child’s heartbeat during symptoms
• Exercise stress test
• Implantable loop recorders
• Intracardiac electrophysiology study

Depending on the type of arrhythmia your child has, our team will recommend a comprehensive treatment plan.

Treatment options include:

• Medications to control arrhythmias.
• Electrophysiology studies: A specialized heart catheterization to evaluate the heart’s electrical system to determine the mechanism of your child’s arrhythmia
• Ablation: Part of the electrophysiology study, ablation techniques are used to cure your child’s heart arrhythmia problem.  
• Pacemakers: Implantable devices to support and prevent your child from having abnormally slow heart rhythms. 
• Implantable cardioverter-defibrillators (ICD):  Implantable devices to convert ventricular tachycardia to a normal sinus rhythm, thereby, preventing sudden cardiac death.

It is important to know that many pediatric arrhythmias are treatable, curable and don’t typically lead to sudden death. Additionally, most children with these diagnoses do not require exercise or sports restrictions and may be treated normally.

How long can you live with this?

Thankfully, most children treated for arrhythmias live normal, healthy lives. Depending on the type of arrhythmia, they may require life-long follow-up but are still able to develop normally, have children and live happy, active and fruitful lives.

Arrhythmia care at CHoR

Our pediatric electrophysiologist and pediatric cardiologists are here to help care for your child. Our team will diagnose and treat your child’s condition so they can spend time just being a kid. 

• Dr. John Phillips is the only pediatric-trained electrophysiologist in the Central Virginia area. His training, bedside manner and years of experience caring for children puts families at ease during this stressful time. 
• We offer the region’s most advanced imaging and testing services for children with heart abnormalities. 
• Our team provides care across a range of specialties so we can achieve the best outcomes for both simple and complex cases. From our fetal cardiologists and child life specialists – to our dedicated nurse educators and navigators – we’re here to help your family every step of the way.

Learn more about our electrophysiology program