Arrhythmia Clinic For Children

Arrhythmias in normal infants & children

• Sinus arrhythmia
• Transient 2o AV block
• Atrial / ventricular extrasystoles
• Short runs of VT
• Sinus bradycardia, sinus pauses

Major arrhythmias in infants & children

• Supraventricular Tachycardia (SVT)
• Ventricular tachycardia (VT)
• Complete Heart Block (CHB)
• Arrhythmias in special settings

SVT

• Commonest serious arrhythmia in children
• Mechanism - reentry commonest
  • Accessory pathway (80%)
  • AV Nodal re-entry (20%)

SVT Presentation

Neonates/infants

• Unexplained "sickness"
• Recognition by parents
• CHF / Shock

Children

• Palpitation
• Recognition by parents

SVT Treatment

• Patient's factors : - age
  • normal or abnormal heart
  • frequency and duration of T.
  • symptoms, hemodynamics
  • other drugs
• Doctor's factors: - personal drug preference
  • culture
• Vagal maneuvers
• Anti-arrhythmic drugs ( i.v. or oral)
• Electrical termination
  • DC cardioversion
  • Endocardial pacing
  • Trans-esophageal pacing
• Adenosine 100-500 microgram/kg BOLUS
• Verapamil-contraindicated < 4 yrs.Useful in older children.0.1mg/kg iv.
• Propranolol 0.1mg/kg iv
• Digitalisation
• Propafenone , Flecainide 0.5-2 mg/kg iv
• Amiodarone 5mg/kg in 30 min,0.5-1mg/hr
• Cardioversion 05-1 J/kg

VENTRICULAR TACHYCARDIA

• Rare ,but does occur in children.
• Long QT syndrome,post cardiac surgery,idiopathic
• Rapid deterioration may occur
• IV Lignocaine o.5 mg/kg bolus, Amiodarone
• Cardioversion