Abstract
Of the over 25 million yearly pediatric emergency room (ER) visits in the United States, primary cardiac-related issues in children <18 years of age are much less common than seen in adults who frequently present with acute coronary issues (Wier et al., Overview of children in the emergency department 2010. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, 2013). However, heart rate changes and arrhythmias occur not infrequently, and monitoring the rate and rhythm and obtaining an electrocardiogram (ECG) are often useful. Since children are seen in many ER settings from those in a dedicated children’s hospital to primarily adult-oriented hospitals, to urgent care facilities, and to rural areas where pediatric specialty services may not be readily available, interpretation of pediatric ECGs often becomes the responsibility of physicians who may have limited experience with the age-related variances of ECG patterns among children with and without congenital heart defects (CHD) (Lee et al., Korean Circ J 40: 36–41, 2010). In addition, with the increasing numbers of patients with repaired congenital heart defects surviving into adulthood who present to emergency rooms with various complaints, variations of their ECGs associated with their underlying anatomical/structural CHD may mimic ECG findings associated with ischemic coronary disease. In this regard, close examination of the full 15-lead ECG, rather than a single rhythm strip, is often required for proper interpretation. In addition the computer interpretation of ECGs may be erroneous with a reported error rate up to 75% which can result in unnecessary additional testing and costs, as well as patient distress and inappropriate referrals to cardiac specialists (Shah and Rubin, J Electrocardiol 40: 385–390, 2007; Guglin and Datwani, J Electrocardiol 40: 144–146, 2007).
The purpose of this chapter is to enable the reader to identify commonly seen normal and abnormal ECGs and the diverse rhythm disturbances seen in children and adults with various congenital heart defects. In addition, specific pathophysiologies of arrhythmias and appropriate therapies will be presented.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wier LM, Yu H, Owens P, Washington R. Overview of children in the emergency department 2010. Rockville, MD: Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; 2013.
Lee YS, Baek JS, Kwon BS, Kim GB, BAe EJ, Noh C, Choi JY, Yun YS. Pediatric emergency room presentation of congenital heart disease. Korean Circ J. 2010;40:36–41.
Shah AP, Rubin SA. Errors in the computerized electrocardiogram interpretation of cardiac rhythm. J Electrocardiol. 2007;40(5):385–90.
Guglin ME, Datwani N. Electrograms with pacemakers: accuracy of computer reading. J Electrocardiol. 2007;40:144–6.
Seppala S, Laitinen T, Tarvainen MP, Tompuri T, Veijalainen SK, Lakka T. Normal values for heart rate variability parameters in children 6-8 years of age: the PANIC study. Clin Physiol Funct Imaging. 2014;34:290–6.
Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, Tarassenko L, Mant D. Normal ranges of heart rate and respiratory rate in children from birth to 18 years: a systematic review of observational studies. Lancet. 2013;19:377–92.
Tang CW, Scheinman MM, VanHare GF, Epstein LM, Fitzpatrick AP, Lee RJ, Lesh MD. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol. 1995;26:1315–24.
Yap Y, Camm J. Drug induced QT prolongation and torsade de pointes. Heart. 2003;89(11):1363–72.
Woosley RL, Romero K. Assessing cardiovascular drug safety for clinical decision-making. Nat Rev Cardiol. 2013;10:330–7.
Vink AS, Clur SB, Geskus RB, Blank AC, De Kezel CC, Yoshinaga M, Hofman N, Wilde AA, Blom NA. Effect of age and sex on the QTc interval in children and adolescents with type 1 and 2 long-QT syndrome. Circ Arrhythm Electrophysiol. 2017;10(4):pii: e004645.
Safa R, Thomas R, Karpawich PP. Electrocardiographic early repolarization characteristics and clinical presentations in the young: a benign finding or worrisome marker for arrhythmias. Congenit Heart Dis. 2017;12(1):99–104.
Saoudi N, Cosío F, Waldo A, Chen SA, Iesaka Y, Lesh M, Saksena S, Salerno J, Schoels W, Working Group of Arrhythmias of the European of Cardiology and the North American Society of Pacing and Electrophysiology. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22(14):1162–82.
Blaufox AD, Rhodes JF, Fishberger SB. Age related changes in dual AV nodal physiology. Pacing Clin Electropysiol. 2000;23:477–80.
Obeyesekere M, Gula LJ, Skanes AC, Leong-Sit P, Klein GJ. Risk of sudden death in Wolff-Parkinson-white syndrome. How high is the risk? Circulation. 2012;125:659–60.
Mond H, Karpawich PP. Pacing options in the adult patient with congenital heart disease. Malden, MA: Blackwell Futura (Pubs); 2007.
Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot N, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease. Heart Rhythm. 2014;11:e102–65.
Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes:document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10:1932–63.
Johnson JN, Ackerman MJ. QTc: how long is too long? Br J Sports Med. 2009;43:657–62.
Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E, European Heart Rhythm Association; Association for European Paediatric and Congenital Cardiology. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15:1337–82.
Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm. 2014;11:e55–78.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Safa, R., Sriram, C., Karpawich, P.P. (2018). Arrhythmia Identification: Stabilization and Treatment. In: Sarnaik, A., Ross, R., Lipshultz, S., Walters III, H. (eds) Cardiac Emergencies in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-73754-6_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-73754-6_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-73753-9
Online ISBN: 978-3-319-73754-6
eBook Packages: MedicineMedicine (R0)