Procedures
Understanding these options can help families work with their care team to choose the best approach for their child.
Cardiac (Heart) Ablation for Children
A cardiac (heart) ablation is a procedure to treat heart arrhythmias. An ablation is done by placing long, soft, flexible tubes called catheters into the big blood vessels in the body. These catheters are used for diagnosis of the arrhythmia and ablation where they burn or freeze an area in the heart to eliminate the source of the arrhythmia. Ablation can cure arrhythmias that occur in the upper chambers (atria) or lower chambers (ventricles) of the heart.
Cardioversion in Children
Cardioversion is a medical procedure to treat heart arrhythmias and restore a normal heart rhythm. There are two different types of cardioversion:
Direct current cardioversion is done by sending an electronic shock to your heart through patches or paddles placed on the chest to quickly restore a normal heart rhythm. Sedation or general anesthesia will be given prior to direct current cardioversion. In most instances, patients can go home the same day as their procedure.
Medical cardioversion is done by giving an anti-arrhythmic medication either by mouth or in an IV to restore a normal heart rhythm. The effect of these medications can take a few hours to work.
Electrocardiogram (ECG/EKG) for Children
An electrocardiogram (ECG), sometimes called an EKG, is a noninvasive test that records the electrical signals of your heart and can help diagnose many common heart problems. For this test, small, sticky patches called electrodes are placed at specific locations on the skin and attached to wires and a recording machine. This test takes only a few seconds.
Echocardiogram (Echo) for Children
Echocardiogram (or an echo) uses ultrasound waves to show images of your heart. An echo can show how well the heart is functioning (squeezing) and will identify if there are any structural heart abnormalities.
Exercise Stress Tests for Children
Exercise ECGs, also called Exercise Stress Tests require electrodes to be placed on the skin just like resting ECGs. However, instead of lying down, patients will engage in physical activity, like walking on a treadmill or pedaling a stationary bike, with the ECG recording the entire time. This test is used to look for arrhythmias during exercise or changes in the ECG that may occur as the result of exercise. Brief post exercise ECG monitoring will also be recorded while you recover from the exercise test.
Electrophysiology (EP) Studies in Children
An electrophysiology study involves studying the heart's electrical activity to look for irregularities that cause arrhythmias. Electrophysiology (EP) studies are typically performed in patients with known abnormally fast heart rates, called tachyarrhythmias. Patients with structural congenital heart disease can have any of these arrhythmias but are also more likely than other people to develop atrial flutter and, sometimes, atrial fibrillation. Some patients with specific kinds of ventricular tachycardia may benefit from EP study as well. The key point to remember is that whatever the arrhythmia is called, it is caused by something abnormal in the heart's electrical system.
Cardiac MRI for Children
Cardiac MRI uses a powerful magnetic field, radio waves and a computer to produce the detailed structures of the heart. This is a useful tool to evaluate structures that may be difficult to visualize by echocardiography. Details regarding scar within the heart muscle can be seen by cMRI and is useful when evaluating a patient for many different types of cardiac diseases.
Genetic Testing & Counseling for Children
Genetic testing and genetic counseling can be valuable tools when evaluating patients, and their family members, for channelopathies (Long QT Syndrome, CPVT, Brugada). The genetic changes that cause some channelopathies may even guide your cardiologist or electrophysiologist (a cardiologist who specializes in heart rhythm conditions) to choose one specific medication. If a known disease-causing genetic mutation (a change in the gene’s sequence or pattern) is found in a patient, it can help direct future testing in other family members to determine their risk of developing the disease.
While genetic testing is valuable in both diagnosis and prognosis, it has limitations as well. Sometimes, a genetic change may be found that has not been shown to be disease-causing, but also has not been found to be harmless. In addition, a genetic defect may be present but it is not able to be detected with current testing. Genetic testing is expensive, especially during the initial evaluation, because many genes may need to be tested. These costs may or may not be covered by a patient’s medical insurance. Finally, testing may take weeks to months to complete, and this waiting period can be very stressful for patients and their families.
The decision about whether or not to do genetic testing is best made after thoughtful discussion with your healthcare team.
For more information about genetic testing, visit SADS.org
Devices
Explore detailed information on implantable cardiac devices, how they work to protect your child's heart health, and what living with them looks like day-to-day.
Event Monitors for Children
Event monitors are long-term rhythm monitors that are worn outside the body. They are often programmed to record arrhythmias automatically and also allow patients to trigger recordings when they have symptoms. Some are worn continuously and some are worn to record during symptoms. These monitors can be a single large sticker (patch monitor) or can have electrodes (small, sticky patches) attached to wires and a device for transmitting information. Certain monitors may require restriction from certain activities, such as swimming or contact sports, to prevent damage to the device.
These recordings are usually reviewed by a monitoring service and may not be immediately available to your healthcare team. Some monitors can send information at the moment a patient feels symptoms or an arrhythmia is detected. Other monitors are sent back via mail and then downloaded.
There are also commercial products available that can be worn, such as smart watches, rings, or cell phone accessories that can record heart rates and heart rhythms. These products are compatible with most smart phones and can save the ECG tracings for review by your cardiologist/electrophysiologist. While some of these devices are approved by the Food and Drug Administration (FDA) for detecting certain arrhythmias, these approvals do not typically include children or any patients with congenital heart disease.
Your cardiology team will discuss which type of event monitor is right for you.
Implantable Cardioverter Defibrillators (ICDs) in Children
An implantable cardioverter defibrillator (ICD) is a special type of cardiac device that can recognize abnormal heart rhythms in the bottom part of the heart and deliver therapy if needed to restore the heart to a normal rhythm.
Implantable Loop Recorders (ILRs) in Children
Implantable loop recorders (ILR) are small event monitors implanted under the skin that are battery-powered and can stay in place for years. ILRs allow for long-term monitoring of your heart rhythm. ILRs can automatically detect arrhythmias and have a patient-activated recorder for symptomatic episodes.
Pacemakers for Children
A pacemaker is a device that uses low energy electrical pulses to prompt the heart to beat whenever a pause in the rhythm is detected. They can help to coordinate electrical signals between the upper and lower chambers so they will beat in a coordinated fashion. Pacemakers can help speed up a slow heart rate.
Remote Monitoring for Children
Patients with cardiac devices such as pacemakers, implantable cardioverter defibrillators (ICDs) or insertable cardiac monitors/implantable loop recorders (ICM/ILRs) have the option of remote monitoring. This allows your cardiology team to continue to monitor your device from home.
Medications
Understand the prescriptions your doctor may recommend to help regulate your child's heart rhythm, manage blood pressure, or reduce the risk of complications.
Drug Infusion Studies in Children
A drug (medication) infusion study is used to try and help an electrophysiologist determine if a patient has certain kinds of cardiac (heart) genetic syndromes or channelopathies (genetic syndromes). It can help diagnose patients who have been thoroughly evaluated but still don’t have a confirmed diagnosis that explains their symptoms.
