Is your child's heartbeat irregular? Let's talk about this heart rhythm arrhythmia!

As a mother or father, we know how concerned you are about your child. Have you ever felt your child's heart rate suddenly increase, or feel like it's beating too fast? Or do you feel like your heart beats once, then stops for a moment and then starts beating again (a skipped beat)? It's normal to feel scared when you see something like this. But before we get scared, let's be aware of this. In medical terms, we call this condition Arrhythmia.

Simply put, what is this heart rhythm arrhythmia?

Arrhythmia is a very simple thing. It means a change in the rhythm of our heart. Normally, our heart beats in the same way, in a regular rhythm. It's like the hands of a clock ticking at the same speed. What happens in an arrhythmia is that this rhythm goes out of whack.

There are several things that could happen here:

• The heart can beat very fast .
• The heart may beat very slowly .
• A skipped beat may occur .
• An extra heartbeat may occur.

This condition can affect both adults and young children. Most of the time, it is not serious and does not require treatment. However, it is important to be aware of this, as very rare cases can be serious.

So how exactly does our heart beat?

To understand this, we need to know a little about the amazing electrical system in our hearts. Think of it like the lighting system in your home. Just as the light turns on when you flip the switch, our hearts beat when they receive electrical signals.

This process goes like this:

1. The first signal: Every heartbeat begins with a cluster of cells in the right atrium of our heart. We call this the sinoatrial (SA) node . This is our heart's natural 'pacemaker'. It's like the conductor of an orchestra.

2. Atrial contraction: The electrical signal from the SA node causes the two upper chambers of the heart, the atria, to contract. The blood in those chambers is then pumped into the two lower chambers, the ventricles.

3. Signal transmission: This electrical signal then travels to another group of cells called the atrioventricular (AV) node . This is like a wire that carries electricity from the upper chambers to the lower chambers.

4. Cardiac contraction: The AV node then sends another signal to the two chambers below, the ventricles. This signal causes the ventricles to contract strongly, pumping blood from the heart to the rest of the body.

5. Relaxation and a new beginning: Finally, the two cells relax. At the same time, a new signal arrives from the SA node, and a new heartbeat begins.

When this process happens properly, our heart rate and rhythm are correct. But if for some reason this electrical system is disrupted, then an arrhythmia occurs.

What types of arrhythmias occur in children?

There are several types of arrhythmia that occur in both adults and children. Let's categorize them as follows for easy understanding.

Is Sinus Arrhythmia Common in Children?

Yes. Although the name may sound scary, Sinus Arrhythmia is not actually an arrhythmia. It is a completely normal and healthy condition . Almost every child has it.

This is when the baby's heart rate increases slightly when they inhale and decreases slightly when they exhale. This does not cause any symptoms and does not require treatment. In fact, it is a sign that the baby's heart is in good health.

What are the symptoms of a child having arrhythmia?

Symptoms can vary greatly depending on the type of arrhythmia your child has. Some children may not show any symptoms at all. However, if you see these things in your child, pay attention.

• If you are talking about chest pain .
• Difficulty eating and breastfeeding . This is sometimes the only symptom a newborn baby will notice.
• Dizziness, lightheadedness, or fainting (syncope) .
• If you feel very tired or weak .
• If you say you feel your heart beating , you may feel like a butterfly flying inside your chest, or your heart is racing (palpitations).
• Constantly feeling restless and angry . Young children who cannot express their feelings may behave this way.
• Difficulty breathing (dyspnea) .

What causes arrhythmia in children?

Most of the time, children with conditions like SVT have no other structural problems with their hearts. However, there are several factors that can contribute to the development of other types of arrhythmia.

• Cardiomyopathy: This is when the heart muscle becomes thickened, enlarged, or stiff.
• Hereditary conditions: For example, conditions such as long QT syndrome (a condition in which the heart's electrical system takes a long time to recharge).
• Certain medications: Certain medications, especially those given to children in intensive care units.
• Congenital heart disease: Certain abnormalities in the heart that are present at birth .
• Chemical imbalances in the body: Increases or decreases in things like electrolytes in the blood.
• Other causes: fever, dehydration, stress, insomnia, or inflammatory conditions in the body.
• Infections: Viral or bacterial infections.

How does a doctor accurately diagnose this condition?

Most of the time, this is discovered when the doctor does a routine checkup on the child. Or, when you tell him about your child's symptoms, the doctor becomes suspicious and refers him for tests.

Typically, a pediatrician or pediatric cardiologist will listen to the child's and family's health history, listen to the child's heart, and then perform tests such as these if necessary.

• Blood tests: Check for any medications, infections, or chemical imbalances.
• Echocardiogram (Echocardiogram - echo): This is like a scan of the heart. It uses sound waves to look at the structure and function of the heart in detail.
• Electrocardiogram (ECG): This is a very simple, painless test. Small electrodes are placed on the child's chest to record the electrical activity of the heart. The child may also be asked to walk or ride a bike for this test.
• Electrophysiologic study (EPS): In this, the doctor inserts a very thin tube through a blood vessel in the child's arm or leg into the heart and looks for exactly where the abnormal electrical signal is coming from.
• Holter monitor: This is a small device that monitors the child's heart activity for 24 hours or several days. The child can wear it and go about their daily activities as normal.

Very rarely, if these tests are inconclusive, the doctor may recommend using a device called a loop recorder , which is inserted through a very small incision under the skin of the child's chest.

What treatments are given to children?

Some arrhythmias do not require any treatment . The doctor will tell you to monitor the child's heart rate from time to time.

In other cases, the underlying condition causing the arrhythmia is treated. For example, if it is an infection, antibiotics are given. If it is a chemical imbalance, medication is given to correct it.

Your doctor may prescribe medications such as beta-blockers or calcium channel blockers to control your heart rate.

For a child with a more serious condition, these types of treatments may be needed:

• Ablation: In this, heat or energy is delivered to the heart tissue where the arrhythmia is starting, stopping the abnormal signal from coming.
• Cardioversion: This is a procedure that corrects an irregular rhythm by delivering an electrical shock to the heart. It can also be done with medication.
• Implantable devices: A device, such as a pacemaker or implantable cardioverter defibrillator (ICD) , is implanted under the skin and delivers electrical signals or shocks to control abnormal rhythms.
• Maze surgery: A surgeon makes small cuts or burns in the heart tissue to stop the abnormal electrical signals from traveling.

What will the future be like for a child with this condition?

This largely depends on the type of arrhythmia the child has. Most arrhythmias in children are harmless and do not have any long-term health effects. Some children will outgrow the condition as they get older. Others may continue to have arrhythmias but can live a normal life without any treatment.

Even serious types of arrhythmia can be successfully managed with the advanced treatments available today.

However, very rarely, if a serious arrhythmia is left untreated, it can lead to serious consequences such as:

• Blood clots . If these travel to the brain, they can cause a stroke.
• Heart failure .
• Damage to organs (e.g. brain, kidneys, lungs).
• Sudden cardiac death .

Is there anything I can do at home when symptoms occur?

Yes. If your child has symptoms like a fast heart rate, you can try these simple things before seeing a doctor. These are called 'vagal maneuvers'.

• Tell them to cough loudly or pretend to be nauseous .
• Place an ice pack or a cloth soaked in cold water on the child's face.
• Try the Valsalva maneuver: Ask the child to close their nose and mouth and squeeze as if they are about to exhale.

These can sometimes help control the rapid heartbeat. But these are only temporary solutions. If symptoms persist or your child is having difficulty, be sure to see a doctor.

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