Cardiac Electrophysiology and Rhythm Device Program
The Cardiac Electrophysiology Program provides comprehensive care for children with heart rhythm disorders, including slow heart rate, fast heart rate and other irregularities. While these disorders often occur in otherwise healthy children without other heart conditions, children with congenital heart disease are at higher risk.
Our team of leading cardiologists, nurses and technicians manages the entire spectrum of heart rhythm abnormalities, starting with a thorough diagnostic assessment using a series of noninvasive and, when necessary, invasive tests in order to clearly understand the patient’s heart rhythm condition. Subsequently, if treatment is required, it is tailored to the individual patient’s and family’s needs. Chronic medications may be administered when deemed appropriate. In addition, We may also perform definitive catheter ablation therapy, which is usually successful.
At times, medical devices need to be implanted in order to treat heart rhythm abnormalities. These procedures are managed by the expert team of electrophysiologists and nurses at the comprehensive Cardiac Rhythm Device Program, who begin with a thorough evaluation of the child to determine whether a device needs to be implanted and which device is optimal for the individual patient needs. When deemed necessary, a device is implanted and our staff performs follow-up both at home and in person.
- Comprehensive Care
- Clinical Trials and Research
- What to Expect During Your First Visit
- Commonly Treated Disorders
Our team of cardiologists, nurses and technicians employs a number of diagnostic and therapeutic tools to evaluate and treat arrhythmias, syncope, and children potentially at risk for sudden cardiac death. A variety of invasive and noninvasive testing modalities are available, including:
A standard 12-lead electrocardiogram (ECG) is often the first diagnostic test performed in the evaluation of arrhythmias. The 12-lead ECG can provide important information regarding many arrhythmias. With a number of rhythm disorders, however, the 12-lead ECG will appear normal unless the patient is having a rhythm disturbance at the time the test is administered. As a result, other rhythm monitoring modalities may be required for the diagnosis of arrhythmias.
24-Hour Holter Monitoring
Standard 24-hour rhythm monitoring (Holter monitoring) may help diagnose a variety of arrhythmias if they are occurring on a daily basis. By recording a child’s rhythm over many consecutive hours, we are able to determine various patterns of rhythm changes and can diagnose a number of rhythm disorders.
Extended Holter Monitoring
Longer periods of continuous rhythm monitoring are required in select patients, especially when symptoms are unclear and dangerous arrhythmias may be suspected.
Event monitoring allows for a prolonged monitoring period and equips the patient with the ability to trigger a rhythm recording whenever a symptom is felt. Event monitoring usually requires the child to be able to recognize that they are having symptoms so that they (or their family) can activate the recording feature.
A number of arrhythmias are more likely to occur with exertion, and 12-lead ECG monitoring during exercise (walking on a treadmill or pedaling on a stationary bicycle) allows for close monitoring of rhythm during strenuous activity.
Provocative Medication Challenge
For a number of heart rhythm disorders, understanding the child’s response to certain cardiac medications allows us to diagnose and better manage his or her condition. These medications are usually administered intravenously (IV) while the child is monitored closely in the hospital setting.
In select cases, an electrophysiology study is performed using catheters placed through intravenous access sites (usually in the groin region). These catheters can record electrical impulses in the heart and pace different regions of the heart to provide definitive diagnoses in a number of rhythm disorders. Since these procedures are “invasive,” they are usually reserved for very specific rhythm issues when abnormalities are suspected.
In addition to performing diagnostic electrophysiology studies, catheters can be used to heat or freeze a number of rhythm substrates in the heart. These ablation procedures are regularly performed at our center, providing definitive cures for many arrhythmias and thereby allowing children to live normal lives free of chronic medications. Ablations are usually done as an outpatient procedure, with the patient returning home on the same day. We perform these procedures using the latest technologies to precisely target the arrhythmia abnormalities.
Cardiac Rhythm Device Procedures
A number of arrhythmias require implantation of cardiac devices for their chronic management. These devices include pacemakers, implantable cardioverter defibrillators (ICDs) and, rarely, implantable recording monitors. A decision regarding implantation of these devices always necessitates careful consideration of the risks and benefits of these procedures, but these cardiac devices can be life-saving and we follow a large number of children who are enjoying full lives with these devices.
Genetic Testing for Inherited Disorders of the Cardiac Rhythm
Advances in medical knowledge and testing now allow us to identify individual patients and families in whom a specific single gene mutation places a patient and possibly siblings at risk for a serious cardiac arrhythmia. Further advances in identification of more complex genetic variants will undoubtedly occur in the next decade to further extend the application of this testing and enable us to more accurately identify both the risk and optimal treatment(s) for individual patients. Management of patients with these disorders is achieved through collaboration between our team of electrophysiologists and dedicated pediatric cardiac geneticists.
The Cardiac Electrophysiology Program is involved in a number of clinical trials and performs state-of-the-art research in the care of heart rhythm disorders. Ongoing research in the program includes optimization of catheter ablation therapy, study of risk factors and prevention of sudden cardiac death in children, and optimization of cardiac rhythm device therapy in pediatrics. The program is also designing and testing the first fetal pacemaker as well as innovating a new method for minimally invasive pacemaker placement in children.
Prior to your first visit, your electrophysiologist will review the relevant medical information and test results from your child’s referring physician. Upon arrival, you will be checked in by the front-office staff and one of our nurses will meet with you and your child. An electrocardiogram will likely be performed on your child by one of our technicians. The electrophysiologist will then meet with you to discuss your child’s symptoms and condition.
In many cases, enough information is available by the end of the visit for the electrophysiologist to discuss with you in detail your child’s condition and treatment options (if necessary). At times, the electrophysiologist may recommend further testing to better understand your child’s heart rhythm condition and the best way to manage it.
When a procedure such as a catheter ablation procedure or device implantation is considered, the electrophysiologist will discuss its risks and benefits, and if mutually agreed upon, the procedure may be scheduled at the time of the visit. At the conclusion of your visit, the electrophysiologist will summarize any testing or procedures that need to be scheduled and determine if future follow-up is required.
The Cardiac Electrophysiology Program treats a number of rare heart rhythm disorders in children, but certain conditions are more commonly seen. These include the following:
Premature Atrial Contractions
Premature Ventricular Contractions
Long QT Syndrome
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)