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