Irregular heart rate (arrhythmias) in children
- Andrew D Blaufox, MD
Andrew D Blaufox, MD
- Associate Professor of Clinical Pediatrics
- Albert Einstein College of Medicine
The child with an irregular heart rate is a common problem that has numerous etiologies ranging from normal benign variants to malignant arrhythmias. Determining the underlying cause of an irregular rhythm is important, as it may be a life-threatening or serious condition. In the majority of children, the cause of an irregular heart rate is identified by an in-depth history and physical examination, and electrocardiogram, which can be completed by the primary clinician. In some cases, referral to a pediatric cardiologist is required for further diagnostic work-up and, if necessary, treatment.
The etiology and evaluation of an irregular heart rhythm in children will be reviewed here.
The most likely diagnosis for an irregular heart rate varies with the clinical setting in which the irregularity is first noted. The differential diagnosis and subsequent evaluation differs for an asymptomatic child with an incidental finding of an irregular heart rate compared with a symptomatic child who complains of palpitations or who has an episode of syncope. In general, the asymptomatic child will have a benign condition, whereas the symptomatic child is more likely to have a significant arrhythmia that may require intervention.
Asymptomatic child — The following are the most common causes of an irregular rhythm in an asymptomatic child, which is usually detected as an incidental finding during a routine physical examination or evaluation for some other issue.
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- Asymptomatic child
- - Sinus arrhythmia
- - Ventricular premature beats
- - Atrial premature beats
- Symptomatic child
- INITIAL EVALUATION
- Physical examination
- CARDIAC REFERRAL AND FURTHER EVALUATION
- Further testing
- - Holter monitor
- - Event monitor
- - Exercise testing
- - Echocardiogram
- - Electrophysiology study
- SUMMARY AND RECOMMENDATIONS