Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Irregular heart rate (arrhythmias) in children

Andrew D Blaufox, MD
Section Editor
John K Triedman, MD
Deputy Editor
Carrie Armsby, MD, MPH


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.

Sinus arrhythmia

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 12, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.