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. 2010 Jul;3(3):251-60.
doi: 10.4103/0974-2700.66525.

Emergency diagnosis and management of pediatric arrhythmias

Carla R Hanash  1 , Jane E Crosson
Affiliations

Emergency diagnosis and management of pediatric arrhythmias

Carla R Hanash et al. J Emerg Trauma Shock. 2010 Jul.

Abstract

True emergencies due to unstable arrhythmias in children are rare, as most rhythm disturbances in this age group are well-tolerated. However, presentation to an emergency department with symptoms of palpitations, fatigue and/or syncope is much more common. Sinus tachycardia is by far the most commonly reported arrhythmia, followed by supraventricular tachycardia. Emergency physicians should be prepared for diagnosis and to acutely manage various types of arrhythmias seen in children, to assess the need for further diagnostic testing, and to determine whether cardiology evaluation and follow-up are needed. This article is intended to provide diagnostic and management guidelines of the most common types of arrhythmias seen in children with structurally normal hearts as well as those associated with congenital heart disease and cardiomyopathies.

Keywords: Congenital heart disease; cardiomyopathies; narrow-complex tachycardia; pediatric arrhythmias; supraventricular tachycardia; wide-complex tachycardia.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Diagnostic algorithm to determine underlying mechanism of various tachycardias. AV, atrioventricularratio; SVT, supraventricular tachycardia; BBB, bundle brunch block; AR, atrial rate; EAT, ectopic atrialtachycardia; VT, ventricular tachycardia
Figure 2
Figure 2
(a) Sinus tachycardia with normal P wave morphology; (b) SVT with abnormal P wave axis. Both ECGsare from neonates. Note the similar ventricular rates
Figure 3
Figure 3
WPW syndrome. Note the short PR interval and slurred QRS upstroke (delta wave)
Figure 4
Figure 4
Atrial flutter in a newborn with atrial rate of 375 and ventricular rate of 185 bpm. Note the typical “sawtooth” appearance and AV conduction >1:1
Figure 5
Figure 5
EAT in an asymptomatic 8-month patient with abnormal P wave axis. Note merging of T and P waves
Figure 6
Figure 6
Atrial fibrillation in a 2½ year old asymptomatic patient. Note chaotic atrial waves with irregular ventricular response
Figure 7
Figure 7
VT in patient with TOF
Figure 8
Figure 8
Atrioventricular block in patient with myocarditis. Required temporary pacing for 3 days with resolution of heart block
See this image and copyright information in PMC

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