Paediatric arrhythmias in the emergency department

Area of Science:

• Pediatric Cardiology
• Emergency Medicine
• Clinical Epidemiology

Background:

• Arrhythmias in children require rapid diagnosis and management in emergency departments (EDs).
• Limited data exist on the presentation, epidemiology, and management of pediatric arrhythmias in the ED setting.
• Understanding these patterns is crucial for optimizing care in tertiary children's hospitals.

Purpose of the Study:

• To characterize the incidence, presenting features, management strategies, and outcomes of arrhythmias in children presenting to a large tertiary children's hospital ED.
• To provide insights into the epidemiology of pediatric arrhythmias encountered outside of intensive care and postoperative environments.

Main Methods:

• Retrospective review of medical records from 2002-2008.
• Identification of patients (<18 years) with arrhythmias using ICD-10 codes from the ED electronic database.
• Analysis of presenting features, management interventions, and outcomes, including cardiac arrests.

Main Results:

• 444 non-arrest arrhythmias occurred, with an incidence of 11.5 per 10,000 presentations.
• Supraventricular arrhythmias (SVTs) were the most common (56%), while conduction disorders and ventricular arrhythmias were rare.
• Cardiac arrests occurred in 19 children, with 18 deaths; defibrillator use was infrequent for both arrhythmias and arrests.

Conclusions:

• Pediatric arrhythmias are uncommon in the ED setting, with SVTs being the predominant type.
• Management primarily involved vagal maneuvers and antiarrhythmic drugs for SVT; defibrillator use was exceptionally rare.
• Overall mortality for pediatric arrhythmias in this cohort was low, particularly for non-arrest cases.