Recognition and management of childhood cardiac arrhythmias

Cardiac arrhythmias are common in children, but most of them are benign and do not signify underlying heart disease. However, the main tachyarrhythmias (SVT and VT) can cause cardiovascular collapse, and should therefore be treated promptly. Drug treatment is generally effective and is appropriate in stable patients. DC shock is the treatment of choice in patients with compromised circulation. There is a wide array of antiarrhythmic drugs and though they are generally safe, most of them have the potential for serious adverse effects. Hence, there is a need to exercise caution and balanced judgement in prescribing them. It is perhaps best for the general duty paediatric staff to be familiar with a select few, and stick to them if possible. Management of most cases of cardiac arrhythmia in children is within the competence of non-cardiologist paediatric staff. But in some instances cardiology referral will be required, either for further investigations, for decision regarding longterm drug therapy, or for more technical management modalities.