Cardiac Dysrhythmias in Children
Paul C. Gillette MD1
1 Professor of Pediatrics and Associate Professor of Experimental Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
As our understanding of heart rate and rhythm disorders is changing, so too is the terminology. Hence, the words in the title of this article are "cardiac dysrhythmias" rather than "cardiac arrhythmias." The word "arrhythmia" means totally without rhythm. The only rhythm abnormality that fits this definition is fibrillation, either atrial or ventricular. The word "dysrhythmia," meaning an abnormal rhythm, conveys our meaning more precisely.
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The number of pediatric patients with cardiac dysrhythmias is increasing, mainly because a common sequela of cardiac surgery is damage to the specific conduction system and working myocardium. Dysrhythmias also are being recognized more frequently in children who have no structural heart disease. This discovery is probably due to increased awareness on the part of pediatricians that certain cardiac dysrhythmias in otherwise normal children are important. We must not let this new awareness lead to overenthusiasm that might label a child with a benign dysrhythmia a "cardiac patient." A basic tenet in evaluating the pediatric patient with a dysrhythmia is that very few dysrhythmias in children with otherwise normal hearts are life-threatening, although some are persistent and even disabling. On the other hand, any rhythm abnormality in a child with an abnormal heart should be viewed with concern.
