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Paediatric EP “foreign to most”?

The first European statement1 concerning the diagnosis and management of paediatric arrhythmias has been published recently in Europace.

The consensus statement was the first joint document released by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The paper covers four main areas: mechanisms, pharmacological treatment, radiofrequency ablation, and devices.

The first chapter explains the mechanisms of arrhythmias in children and how they differ from adults. Professor Josep Brugada (Spain), Chairman of the Working Group said: “Patients with congenital heart disease have specific arrhythmias during the very early years of life and after surgery which have different mechanisms to arrhythmias in adults. It’s important to understand these differences when treating children.”

Chapter two covers pharmacological treatment of paediatric arrhythmias in the acute and chronic phases. The drugs used to treat children and adults are the same, but there are different doses and indications.

Chapter three deals with radiofrequency catheter ablation, which is increasingly used in children as an alternative to antiarrhythmic drug treatment. There are important differences in children with respect to the catheters, the technique, and the indications.

Screen shot 2013-09-18 at 18.02.30

Dr Jan Till (Royal Brompton Hospital, London)

The last chapter is about device treatments including pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronisation therapy (CRT). Adults can keep the same device and cables for their lifetime but in children they must be replaced every 3-4 years as the child grows.

Professor Brugada said: “The numbers of children with arrhythmias are relatively small and very few clinicians and centres have the necessary expertise. Paediatric arrhythmias differ from those in adults and should be treated and diagnosed in specialised centres. The ESC and AEPC decided it was necessary to outline how paediatric arrhythmias differ from adult arrhythmias and the requirements for centres that treat children.”

“There are some indications for ablation of arrhythmias in adults that do not apply to children because their small heart puts them at higher risk of complications. But in general, if clinicians and centres have the appropriate expertise in paediatric ablations they can be performed as safely and effectively as adult ablations, even in young children,” he added.

He concluded: “This extensive document covers all aspects of paediatric arrhythmias and is a working document for physicians who diagnose and treat these patients. We explain how to perform the different procedures, the indications, and how to manage complications. Centres can use it as a check list to ensure they have the equipment and experience needed to effectively treat this specialised patient population.”

Speaking to BJC Arrhythmia Watch, Dr Jan Till (Royal Brompton Hospital, London) said: “The EHRA/AEPC joint consensus statement on the treatment of paediatric arrhythmias is a well written, significant piece of work that will prove extremely valuable to many professionals managing children with arrhythmias.”

“The statement is, I hope, another landmark in the fight to have these patients recognised. Unfortunately, paediatric electrophysiology (EP) continues to be an area that remains foreign to most paediatric cardiology trainees who, I believe, perceive it as a mysterious niche subject. Increased teaching and specialist guidance can only help to prove that it is not unassailable to any trainee,” Dr Till added.

References

1. Brugada J, Blom N, Sarquella-Brugada G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the paediatric population. EHRA and AEPC – Arrhythmia Working Group joint consensus statement. Europace 2013. http://dx.doi.org/10.1093/europace/eut082

Published on: September 18, 2013

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