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Cardiology

Arrhythmia Management and Electrophysiology Services

The arrhythmia management and electrophysiology service of the Division of Pediatric Cardiology is dedicated to the diagnosis and treatment of rhythm disorders in pediatric patients. Pediatric cardiac electrophysiologists care for children with a wide range of arrhythmias, from those with occasional episodes of palpitations, to patients with complex cardiac arrhythmias, including rhythm disturbances following open heart surgery.

Our pediatric cardiac electrophysiologists manage one of the largest programs of its kind in the metropolitan region. More than 500 invasive electrophysiologic procedures were done between 2004 and 2008 at NewYork-Presbyterian Morgan Stanley Children's Hospital using state-of-the-art technology, including three-dimensional mapping to define the source of the abnormal rhythm. Our team is specifically trained in performing electrophysiology procedures in children, which require an in-depth knowledge of anatomical development and the use of smaller catheters.

In this type of procedure, which is performed in a dedicated Pediatric Catheterization Lab, catheters are inserted into the veins via the groin and advanced toward the heart. The catheters electrically stimulate the heart to induce the abnormal cardiac rhythm that has been causing the symptoms. The pediatric electrophysiologist interprets the rhythm, and then delivers energy via the catheter, using either radiofrequency energy or cryotherapy. These therapies eliminate the cause of the abnormal rhythm and can permanently cure the problem. To provide comfort of the patient during the procedure, the majority of studies are performed under anesthesia by an outstanding and experienced pediatric anesthesia team that has managed hundreds of these procedures. Procedures have been performed on children of all ages including young infants.

In addition to invasive electrophysiologic studies, non-invasive diagnostic procedures are performed in patients with palpitations or syncope (fainting or temporary loss of consciousness). These procedures include electrocardiograms, 24-hour Holter monitors, event recorders, and stress testing to determine if there is an abnormal heart rhythm.

Our electrophysiologists have expertise in the diagnosis and management of patients with slow cardiac rhythms and different types of heart block. When the heart rhythm is too slow, a pacemaker may be implanted to stimulate the heart, thus avoiding symptoms. On the other hand, in certain conditions that can lead to a life-threatening arrhythmia, a permanent implantable cardiac defibrillator (ICD) may be implanted. These devices could potentially save the patient's life by sensing and treating a life threatening arrhythmia.

Among the conditions treated by our pediatric electrophysiologists are:

• Supraventricular tachycardia
• Wolff-Parkinson-White syndrome
• Ventricular tachycardia
• Arrhythmias related to hypertrophic and dilated cardiomyopathy
• Long QT syndrome, which predisposes patients to a life-threatening arrhythmia called Torsades de pointes
• Catecholaminergic polymorphic ventricular tachycardia
• Brugada syndrome
• Heart block
• Arrhythmias following surgery for congenital heart disease
• Management of young patients with a family member who died suddenly because of a cardiac problem

In addition, our electrophysiologists participate in the care of fetal arrhythmias by treating the mother with anti-arrhythmic medications and working with maternal-fetal medicine specialists to treat the arrhythmia prenatally.