Arrhythmia Diagnosis and Treatment

Columbia’s electrophysiologists are leaders in the diagnosis and treatment of heart rhythm problems. Our electrophysiology team routinely treats the most complex conditions, provides second opinions, and provides arrhythmia care for children who have not had successful treatment elsewhere. 

We are continually developing new methods and using new technologies to improve our level of care. Our doctors pioneered the use of 3D imaging technology for implanting cardiac devices in children, thereby minimizing exposure to X-rays, and we now perform more than 60 percent of ablation procedures using radiation-free procedures.

Heart rhythm issues vary in severity and complexity, and an accurate diagnosis and effective treatment are important to your child’s well-being. We are dedicated to compassionate, individual care for each of our patients and our outcomes are among the best in the nation.  

Learn About Our Electrophysiology Service

Diagnosing Arrhythmias in Children

Arrhythmias can be intermittent, so we perform diagnostic testing in ways that will enable us to detect the problem while it is happening. At Columbia, all tests for arrhythmias are read by our electrophysiologists—physicians who have board certifications in pediatrics, cardiology, and electrophysiology. Depending on your child’s particular heart rhythm issue, diagnosis may involve some combination of non-invasive or minimally-invasive procedures, including:

• Electrocardiogram (ECG): ECG is a non-invasive test that measures the electrical activity of your child’s heart over a short period of time, and allows physicians to rapidly gather information about your child’s heartbeat. We will place electrodes on your child’s chest, arms, and legs, and record the timing and duration of each phase of the heartbeat. We may perform the ECG when your child is at rest or when he or she is active. ECGs that takes place during activity are called stress tests. 
• Holter Monitor: To capture symptoms as they occur we may use a small device called a Holter monitor—essentially a mobile ECG—that can record your child’s heartbeat over a period of 24 hours or longer. We will attach three electrodes connected to the portable monitor to your child’s chest. As your child goes about his or her daily activities, the monitor records the heartbeat. We pair the Holter monitor with cellular technology that can visualize arrhythmias almost immediately after symptoms start, eliminating the delay to diagnosis. 
• Extended event monitoring: If your child needs more definitive long-term rhythm observation, we may implant a small monitor under the skin on his or her chest. We perform this procedure, which takes about five minutes and requires a small incision, while your child is under local anesthesia if he or she is old enough, or with sedation for younger children. This device can record the heart rhythm for a few years, allowing us to “never miss a beat” when more extended monitoring proves necessary.
• Electrophysiology study (EP study): An EP study enables us to view the arrhythmia as it occurs in the heart tissue. We will insert a small, thin tube called a catheter into a blood vessel in your child’s groin area and guide it—using fluoroscopy or 3D imaging techniques—to the heart. Our electrophysiologists can then determine how best to treat the rhythm problem. In some cases we can treat the tissue causing the arrhythmia at the time of the test. 

Treatment for Arrhythmias in Children 

Many arrhythmias do not require treatment. If your child does require treatment, our specialists will determine the most effective approach based on a number of factors, including your child’s age and the type and cause of the arrhythmia. Over the past decade, advances in technology have made arrhythmia treatments less invasive, with lower levels of radiation exposure, 

Minimally-invasive procedures use imaging to guide treatment. Our state-of-the-art electrophysiology suites are equipped with the latest imaging technology, which creates precise, 3D images of the heart in real time without radiation—minimizing your child’s risk and improving the likelihood of eliminating the arrhythmia. Depending on the nature of your child’s condition, treatment may involve:

• Medication: Your child’s cardiologist may prescribe medications such as calcium channel blockers, beta blockers, or other medications to treat the arrhythmia.
• Ablation: Ablation is a minimally-invasive procedure in which an electrophysiologist guides a thin tube (a catheter) to the abnormal area in the heart, and uses a tool on the tip of the catheter to modify the tissue causing the problem. This procedure is often performed at the same time as an EP study. Radiofrequency ablation uses high-frequency radio waves to heat the tissue until it is no longer able to cause an abnormal rhythm. Cyroablation affects the tissue by freezing it.
• Pacemaker: When a child’s heart rhythm is too slow, or for different types of heart block, we may implant a pacemaker, a small, electronic device that regulates the heart’s rhythm, to prevent symptoms. 
• Cardiac defibrillator (ICD): For children with certain conditions that can lead to a life-threatening fast arrhythmia, we may use a permanent implantable cardiac defibrillator (ICD). An ICD can potentially save a child’s life by sensing and treating a life-threatening arrhythmia.

To ensure your child is comfortable, we perform most procedures under anesthesia delivered by an experienced pediatric anesthesia team. We have performed these procedures in children of all ages, including young infants.

What to Expect After A Procedure

Depending on your child’s age and the type of arrhythmia, your child’s care after the procedure will vary. Infants will be cared for and monitored in the Infant Cardiac Intensive Care Unit, which is dedicated solely to heart care for infants who are zero to three months of age. Here, a team of experts in infant heart care will provide round-the-clock monitoring and care for your baby.

Older children are often able to go home on the day of the procedure. Our electrophysiologists work closely with your child’s cardiologist to provide follow-up care.

Learn About Arrhythmias in Children