Advances in treatment of pediatric arrhythmias

Abstract

Treatment of cardiac arrhythmias in children has advanced to the point where it is successful for most children, and life-threatening arrhythmias have become rare. Nevertheless, the physical and psychosocial impact can still be significant. The aim of this thesis was to investigate the progress in treatment modalities for cardiac arrhythmias in children. This thesis demonstrates that by using electro-anatomical mapping techniques, radiation exposure can be almost entirely avoided without compromising effectiveness. Catheter ablation of atrial arrhythmias as a definitive treatment can now be safely performed in increasingly younger children, including infants. For frequent ventricular extrasystoles, medication use is emphasized to prevent damage to the still-developing heart muscle. This thesis shows that flecainide is much more effective than metoprolol (recommended in the current guidelines) and that reduced ventricular function after treatment is reversible. Some ventricular arrhythmias cannot be fully controlled with medication, necessitating the implantation of an implantable cardioverter defibrillator (ICD). This thesis shows that by optimizing ICD settings and using remote monitoring, the number of shocks—and thus the impact on the child—can be significantly reduced. In conclusion, this thesis provides practical insights for clinicians and researchers to improve outcomes and quality of life for children with cardiac arrhythmias.