Characteristics of Pediatric Emergency Department Patients with Suspected Arrhythmias

Background: Many children are seen for evaluation of their heart rhythm in the emergency department but little is known about the presentation, evaluation, and final diagnoses of these patients.

Methods: A retrospective chart review was conducted on all pediatric patients seen in the AFCH emergency room between May 2011 and December 2020. Inclusion criteria were age 0-17, electrocardiogram (ECG) performed as part of evaluation, and clinical suspicion of an arrhythmia on presentation. We determined the demographics, presenting concern, laboratory tests performed, ECG results, and final diagnosis.

Results: : In total, 234 pediatric patients had 285 emergency room visits where an arrhythmia was suspected and ECG was performed. The average age at the time of visit was 9.9 years (SD 5.7 years). There were 133 boys and 152 girls. Most common concerns were racing heart (100), palpitations (90), and arrhythmia (30). Of the patients evaluated, 80 had a prior arrhythmia diagnosis and 42 had known congenital heart disease. In total, 182/285 patients had some abnormality on their ECG.
SVT with a presumed re-entrant mechanism was documented in 73 patients. Additional arrhythmias included atrial fibrillation (4), atrial flutter (1), atrial ectopic tachycardia (1), ventricular fibrillation (1) and ventricular tachycardia (1). 80 visits resulted in hospital admission for arrhythmia management or other concern. For SVT patients, conversion occurred spontaneously (13), or with vagal maneuvers (17), adenosine (36), additional antiarrhythmics (9), electrical cardioversion (4).
Blood testing performed in the evaluation of these patients is shown in Table 1.

Conclusion: Symptoms suggesting heart rhythm concerns are frequently addressed in the pediatric emergency department, but arrhythmias are diagnosed in a minority of cases. SVT is the most common documented arrhythmia. Laboratory testing is commonly performed, but abnormal blood tests are rarely found to be contributory to the diagnosis or management of arrhythmias.