Diagnosis, evaluation and treatment of cardiac arrhythmias

Paediatric cardiac arrythmias commonly occur in the absence of structural heart disease, and are classified according to their cardiac site of origin. Although a detailed history and examination are invaluable, a correct diagnosis cannot be made unless the ECG is analysed, taking into account features specific to this age group. A 24-hour ECG recording may also be helpful. As many of these conditions have a genetic basis, a careful family history should be taken. For patients presenting acutely with haemodynamic collapse, paediatric life support measures should be instigated. For others, there is more time to undertake investigations prior to treatment. A relatively small number of agents, described here, are used in therapy, and in older children, radiofrequency ablation or fitting of a pacemaker offers a more permanent treatment. Advances in genetics suggest the chance of improved screening and treatment for those conditions which are inherited.