• Lifestyle modifications: Factors such as stress, caffeine, nicotine, alcohol, and some medications can cause arrhythmias. A physician may order the elimination of caffeine, alcohol (teens and young adults), or any other substance believed to be causing the problem. If stress is suspected as a cause, the physician may recommend stress-reduction measures such as an exercise program or family therapy.
• Medication: There are various types of medications which may be used to treat arrhythmias. If the physician chooses to use medication, the decision of which medication to use will be determined by the type of arrhythmia, other conditions which may be present, and other medications already being used.
• Cardioversion: In this procedure, a small, electrical shock is delivered to the heart through the chest to stop certain, very fast, arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia. A child is given medication to fall asleep, and is then connected to an ECG monitor which is also connected to the cardioversion device. The small, electrical shock is delivered at a precise point during the ECG cycle. An anesthesiologist is present to monitor the airway, breathing, and sedation during the procedure.
• Ablation: An ablation procedure is similar to the Electrophysiology Study described above. In fact, in the first part of the ablation procedure is an electrophysiology study.This is an invasive procedure done in the electrophysiology laboratory, and involves several small, thin tubes (catheters) being inserted into the heart through the veins in both groins and possibly the neck. Once the site of the arrhythmia has been determined, an ablation catheter is moved to the site at which the arrhythmia originates. By using techniques such as radiofrequency ablation (very high frequency radio waves are applied to the site, heating the tissue until the site is destroyed) or cryoablation (an ultra-cold catheter tip is applied to the site, freezing the tissue and destroying the tissue), the site of the arrhythmia is destroyed. Usually this means the arrhythmia can no longer occur. After the ablation procedure, all the catheters will be removed; a child will be awakened and taken to the Recovery Center. He or she will be monitored over night, and have a small IV in the hand or arm. If there are no complications, the child may go home in the morning. For the first six hours, a child will have to stay in bed with the legs held straight. After 6 hours a child may get up, walk around, sit in a chair and go to the bathroom. He or she will have restricted activity for about 3 days. The child will need to be protected from getting an infection in the heart for six months after the ablation. If the child gets a deep cut, has surgery, or goes to the dentist, the child will need to take antibiotics. Written information about the plan of care is provided before going home. If an ablation in done in the left atrium or left ventricle the child will need to take aspirin for 1-3 months following the procedure.
• Surgery: Surgical treatment for arrhythmias is usually done only when all other appropriate options have failed. Surgical ablation is a major surgical procedure requiring general anesthesia. The chest is opened, exposing the heart. The site of the arrhythmia is located, then destroyed or removed in order to eliminate the arrhythmia. We perform surgical ablation for treatment of atrial fibrillation, some forms of refractory atrial flutter, and ventricular tachycardia

The Electrophysiology Team commonly treats many arrhythmias with ablation, including ventricular tachycardia, atrial flutter, and supraventricular tachycardia (SVT).

• Below is more information about the different mechanisms that can cause SVT Wolff Parkinson White (WPW): This is caused by an extra electrical pathway, called an “Accessory pathway” that connects the atria and ventricles. The accessory pathway is able to get the electrical impulse from the atria to the ventricles more quickly that the normal route, because the normal route includes a pause in the AV Node. After the accessory pathway is ablated, the impulse travels through the AV node in the normal way. Children with WPW are susceptible to SVT because there are two ways for electrical impulses to travel from the atrium to the ventricles (the accessory pathway and the AV Node), setting up the possibility for re-entry. In re-entry the impulse is able to travel in a circle, around the accessory pathway and the AV Node. With each trip around the circle the heart beats, causing tachycardia. Re-entry usually gets started by one or several early or premature beats (PAC or PVC). WPW can usually be seen on the resting ECG.
• AVRT (AV Reciprocating Tachycardia): AVRT is caused by the presence of an extra electrical pathway between the atria and the ventricles, but unlike WPW, during SVT the impulse travels down the AV Node and circles back up via the extra pathway. AVRT cannot be seen on the ECG, so the pathway is often called a “concealed pathway”. A cardiologist may be able to detect clues as to where the pathway is by studying the ECG during SVT. After the pathway is ablated electrical impulses will still travel through the AV Node in the normal way, and SVT will not be possible.
• Dual AV nodal pathways and AV nodal reentry tachycardia: Many people have two separate electrical pathways that converge at the AV node. These are called dual AV nodal pathways. They usually do not cause any problems, but in some people this can cause SVT. One of the pathways is known as the slow AV nodal pathway and the other as the fast AV nodal pathway. This refers to the speed at which electrical impulses can conduct down to the AV node. Sometimes an impulse can conduct to the AV node down one pathway and then back up the other pathway. This usually occurs with a premature beat. This can create a re-entry circle similar to WPW and AVRT where the impulse circles around the two AV Nodal pathways. Each time it comes to the AV Node the impulse travels down to the ventricles, and the heart beats faster. During an ablation procedure, the slow pathway is damaged so that the electrical re-entry circuit cannot occur. The fast pathway alone is adequate for normal electrical conduction.
• Ectopic Atrial Tachycardia: This occurs when instead of the sinus node (the heart’s normal pacemaker) generating the electrical stimulus of the heart beat, an abnormal or ectopic area in the atrium generates the electrical stimulus. The abnormal area often causes a fast heart rate. Atrial tachycardia is often seen in children who have scar tissue in the atrium from heart surgery. During an ablation the abnormal area is found and destroyed. This allows the sinus node to take over, and the heart rate to return to normal.