Living with CAS

An arrhythmia doesn’t have to be a death sentence. Once detected, your child’s physician can offer various treatment options based on the type of arrhythmia, the severity of symptoms being experienced, and the presence of other conditions (i.e., diabetes, kidney failure, heart failure) which can affect the course of the treatment.

Treatments may include:

Lifestyle Modifications

Factors such as stress, caffeine, or alcohol can cause arrhythmias. Your child's 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, your child's 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 your child's 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 by your child.

Cardioversion

In this procedure, an electrical shock is delivered to the heart through the chest to stop certain very fast arrhythmias such as atrial fibrillation, supraventricular tachycardia, or sinus tachycardia. The patient is connected to an ECG monitor which is also connected to the defibrillator. The electrical shock is delivered at a precise point during the ECG cycle to convert the rhythm to a normal one.

Ablation

This is an invasive procedure done in the electrophysiology laboratory, and involves a small, thin tube (catheter) being inserted into the heart through a vessel in the groin or arm. The procedure is done in a manner similar to the electrophysiology studies (EPS) described above. Once the site of the arrhythmia has been determined by EPS, the catheter is moved to the site. By use of a technique 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 substance is applied to the site, freezing the tissue and destroying the site), the site of the arrhythmia may be destroyed.

Pacemaker

A permanent pacemaker is a small device that is implanted under the skin and sends electrical signals to start or regulate a slow heartbeat. A permanent pacemaker may be used to make the heart beat if the heart's natural pacemaker (the sinoatrial, or SA, node) is not functioning properly and has developed an abnormal heart rate or rhythm or if the electrical pathways are blocked. Pacemakers are typically used for slow arrhythmias such as sinus bradycardia, sick sinus syndrome, or heart block.

In infants and young children, pacemakers are usually placed in the abdomen. The wires that connect the pacemaker to the heart are placed on the outside surface of the heart. This position is beneficial because the fat in the abdomen protects the pacemaker and pacemaker wires from injury that might occur during everyday childhood activities such as climbing and falling.

School-aged children and adolescents may have the pacemaker placed in the shoulder area just under the collarbone. The pacemaker wires are often placed inside the superior vena cava, a large vein that connects to the right atrium, and then guided inside the heart.

Implantable Cardioverter Defibrillator

An implantable converter defibrillator (ICD) is a small device, similar to a pacemaker, that is implanted under the skin, often in the shoulder area just under the collarbone. An ICD senses the rate of the heartbeat. When the heart rate exceeds a rate programmed into the device, it delivers a small, electrical shock to the heart to slow the heart rate. Many newer ICDs can also function as a pacemaker by delivering an electrical signal to regulate a heart rate that is too slow. ICDs are typically used for fast arrhythmias such as ventricular tachycardia.

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. At the site where the arrhythmia is located, the tissue is destroyed or removed in order to eliminate the source of the arrhythmia.