Diagnosing Your Child’s Arrhythmia

When you first come to us, your child will see one of our cardiologists, who will perform a physical exam and conduct a careful health history. He or she may also perform diagnostic procedures to study your child’s heartbeat, including an ECG. When needed, we send you home with a noninvasive monitoring device for your child to wear for a few days or weeks. The monitor can deliver continuous data, allowing us to see your child’s heart rhythm, even in real time. In this way, we can identify your child’s type of arrhythmia.

Our nationally recognized, board-certified electrophysiologists have specialized training in reading and interpreting ECG and heart monitoring data. An electrocardiogram, or ECG (same as EKG), is one of the simplest and fastest procedures used to evaluate the heart.

Diagnostic procedures include:

• Pediatric electrocardiogram (ECG): Electrodes (small plastic patches with leads) are placed on your child’s chest, arms, and legs, giving doctors a reading of your child’s heart’s electrical activity. This standard electrocardiogram can be done on-site, at our hospital, under the supervision of a trained professional, or in the comfort of your home, with your help, using our tele EKG (or ECG) device.
• Exercise ECG, or stress test: While your child walks on a treadmill or pedals a stationary bicycle, we monitor the heart’s electrical function and the body’s breathing and blood pressure rates.
• High V1,2 ECG: Specialized ECG to test for inherited arrhythmias in a similar procedure as the standard ECG.
• Stand-up ECG: This is similar to the resting ECG but recorded in an upright position.
• Electrophysiologic study (EPS): A study that looks for abnormal heart rhythms by measuring electrical signals from your child’s heart. A doctor inserts a small, thin tube (catheter) in a large blood vessel in your child’s leg or arm, then advances it to the heart.
• Implantable loop recorder (IRL): This cardiac monitor is placed under the skin in the chest and records every heartbeat over a long period of time, even up to three years. It’s used to catch hidden rhythms or ones difficult to find with ECGs.

We are unique in that we use a variety of noninvasive Holter and event-monitoring devices to provide highly personalized care, as we understand that heart monitors are not one size fits all. We have selected monitors for their accuracy and ability to track even the most irregular and hard-to-capture arrhythmias. Monitoring devices are used to diagnose, screen, and monitor childhood arrhythmias, especially heart palpitations and episodes of passing out. They are also used to make sure that medications are working as desired to control an irregular heartbeat, or to monitor the heart’s reaction to medications. Patients wear monitors during all activities, including sports, for a designated amount of time while data is gathered on the precise type and occurrence of arrhythmia. Your child’s physician team reviews results with you in a follow-up appointment.

Heart monitoring devices include:

• BioTel Cardiokey: This ambulatory ECG recorder has two electrode leads that are connected to a device. It monitors heart rhythms 24 hours a day for 14 days. The device, which can be removed during water activities, is then mailed to the manufacturer, where trained technicians review the data and send a report to your child’s doctor. This monitor is often a first choice for babies.
• BioTel MCOT: This convenient mobile cardiac outpatient recording device, in the form of a leadless patch, gathers data via Bluetooth and sends real-time data automatically, 24 hours a day, with no need to mail it in at the end of the study period. Patients have the option to record symptoms as they feel them. Patients can shower but not swim with this patch.
• Holter: An ECG recording done over a period of 24 or more hours. Three electrodes are attached to the child’s chest and connected to a small, portable ECG recorder by lead wires, which is then returned to your child’s doctor, where data is uploaded and reviewed.
• Zio Patches: Zio patches have revolutionized the way doctors detect and diagnose arrhythmias, or irregular heart rhythms. In certain circumstances, Zio patches can replace the Holter monitor. While Zio patches cannot supply 12-lead quality readings as the tele EKG, they have other advantages. For example, while the tele EKG provides a snapshot of your child’s heart rhythms, Zio patches provide continuous monitoring over time. Zio patches also are easier to use and do not require in-office training.
  
  • Zio AT: The Zio AT provides up to 14 days of uninterrupted monitoring and delivers comprehensive, precise, real-time data on your child’s heart rhythms. The AT version notifies EKG technicians standing by of the most significant heart events, complete with full analysis of the data, more quickly than other monitoring devices. The patch is leadless, small, hidden, and comfortable to wear. It records every beat day and night during all activities from sleep and bathing to sports. The patch boasts earlier detection compared with other telemetry monitors, which is important for detecting more serious arrhythmias. This wearable patch is sent directly to your home. The Zio AT is less detailed (only one lead) than the tele EKG, but it can provide up to 14 days of continuous recordings.
  • Zio XT: The Zio XT is similar in size and usage to the Zio AT, but it can be a more affordable option. It’s a relatively small patch that has no leads, so it is discreet and convenient to wear and can be worn at all times. It records electrical activity of the heart for up to two weeks, but it doesn’t provide real-time feedback; rather, the device is mailed to the manufacturer, where trained EKG technicians review the data and send a report to your doctor. It is typically used to monitor less serious arrhythmias.