2023-08-29 09:04:17
The head of the Pediatric Cardiology Service at the University Hospital of La Paz (Madrid), Federico Gutierrez Larrayain an interview with EFEsalud, delves into the arrhythmias that manifest in children, their causes and their therapeutic approach.
“The rhythm of the heart is synchronized with the rest of the sensors that the organism has and with the brain. It is integrated into that triangle and responds to what those other parts of that team are saying,” says the cardiologist.
When that connection is lost and depending on the circumstances, arrhythmias. These can occur in hearts with an abnormal but also normal structure.
To shed more light on this ailment, Gutiérrez Larraya explains that the heart is fully formed at week seven of gestation. And until it is formed, the brain does not, which needs a fair amount and type of blood to develop, because both are completely integrated.
Why do they appear?
Arrhythmias in children and adolescents can appear for various reasons. One of them is that there are occasions in which “vestiges of abnormal paths of embryonic life remain that should have disappeared and do not disappear, they remain and cause problems,” says the cardiologist from La Paz.
In others, they occur because there are some cells or a group of them that acquire functional capacities that do not correspond to them. They are heart diseases because it has formed badly. This may be due, among others, to family heart disease, in which the genetic weight causes the organ to function poorly.
And then there is a third cause, and it occurs in those children who have undergone surgery.
“There are heart diseases, a third of them, that we can solve forcefully and that’s it, for life. And there are other quite serious diseases that are going to need more than one intervention. And those are many stitches, many sutures. In places where scars have been left, it may be that the electrical functioning of the area where they are is not normal and arrhythmias occur, ”says the expert.
How to detect them
Arrhythmias are difficult for families to detect when the sufferer is a baby, since the latter cannot express himself. Infants who suffer from them may not respond to stimuli, or have a paler color than usual. And in the shots, there may also be signs of this ailment.
“To have a disease you have to have what the English call a double kick, which is quite expressive, that is, you have to have a circumstance that predisposes something to happen and a stimulus. You may have a predisposition, but perhaps until you reach adolescence, when there are very marked hormonal changes, you have that second kick”, says the doctor.
From the least aggressive to the most invasive
It is easier to detect them in older children, although it must also be taken into account that arrhythmia is a “very generic” term and there are more than a hundred types with their particularities. That is why knowing the approach that the cardiologist will have with the patient, what type it is and what causes it “is already an art”. And it is not always achieved in a single visit, so diagnostic tests must be done.
“We go from the least aggressive to the most invasive,” says the cardiologist. In this way, you start from an electrocardiogram to an echocardiogram. Holter monitoring is also taken into account, as well as stress tests.
Two hearts printed in real size. EFE/Jorge Zapata
Sometimes, an implantable Holter monitor must be placed in the same area as the pacemaker, because in this patient the arrhythmia occurs from time to time and it is more difficult to know what is happening in the heart.
And there are also remote electronics, which are devices like credit cards. It is a “very useful” tool because when the patient has any symptoms, they make a chart and the data is sent to the doctor via Bluetooth or Wi-Fi.
“We have a whole armament,” sums up the cardiologist from La Paz.
And you have to know the substrate that has these arrhythmias and what type of patient suffers from them in order to treat them because “it is not the same, a small patient operated on, than a twelve-year-old patient who plays sports.”
The approach to bradycardia
Therefore, the therapeutic approach depends on the type of arrhythmia.
Those in which the heart rate is inappropriately low, the patient is given a pacemaker.
It must be taken into account that children are growing, so you have to be vigilant about the route of the pacemaker cables, because they can become short. And in the case of the battery, depending on how you use it, it will run out and you will need replacements. And it is that children have a very high metabolism, so they will consume more battery.
The cardiologist assures that the pacemaker is a good alternative and despite the inconvenience of changing the cables and batteries, the patients who wear it can carry a normal life.
How to treat tachycardia
And how are fast arrhythmias, the so-called tachycardias, treated? There are several possibilities. At this point, Gutiérrez Larraya makes an aside and points out that there is an option to prescribe drugs, but it is not the option that pediatric cardiologists like the most.
Electro of a tachycardia.
“The drugs try to optimize that tachycardia does not occur, that the heart does not lose control over the nervous system, but at the cost of accepting all the beats of the day, so it is not something we like, it is an alternative that we use when we cannot resort to something more definitive,” he points out.
This occurs in smaller patients, because finding a definitive solution is more complicated.
One of the solutions for tachycardia is catheterization, “entering the veins” and locating exactly where the patient’s surplus circuit is and removing it. In this case, the term “burn” is used colloquially, but it is not exactly what is done.
A type of energy that can be cold or radiofrequency is used to modify the characteristics of the tissues so that they do not have tachycardia.
“The efficiency of these methods is above 90%, but it is not 100%. It is allowed to lead a very good life. They remain as if the problem had not occurred ”, she assures.
Defibrillators, another option
Another option is the use of defibrillators because there are some arrhythmias that cannot be addressed with catheterization.
“There are cells that occasionally become disorganized, so the muscle that is apparently normal because it is not different in terms of structure, but it is in terms of function, triggers and can lead to the person’s death,” adds the expert.
In these heart diseases, a defibrillator is permanently placed in the heart, depending on age. What it does is give electrical shocks to the heart.
“The role of technological development and artificial intelligence in the world of cardiology is impressive. We have arrhythmic heart function algorithms that make the pacemaker and defibrillator interpret them and discharge at the right time”, details the expert from Peace.
Thanks to the defibrillator, small patients can lead a practically normal life.
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