Children have unique aspects related to the management of their heart rhythm. While
there are some similarities with electrophysiological issues seen in adult patients,
there are also important differences, not just in size and maturity, but also in etiologies
(for example, congenital vs. acquired), management and treatment options. The field
of pediatric and congenital electrophysiology has evolved rapidly, particularly over
the past 35 years, predominantly due to the successful application of interventional
electrophysiology techniques to children. In fact, some of the first uses of catheter
ablation techniques were in small children with medically-refractory supraventricular
arrhythmias.
1
,
2
,
3
Similarly, the early application of transvenous pacemakers was in children with post-operative
bradyarrhythmias following congenital heart surgery.
4
The subspecialty field of pediatric electrophysiology begun only a half-century ago
with pioneers who utilized techniques such as programmed electrical stimulation for
diagnostic purposes and pharmacologic evaluation, epicardial pacing, intraoperative
mapping and open-chest surgical ablation to cure tachyarrhythmias in children.
5
Rapid advancements in technologies and techniques allowed for the use of transcatheter
ablation, transvenous pacing, cardiac resynchronization, and defibrillation, and other
interventional techniques, even in small children when medically necessary. Improvements
in mapping technologies and ablation tools and techniques increased the success rates
and allowed for these therapeutic procedures to be effectively accomplished in patients
with complex congenital heart disease and post-operative conditions. Acceptance of
interventional pediatric electrophysiology promoted a strong demand for trained physicians
in this field, leading to expansion of pediatric and congenital EP training programs
and an expectation that most respected children’s hospitals and pediatric programs
would have a pediatric electrophysiology program for the care of their patients.
6
Around the same time, investigators began having a much clearer understanding of
the genetics underlying inherited arrhythmia disorders, increasing our diagnostic
capabilities and treatment armamentarium for children with cardiomyopathies and heritable
arrhythmias. Close collaboration with nonprofit organizations (such as Sudden Arrhythmic
Death Syndrome Foundation and others) have aligned pediatric electrophysiologists
and geneticists together with scientific, educational, and advocacy communities to
better the care of patients and understanding of these arrhythmia conditions.Key words
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Article info
Publication history
Accepted:
March 13,
2023
Received:
March 10,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
