Detection of dangerous arrhythmias

This review focuses on arrhythmias in children and youth occurring in the community. Case examples with illustrative ECGs are presented, differentiation of cardiac from non-cardiac syncope is discussed, and examples of significant misdiagnosis and mismanagement are given. Aside from detection, there is also a focus on prevention, particularly through the recognition of inherited arrhythmic syndromes and through family screening.Key educational messages regarding syncope are the importance of detailed clinical history and of eliciting family history of sudden death, and the potential to misdiagnose arrhythmic syncope as epilepsy, particular when it occurs at night. Note is made that most community sudden death in children occurs at night or rest. In investigating dilated cardiomyopathy, incessant arrhythmias need to be excluded as a cause.Due to an incidence of sudden death in Wolff–Parkinson–White syndrome (WPW), children with a delta wave on their ECGs after 4 years of age should see an electrophysiologist to assess risk of sudden death. Syncope with WPW requires immediate referral.To avoid causing iatrogenic harm in acute arrhythmia management, seek advice early and try to avoid the use of intravenous bolus doses of antiarrhythmic drugs with negative inotropic effect, particular verapamil, especially in infancy.