Pediatric Electrophysiology

Pediatric electrophysiology is a specialized branch of cardiology focused on the electrical activities of the heart in children and adolescents. This evolving field encompasses a broad spectrum of diagnostic and therapeutic procedures, targeting the heart's electrical system to diagnose and treat various heart rhythm disorders.

• Devices: Implantable electronic devices like loop recorders, pacemakers and ICDs play a pivotal role in diagnosing symptoms like palpitations, racing heartbeats, chest pain, syncope (fainting), and treating slow or fast heart rates and sudden death that can affect younger patients.

• Electrophysiology studies: Electrophysiology studies are used to analyze the heart's electrical properties and diagnose potential disorders. Common issues include diseases of the AV (atrioventricular) node and extra electrical pathways in the atrium or ventricle, which can cause rapid heart rates and often necessitate intervention. The electrophysiology procedure involves using specialized catheters inserted through the veins or arteries and guided to the heart to map the heart's electrical activity. This mapping, utilizing a 3D GPS-like system and sometimes combined with intracardiac echocardiography, is crucial for understanding the heart's electrical behavior. In addition to being used for diagnostic purposes, these studies can also lead to interventions, such as ablation.

• Ablation therapy: Ablation therapy is used to eliminate an abnormal pathway once it has been identified during the electrophysiology study. The method, which involves either heating (microwave energy, also known as radiofrequency) or freezing (cryoablation), depends on various factors, including the fiber's location and its proximity to critical structures like the AV node.

Children’s Memorial Hermann Hospital utilizes pediatric electrophysiology to address a wide range of cardiac issues, from common arrhythmias to complex genetic disorders and sudden cardiac events in young patients.

In addition to procedures like electrophysiology studies, ablations, pacemaker and ICD implantations, the affiliated team at Children’s Memorial Hermann Hospital specializes in diagnosing and managing arrhythmias due to genetic conditions. These include Long QT Syndrome, Brugada Syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia, (CPVT), and other inherited syndromes. Treatment typically involves medications and, in some cases, the use of devices to prevent abnormal heart rhythms.

We also treat cases of sudden collapses in young athletes and offer comprehensive evaluations that include genetic testing and heart protection strategies. Children’s Memorial Hermann Hospital conducts tilt table tests and non-invasive monitoring to evaluate fainting and syncope episodes.

In addition to pediatric care, the affiliated electrophysiology team at Children’s Memorial Hermann Hospital also treats adults with congenital heart conditions. These patients, often born with congenital heart diseases and possibly having undergone surgeries as children, are sometimes at a higher risk of arrhythmias or other cardiac electrical disturbances.

Electrophysiology procedures are performed in a catheterization lab primarily due to the advanced technological capabilities and the minimally invasive nature of the procedures that this setting offers. The catheterization lab, often referred to as the "cath lab," is a specialized environment that combines cardiac surgery with interventional radiology, making it ideal for a range of cardiac procedures, particularly those related to electrophysiology such as testing for and treating arrhythmias, and placing Implantable Cardioverter Defibrillators (ICDs) and pacemakers.

The catheterization process involves a minimally invasive technique where an affiliated provider inserts a thin tube with electrodes, known as a catheter, into an artery or vein in the patient’s groin, neck, or arm. This catheter is then carefully guided through the blood vessels to the heart. This approach is crucial in electrophysiology for several reasons:

• Precision and Safety: The cath lab's advanced imaging technologies allow for precise navigation of the catheter within the heart, allowing for targeted treatment with reduced risk.
  
  
• Minimally Invasive Nature: Compared to traditional open-heart surgery, catheter-based procedures are less invasive. This can mean shorter hospital stays, quicker recovery times and less scarring, which can be especially beneficial for pediatric patients.
  
  
• Real-Time Diagnostics and Treatment: In electrophysiology, real-time feedback is essential for diagnosing and treating conditions like arrhythmias. The cath lab provides the necessary equipment for immediate and accurate assessment and intervention.
  
  
• Combined Knowledge: The cath lab environment supports the collaboration of various specialists, which is crucial for complex hybrid procedures. This multidisciplinary approach ensures comprehensive care, combining the insights of different medical fields.

Although there are no pacemakers or ICDs specifically designed for pediatric patients, the unique needs and physical characteristics of children makes every implant a tailored approach.

First, pediatric patients require smaller-sized devices to fit their smaller body sizes, including the pacing leads which are notably shorter in diameter (about 1.4 millimeteres) than those used in adults.

The implantation technique differs as well. Unlike in adults, where devices are typically placed under the subcutaneous tissue (fat layer), in children, the device is implanted under the muscle due to the limited subcutaneous tissue. This method can be more painful, and some children may require pain control post-surgery. Our affiliated pediatric surgeons will also take extra care to close the incision to minimize scarring and ensure a neat appearance, with the long-term implications for a growing child in mind.

As children grow, the device and pacing leads must accommodate their changing size, and in cases of rapid growth, we sometimes do need to make adjustments.

Most modern devices have a battery life extending up to 10 years. For a child implanted at a young age, this means the next replacement may not be needed until their teenage or college years. Typically, only the generator (battery) part of the device is replaced.

At Children's Memorial Hermann Hospital, we strive to make the experience of day surgery as positive and comforting as possible for our pediatric patients. Our approach centers around creating a child-friendly environment, working to see that every aspect of the experience is tailored to the needs of young patients.

From the moment they arrive for day surgery, children are greeted by a Child Life specialist, who prepares them for what to expect, helping to alleviate any anxiety or fear. In our commitment to minimizing discomfort, we may wait to perform any invasive procedure, including the insertion of IVs, until the child is fully under anesthesia.

Our day surgery area is designed to be a welcoming and calming atmosphere for children, and we work to personalize the experience for each child. Upon their arrival, we will ask about their favorite color and adjust the lighting in our catheterization lab to match it, creating a personalized and less intimidating space. To further ease the atmosphere, we also dim the lights to soften the clinical environment and provide warm blankets, as the cath lab can be cool. In addition, the monitors in the cath lab are equipped to display cartoons and play music, offering a distraction and a sense of normalcy during their stay.

Children’s Memorial Hermann Hospital embraces an advanced, evidence-based approach in the field of pediatric electrophysiology.

Together with the affiliated cardiac team, we employ innovative mapping techniques to locate abnormal or extra fibers in the heart and are one of only a handful of centers in the U.S. utilizing the latest multi-electrode mapping technology to create a clear picture of a child’s heart. This advanced approach not only increases the accuracy in identifying these fibers, but it also significantly reduces the duration of the procedure. In addition, we perform intracardiac echocardiography, which allows us to capture detailed images of the heart. These images are then integrated into a 3D system to construct a precise 'shell' of the heart for more effective electrical mapping.

One of our key focuses is minimizing radiation exposure, which is crucial for children's long-term health. By using these advanced mapping systems, we have reduced radiation time for these procedures from the traditional 60-80 minutes to less than four minutes total. Without cutting-edge technology and expertise, these procedures must rely heavily on X-ray and fluoroscopy, which involve higher levels of radiation. By employing these advanced new technologies, we can provide safer, more efficient, and more accurate treatments for our young patients.

Our team also specializes in pacemaker lead extraction and replacement if one becomes damaged or infected, which is not widely available at all heart centers.