Medtronic Presents: Treating Life-Threatening Heart Rhythms in Y

WebMD Live Events Transcript

Event Date: 10/23/2000

Do you know a child or young adult with life-threatening heart rhythms? How are doctors getting the hearts of these children back on pace? Gerald Serwer and Peter Fischbach will answer your questions about treating these special heart patients.

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live Events. Our guests today are pediatric cardiologists Gerald A. Serwer, MD, and Peter S. Fischbach, MD, of the University of Michigan Congenital Heart Center. We will be discussing how doctors treat children and young adults with abnormal, life-threatening heart rhythms. This event is sponsored by Medtronic. Medtronic has had no influence on the selection of the guest or the content presented in this event. The views expressed by the speaker during this event are those of the speaker and do not necessarily represent the opinions of the sponsor. It is a pleasure having you both here today. Before we begin taking questions, would each of you tell everyone a little bit about your background and area of expertise?

Dr. Gerald Serwer: My area of interest and expertise has been in pediatric pacing and device therapy for abnormal heart rhythms. I have been involved with the evaluation and development of treatments for both abnormally fast and abnormally slow cardiac rhythms. I am also the director of the Midwest Pediatric Pacemaker Registry.

Dr. Peter Fischbach: I'm also interested in treating abnormal heart rhythms in children, and particularly in children with heart disease. I am involved in treating patients with abnormally slow and fast rhythms using pacemakers and defibrillators.

Moderator: We have several questions from members today, so lets begin.

Moderator: MJ_Monell asks: "What is the latest on genetic testing for long Q-T syndrome? My background includes three children: an 11-month-old, a 4-year-old, and 6-year-old. My mother died in 1991 at age 44, and her father died at age 25, both of sudden cardiac death. In 1992, my sister, then age 16, had a cardiac arrest and had her device put in. Also in 1992, I had my device put in at that time, with no episodes. My first shock was in 1994, four days after the birth of my second child."

Dr. Peter Fischbach: Long Q-T syndrome is a genetic disease that's passed on between family members. It's a disease of how the heart generates a heartbeat. It can lead to arrhythmias that are fatal. There has been a huge increase in the knowledge of treating and diagnosing this over the last decade. It becomes much easier when a single member of the family has been diagnosed. Their genetic code can be used to diagnose other family members. Currently, it is a long and difficult process to complete genetic testing and families can expect a two year wait to receive a confirmatory test. About 50% can expect it.

Moderator: Member Mike asks: "Recently, my 8-year-old son has begun to have episodes of SVT (supraventricular tachycardia) at about 200 to 240 bpm (beats per minute). He has had about eight episodes now over three months. He has no other medical history at all, and there is none in the family to speak of. During the attacks, which last about a half-hour, he does not get dizzy, nauseated or lethargic. He seems to be wide awake and doing OK, but he is obviously having tachycardia. A number of these attacks happened while playing sports, but at least one or two of the earliest happened without exertion. He has been seen in the emergency department three times now, and each time he is back to 110 to 120 bpm on arrival. He had a normal echocardiogram about a week ago. He was to see the pediatric cardiologist on Wednesday, but the doctor had a conflict and cancelled. He is rescheduled for this Tuesday. His pediatrician told us not to do anything to try to slow his rate in an unmonitored setting (no coughing, no ice on the face, and no bearing down because he was afraid of cardiac arrest). Can you tell me what to expect next in the normal course of the diagnosis and treatment of this? Are there drugs or other therapies that can be used to try to get a handle on this? Thanks!"

Dr. Peter Fischbach: SVT in children is not uncommon. It usually occurs in children whose hearts are otherwise normal. When you have a small number of episodes and they are not associated with problems, such as this situation where the child feels fine, most people would: 1) make certain of the diagnosis -- that this really is SVT; 2) proceed to treat with certain maneuvers if they work; or 3) drug therapy if those don't work. If the number does not decrease and they are not controlled with drugs, then other forms of therapy might be considered, such as radio frequency ablation techniques. Many times, the episodes will go away without specific therapy; sometimes they do not. Hopefully, they can be easily controlled with nothing more than vagal maneuvers or simple medications. If not, other techniques are available. Based on the age of the onset of your son's SVT, it is approximately 70 to 80% likely that this will be an ongoing problem. There is no definitive indication currently for radio frequency ablation in the pediatric population, but it is becoming first-line treatment in many centers. If your son has a normal EKG (electrocardiogram) at rest, the likelihood of anything bad happening is extremely low, even in the absence of therapy.

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