Aritmia Pediatrik

Kino
Bagian Kardilogi dan Kedokteran Vaskuler FK Unand/
RSUP DR. M. Djamil Padang
2020
 Pendahuluan
• Aritmia pada anak sebagian besar bersifat benign dan tidak
mempengaruhi hemodinamik

• Meskipun demikian diagnosis dan tatalaksana yang benar terhadap

gangguan irama yang serius dapat bersifat Life saving pada anak

Biondi EA, Cardiac Arrhytmias in children, 2010

 Jenis Aritmia pada Anak
1. Benign Ectopy
• Premature atrial contraction (PAC)
• Premature junctional contraction (PJC)
• Premature ventricel contraction (PVC)

Premature atrial, junctional and ventricular ectopic beats are common and may
occur in patterns of bigeminy, trigeminy, quadrageminy or couplets. These are
generally benign.
 Jenis Aritmia pada Anak

2. Tachyarrhytmias
• Supraventricular tachycardia (SVT)
• Ventricular arrhytmias

3. Bradycardia
• Sinus bradycardia
• Heart block
 Ventrikular Takikardia
• Three or more consecutive ventricular complexes are by definition VT.
Wide QRS complex morphology and a different QRS morphology than
the usual QRS waveform characterize VT
• Morphology may be monomorphic (uniform), polymorphic
(multiform); or Torsades de Pointes where the points seem to twist
around the isoelectric line.
 Ventrikular Takikardia
• Often associated with structural heart disease, particularly late (years)
after repair
• Other common clinical situations in which one might see VT include
dilated and hypertrophic cardiomyopathy, metabolic alterations
including severe hypoxia, acidosis, hyper/hypokalemia, and drug
toxicity such as cocaine, digoxin, and tri-cyclic antidepressants
• Other conditions include myocarditis and long Q-T syndrome
• Patients may present hemodynamically stable or in cardiac arrest.
Ventrikular Takikardia monomorfik
Ventrikular Takikardia Polimorfik
 Bradikardia
• Often caused by hypoxia, vagal tone, hypothyroidism, cardiac surgery,
endocarditis and myocarditis, hyperkalemia, sleep, hypothermia,
sedation and anesthesia.
Bradikardia
Atrio Ventrikular Blok derajat 1
AV blok derajat 2 tipe 1
AV blok derajat 2 tipe 2
Total Av blok/ AV blok derajat 3
 Klasifikasi Aritmia Berdasarkan
Etiologi
1. Bersifat sporadic
• SVT
• Sebagian ventricle tachycardia
2. Defek Kongenital (PJB)
• Pressure atau Volume overload arrhytmias
• Post operative arrhytmias
• Late arrhytmias related to scars from suture line
3. Familial (genetic)
• Long QT syndrome (LQTS)
• Brugada Syndrome
• Catecholaminergic polymorphic ventricular tachycardia (CPVT)
 Klasifikasi Aritmia Berdasarkan
Etiologi
4. Kelainan pada otot (struktural dan atau genetic)
• Hypertropic cardiomyopathies
• Arrhytmogenic cardiomyopathies
5. Aritmia lain
• Myocarditis
• SLE
Aritmia sporadic : SVT
 Aritmia pada PJB
Penyakit Jantung Bawaan
Aritmia Familal (genetik)
 Diagnosis Aritmia Pediatrik
Anamnesis
• Family history (heart disease, death at young age, sudden death, and
seizures)
• Neonatal history; child’s personal history of syncope, palpitations,
racing heart beat, seizures, exercise intolerance, family, feeding
intolerance
• Genetics, congenital cardiac malformations
• Diagnostic investigations, previous surgical repair and post surgical
anatomy. Inquire about events preceding rhythm disturbance.
 Diagnosis Aritmia Pediatrik
Clinical Assesment
• Irritability
• Feeding intolerance
• Respiratory distress
• Tachycardia/bradycardia for age
• Irregular heart rate/pulse
• Decreased capillary refill time
• Lethargy
• Congestive heart failure
• Decreased level of consciousness, syncope, absent pulses/cardiac arrest.
 Takiaritmia Pediatrik
When to worry?
– Syncope, near syncope
– Poor hemodynamics
– Presence of congenital heart disease
• Tetralogy of Fallot
• Single ventricle physiology (Fontan)
– Cardiomyopathy or heart failure
– Myocarditis
– Concerning family history
 Bradiaritmia Pediatrik
When to worry?
–  Symptomatic
• Fatigue
• Dizziness
• Syncope
–  Severe bradycardia
–  Postoperative heart block
• If persists beyond 7-10 days, needpacemaker
–  Family history of bradycardia, arrhythmias, syncope, sudden
unexplained death
 General Treatment
• Simple observation
• Medications
– Daily prophylactic/maintenance therapy
– Pill-in-the-pocket therapy
• EP study with ablation therapy
– Pacing
– Implantable cardioverter defibrillator (ICD)
• Surgical therapy
– Surgical ablation, Maze procedure, sympathectomy
 Kesimpulan
• All types of arrhythmias are possible in paediatrics
– Many are well tolerated
• SVT is the most common and is usually not life threatening
• Red flags that raise concern:
– Incessant arrhythmias
– Presence of congenital heart disease
– Inherited (genetic) arrhythmia syndromes
– Concerning family history
Terima Kasih