8-year-old undergoes first Electrophysiology study done on a child in Eastern India

In EP study, special electrophysiological catheters are used, to record local electrical activities causing heart rhythm disturbance from different centers of the conduction system of the heart. These signals are picked up by special transducers and interpreted by a cardiologist specializing in Electrophysiology.

 

8 years old Barsha Maity had sudden episodes of chest discomfort and palpitations during which she would lie listless and pale. At a local medical facility she was diagnosed to have a rhythm disorder of the heart, technically known as supraventricular tachycardia. 

 

The doctors over there informed that the condition may initially be controlled with medications, but eventually may need electrophysiological interventions, whereby wires and catheters needed to be put inside the heart to study the pathways of current flow.

 

Dr Munna Das Consultant Interventional Cardiologist and Electrophysiologist, Narayana Superspecialty Hospital said “By doing the EP study on the child we were able to determine the exact nature of the electrical problem of her heart and also decide on the pacemaker, which will take care of the disease and give the child a better life in the future.” 

 

Barsha was diagnosed to have an abnormal heart rhythm called atrial flutter along with intermittent episodes of sinus arrest, suggestive of sick sinus syndrome, in which the signaling capacity of the natural pacemakers of the heart are damaged, leading to consequential non conduction of the heart’s rhythm, so that the heart’s upper and lower chambers lose their synchronicity. Doctors suggested an EP study followed by the decision of a pacemaker implantation to restore the synchronicity of the heart chambers and also to prevent sudden stoppage of the heart beats. With the medications she was put on, she remained symptom free for about six months. As the commuting to the hospital was difficult for the parents, they had fallen out of the regular check up protocol. This led to Barsha having sudden, repeated episodes of unconsciousness. She was brought to the hospital at this juncture, when it was discovered that while on her routine medications for fast heart rates, she had developed a very low heart rate, as she remained unsupervised by any physician for over 18 months and wasn’t taking medications regularly as prescribed.

 

 

According to Dr Amitabha Chattopadhyay Consultant Pediatric Interventional Cardiologist, Narayana Superspecialty Hospital, “Electrophysiological studies in small children are difficult due to several reasons, and the heart being smaller in size due to which it is rarely done on small children as it needs lots of expertise and skilled precision. It is complicated in approach, with difficulty in the maneuver of specialized instruments inside the tiny hearts. As the conducting tissues are too thin and organized within small areas, it is intricate to pinpoint the finest details accurately and work on them without expertise.”  

 

Her heart rhythm was daunting, with probabilities of imminent heart block. She was kept on strict supervision in the ICU, with close monitoring of her heart rhythm, with a back up of pacing facilities. Medicine dosages were titrated, which showed episodes of alternate slow and fast heart beats. Most of the times, she retained a very slow heart rate with no signals coming from the natural pacemakers of the heart.

 

She had an unexcitable right atrium, which was not contributing enough towards the normal signal generation of the heart, so that the lower centers of the heart had taken over the charge of signal generation, leading to a low heart rate. Since the basic heart rate needs to be higher for a child of her age group, lest which the heart may become dysfunctional, it was decided to go ahead with implantation of a VVIR pacemaker implantation in the same sitting.

 

Rakesh Verma, Facility Director Narayana Superspecialty Hospital said “Our team does EP study on adult patients on a regular basis, but this was the first time a small child of 8 years with a body weight of 20 Kg had an EP study done. This is the first time an EP study has been successfully carried on such a small child in the eastern region of India.”