Basics of pediatric electrocardiography and invasive electrophysiology: Principles of cardiac testing

The pediatric electrocardiogram is the cornerstone of evaluation for all arrhythmia conditions and acute arrhythmia analysis and treatment. In the presence of an arrhythmia, additional modalities are available for capturing a paroxysmal rhythm disorder. The interpretation of the electrocardiogram is dependent on understanding the evolution of the electrocardiogram as the child ages. Electrocardiographic abnormalities that occur in children include Wolff-Parkinson-White syndrome, supraventricular tachycardia, complete heart block, junctional ectopic tachycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, long QT syndrome, Brugada syndrome, and myocardial ischemic changes in patients with anomalous origin of the left coronary artery from the pulmonary artery. The indications for invasive intracardiac electrophysiology studies include the risk assessment of patients with ventricular or supraventricular tachycardia, the assessment of anti-arrhythmia drug efficacy, and the evaluation of unexplained syncope.