Palpitations and Congenital Heart Disease
Q: My grandson went through two operations as a baby for a congenital heart problem. He is now 15 and having palpitations. Should we be concerned?
A: Your grandson has reached the age when heart rhythm abnormalities begin to appear in young people who had congenital heart surgery as infants. He should be seen by a congenital heart specialist because "arrhythmias" can be dangerous.
Congenital heart disease – abnormal formation of the heart or major blood vessels – interferes with the circulation. Surgical repair or reconstruction at birth allows blood to flow throughout the body. Sometimes, further operations are needed as the child grows.
As patients who have successful surgery live longer, we have learned that arrhythmias tend to develop 10 to 15 years after their operation. Patients may experience symptoms such as "palpitations," "skipped heartbeats," or fluttering in the chest or neck. Fatigue, dizzy spells, lightheadedness and fainting episodes may follow.
The medications used to treat arrhythmia have serious side effects. A permanent, safe solution involves catheter or surgical ablation (destruction) of the abnormal tissue causing the arrhythmia. Using a catheter that delivers heat or radiofrequency energy, or making tiny surgical incisions, re-routes the heart's "electrical circuitry" and restores normal rhythm.
Dealing with unique anatomy
Because these techniques were developed in adults with normal hearts, however, they do not always translate well to the unique, complex anatomy of the reconstructed heart. One technique, developed specifically to treat arrhythmias in reconstructed hearts, combines surgery with cryoablation (freezing) to destroy abnormal heart tissue.
Seeking a specialist
Specialists familiar with repairing complex congenital heart defects in infants are often best suited to treat arrhythmias that these patients develop as teens and young adults. I would urge you to consult such a specialist about your grandson.
By Constantine Mavroudis, MD, Ross Chair in Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's Hospital
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