Pediatric arrhythmias: a comprehensive integrative review, symptom-based conceptual framework, and practical care guide.

Abstract

Pediatric arrhythmia encompass a diverse array of conditions, ranging from asymptomatic cases to severe life-threatening episodes. Effective management of these conditions, especially for non-specialist physicians, is crucial to improving patient outcomes and reducing the risk of sudden cardiac death (SCD). This integrative review aims to synthesize the present evidence on the strategies for diagnosing and treating pediatric arrhythmias, providing a practical, symptom-based guide for non-specialist physicians. Following Cooper's methodological framework, we conducted a comprehensive literature search using electronic databases (PubMed/MEDLINE and Cochrane Library) up to August 7, 2024. Inclusion criteria focused on studies published between 2019 and 2024, involving pediatric patients aged 2-18 years with several types of arrhythmias, excluding those with congenital heart disease or other systemic conditions. Quality appraisal was performed using the GRADE and CONSORT methodologies. From 176 initially selected studies, 69 met the inclusion criteria. The evidence was synthesized into a symptom-based conceptual framework, categorizing arrhythmias into asymptomatic, paroxysmal tachycardia, and those associated with low cardiac output or syncope. Common arrhythmias, such as sinus arrhythmia, sinus bradycardia, and wandering atrial pacemaker typically do not require treatment. In contrast, conditions, such as supraventricular tachycardia, ventricular tachycardia, and inherited arrhythmias (e.g., long QT syndrome, Brugada syndrome) necessitate specific diagnostic and therapeutic strategies. This review provides a practical guide for non-specialist physicians to diagnose and manage pediatric arrhythmias, aiming to improve patient outcomes and reduce SCD incidence in children. Future research should focus on pediatric-specific studies and the development of novel therapeutic interventions.