Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Home / A–Z Services / Pediatric Heart Institute / Pediatric Cardiology Services / Arrhythmia Services / Electrophysiology
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Arrhythmia Services / Electrophysiology


24-Hour electrocardiogram (ECG) recording
A Holter monitor is a miniaturized, portable electrocardiographic machine that can record an electrocardiogram (ECG) for an extended period of time (usually 24 hours). It can detect rhythm abnormalities during the recording period to help your cardiologists pinpoint the nature of the arrhythmia. Patients can wear the monitor under clothing and participate in normal daily activities while it is working.

Patients with a Holter monitor are asked to keep a diary of activities and symptoms to determine if an abnormal heart rhythm corresponds to their symptoms. Knowing that a patient has a normal heart rhythm at the time of symptoms can help your cardiologist exclude arrhythmias as the cause of the problem.

If a patient has frequent symptoms, such as palpitations or lightheadedness, your cardiologist might prescribe a Holter monitor. For people whose symptoms are more infrequent, a 24-hour period of monitoring may not be long enough to detect an abnormality.

Electrophysiologic testing
An electrophysiologic (EP) test can determine an abnormality of the heart's electrical conducting system when an ambulatory monitoring technique such as the Holter monitor will not work. It involves the insertion of an electrode catheter into the heart's chambers to sense electrical impulses and their conduction within the heart. The same electrode can pace the heart with electrical impulses to induce certain rhythms and evaluate the use of medications in their treatment and prevention.

Radiofrequency ablation
The Pediatric Cardiac Arrhythmia Service provides evaluation for the treatment of all cardiac arrhythmias, including supraventricular tachycardia (SVT), ventricular tachycardia (VT), Wolff-Parkinson-White syndrome (WPW), long QT syndrome, irregular or ectopic heart rhythms, AV block, and sinus node dysfunction.

Radiofrequency ablation (RFA) is a new technique used in the treatment of abnormal cardiac rhythms. It involves placing a catheter in the heart to find the origination of the abnormal rhythm and then destroy its focus using high-frequency radio waves. RFA is used with irregular heartbeats that are difficult to manage with medications, some cases of congenital heart disease, or when other medical problems complicate medical management.

The Pediatric Arrhythmia Service at Children's Hospital has a very active radiofrequency ablation program. We currently perform 70-80 ablations per year in children and adults with congenital heart disease. Dr. Fish holds a faculty appointment in the Department of Medicine, Division of Cardiology. He frequently performs ablations on adult patients and participates in the care of adults with arrhythmias.

Transtelephonic arrhythmia event detection

Tilt table testing
A tilt table can be used to change the position of a person from lying flat to being upright. It is used to measure the response of blood pressure and heart rate to such positional changes.

Tilt tables are most often used to help determine a cause for fainting spells. When a person stands up, there is normally a rapid adjustment by the body that includes constriction of blood vessels and an increase in heart rate to overcome the effects of gravity. If these mechanisms are faulty, the blood pressure drop (postural hypotension) can be sufficient to cause fainting. In people with cerebrovascular disease that impairs blood flow to certain parts of the brain, symptoms occasionally may resemble those of a TIA, a temporary decrease in the supply of blood and oxygen to a part of the brain.

Exercise testing
Exercise testing is one means of evaluating a patient’s functional capacity, determining the amount of exercise they can do and relate this to known normal values. In addition, it can help assess degree of fitness, a lack of oxygen reaching the heart, or the possibility of exercise-induced heart rhythm disturbances. Sometimes it helps evaluate response to various medical and surgical treatments. Exercize testing usually takes place on an outpatient basis.

Last Edited: June 8, 2016
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