Best Hospitals for Arrhythmias in Mumbai, India

Paediatric arrhythmias are disorders of cardiac impulse formation or conduction that occur in children from the neonatal period through adolescence, arising from structural congenital heart disease, primary channelopathies, post-surgical scar tissue, or idiopathic electrophysiological substrates. The spectrum ranges from benign, self-limiting conditions — such as isolated premature atrial contractions — to life-threatening entities including Wolff-Parkinson-White (WPW) syndrome with rapid antegrade conduction, congenital long QT syndrome (LQTS types 1–3), catecholaminergic polymorphic ventricular tachycardia (CPVT), complete atrioventricular block, and junctional ectopic tachycardia (JET) following congenital heart surgery. Haemodynamic consequences range from palpitations and exercise intolerance to syncope, heart failure exacerbation, and sudden cardiac arrest, making accurate risk stratification and timely intervention essential.

• Documented supraventricular tachycardia (SVT) including AVNRT, AVRT/WPW syndrome, atrial flutter, or atrial tachycardia not controlled by or refractory to medical therapy
• Genetically confirmed or clinically diagnosed channelopathies: Long QT syndrome (QTc >500 ms or symptomatic), Short QT syndrome, Brugada syndrome, CPVT — especially with breakthrough events on therapy
• Symptomatic complete or high-degree AV block (congenital or post-surgical) requiring permanent pacemaker implantation
• Junctional ectopic tachycardia (JET) or incessant SVT causing tachycardia-induced cardiomyopathy (EF <45%)
• High-risk WPW: shortest pre-excited RR interval ≤250 ms on ambulatory monitoring, or syncope/cardiac arrest history
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Required Pre-procedural Diagnostics:

• 12-lead ECG and 24–72-hour Holter or event monitor
• Transthoracic echocardiogram (TTE) with congenital anatomy protocol
• Cardiac MRI with late gadolinium enhancement (LGE) where structural or myopathic substrate is suspected
• Genetic arrhythmia panel (NGS-based, covering SCN5A, KCNQ1, KCNH2, RYR2, CACNA1C and ≥40 additional genes) for suspected channelopathy
• Exercise stress test (paediatric Bruce protocol) for CPVT, LQTS type 1, or exertional syncope evaluation
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Pharmacological Management (First-Line and Bridge Therapy):

Beta-adrenergic blockade with nadolol (preferred for LQTS due to sustained plasma levels) or propranolol forms the pharmacological cornerstone for LQTS types 1 and 2 and CPVT. Class IC agents (flecainide) are utilised as adjunct therapy for CPVT and selected SVT subtypes. Amiodarone — a Class III multi-channel blocker — is reserved for haemodynamically significant or post-operative arrhythmias due to its paediatric toxicity profile, with careful monitoring of thyroid, pulmonary, and hepatic function. Mexiletine (Class IB) serves as add-on therapy for LQTS type 3 (SCN5A gain-of-function mutations), and ivabradine is emerging for inappropriate sinus tachycardia in selected paediatric patients.

Catheter-Based Electrophysiology Study (EPS) and Ablation:

This is the definitive curative intervention for most re-entrant SVTs and accessory pathway-mediated tachycardias. The procedure is performed under general anaesthesia in paediatric patients. Vascular access is achieved via femoral vein (standard) or internal jugular/subclavian approaches. Multi-electrode mapping catheters (Lasso, PentaRay, HD Grid) are deployed with 3D electroanatomic mapping systems (CARTO 3 — Biosense Webster; EnSite Precision — Abbott) to reconstruct chamber anatomy and identify the arrhythmia substrate with precision.

Step 1 — Pre-Travel Medical Review (2–4 weeks before departure): GAF Healthcare's clinical team performs a structured remote assessment: review of all prior ECGs, Holter reports, echocardiograms, genetic results, and operative notes (for post-surgical cases). A paediatric cardiac electrophysiologist at the receiving centre provides a written medical opinion confirming candidacy and proposed procedure. The family receives a pre-travel checklist: medications to continue/withhold (e.g., antiarrhythmic hold protocol), fasting instructions for the child, and emergency contact protocols during transit.

Step 2 — Arrival and Pre-Procedural Workup (Day 1–2): Upon arrival, the child undergoes a structured outpatient pre-procedural assessment: consultant review, repeat 12-lead ECG, TTE, blood panel (CBC, coagulation, renal/hepatic function, electrolytes), and anaesthesiology paediatric assessment. Baseline arrhythmia documentation is completed. Consent is obtained from guardians with interpreter support if required. Admission occurs the evening before the procedure; NPO (nil per os) protocol is initiated as per age-appropriate paediatric anaesthesia guidelines (clear fluids up to 2 hours, breast milk up to 4 hours, formula/solids up to 6 hours prior).

Step 3 — The Procedure (Day 2–3): Catheter ablation is typically 2–5 hours under general anaesthesia; device implantation (pacemaker/ICD) is 2–3 hours. The child is continuously monitored with pulse oximetry, invasive arterial pressure, surface ECG, and intracardiac electrograms. Post-procedure, the child is transferred to the Paediatric Cardiac ICU (PCICU) or High Dependency Unit (HDU) for 4–12 hours of cardiac monitoring. A post-procedure ECG and chest X-ray are performed immediately.