It is well known that heart rhythm disorders (arrhythmias) occur in adults, but few are aware that it is a significant problem among many South African children as well. Children may be born with a heart disorder that causes electrical and functional problems in the heart and remain unaware into adulthood that they have a potentially dangerous health problem.
“There needs to be much greater awareness of heart rhythm disorders and congenital heart disease, which is a common birth defect occurring in children and can cause problems with the efficient functioning of the heart,” says Dr Adele Greyling, a paediatric cardiologist who practises at Netcare Greenacres Hospital in Port Elizabeth. She was speaking during World Heart Rhythm Week, which runs from 4 to 10 June 2018.
Dr Greyling, who is the only paediatric cardiologist in the country to have been specifically trained in electrophysiology ? the study of electrical problems of the heart and heart rhythm disorders – says that many children with congenital heart defects go undiagnosed and take these conditions into adulthood. She says that untreated congenital heart defects and arrhythmias may be detrimental to health and in some cases even result in heart failure.
“It has been estimated that about four out of every 1 000 babies are born with inherited heart defects, which provides some idea of the extent of the challenge posed by this condition within the Eastern Cape and nationally,” adds Dr Greyling.
“World Heart Rhythm Week provides a good opportunity to improve knowledge of the problem among all sectors of the population including patients, parents and primary healthcare providers. We need to equip people with the necessary knowledge to be able to identify inherited heart problems and heart rhythm disorders, and to know when and where to obtain help.”
The theme of World Heart Rhythm Week 2018 is ‘Take Fainting to Heart’, as fainting can be an indication that one is suffering from a heart rhythm disorder, and should not be ignored. Dr Greyling says that other symptoms may include heart palpitations, dizziness, light-headedness, discomfort in the chest, or general weakness. A child with an inherited heart rhythm disorder may fail to thrive.
“It has been suggested that some 55 children out of every 100 000 suffer from heart rhythm disorders internationally, and our incidence here in South Africa is likely to echo this. The most common of these are supraventricular tachycardias, which is an electrical problem in the upper chambers of the heart,” notes Dr Greyling, who is accredited as an electrophysiologist by the Cardiac Arrhythmia Society of South Africa.
“Heart damage and rhythm disorders may be caused by a number factors including certain infections and rheumatic heart disease, but heart rhythm problems are particularly common among those born with a complex congenital, or inherited, heart defect.
“A child may, for example, be born with an inherited defect such as a hole in the heart that may cause the heart to function improperly, or with an extra electrical pathway in their heart that might cause heart rhythm disturbances,” she explains.
“Tragically, although many of these inherited heart defects can be relatively easily corrected with a minimally invasive catheter procedure, even in the very youngest of babies, the condition often goes undetected for years.
“We are finding that in the Eastern Cape, as well as nationally, there is a growing population of patients with inherited heart conditions surviving to adulthood due to improved surgical care, which poses unique challenges and a higher incidence of arrhythmias.”
Dr Greyling, who also practises in the state sector in addition to Netcare Greenacres Hospital, says that while the catheters and devices such as pacemakers often need to be smaller for children, the principles and physiology of treating heart rhythm disorders in children are similar to those in adults.
Therefore, cardiologists who have specialised in electrophysiology for adults can and do treat children with rhythm disorders, and likewise Dr Greyling, as a paediatric cardiologist who has super-specialised in heart rhythm disorders, also sometimes treats adults with inherited heart defects and arrhythmia.
Dr Greyling and her team perform interventions to repair structural heart defects, electrophysiology procedures such as cardiac ablations, which involve correcting electrical heart problems and structural abnormalities, and also implant pacemakers and defibrillators.
According to Dr Greyling, each patient is completely different and treatment depends entirely on the nature of their specific problem. “At Netcare Greenacres Hospital we are fortunate to have a team of cardiologists and cardiothoracic surgeons who work together to resolve complex heart problems in children and adults. Sometimes we may need to repair structural defects before addressing the rhythm disorder, at other times a simple ablation procedure can resolve an electrical problem. Having experience in congenital heart disease is thus most useful when dealing with heart rhythm disorders in patients with inherited heart disease.”
Asked if the fields of paediatric cardiology and heart rhythm disorders receive sufficient attention in South Africa, she said that the short answer was “no”. “We do not have enough paediatric cardiologists, adult cardiologists or electrophysiologists, let alone paediatric and congenital electrophysiologists for the patient burden. Many towns in South Africa have no cardiologists at all and Netcare Greenacres Hospital is the only private unit in the Eastern Cape to offer both paediatric cardiology and electrophysiology services.”
Initially working as a paediatrician at Netcare Greenacres Hospital, Dr Greying qualified as paediatric cardiologist in 2014. She realised there was great need for specialists trained in electrophysiology and completed a fellowship in electrophysiology in Belgium. She has trained extensively abroad and under well-known Bay paediatric cardiologist, Dr Lungile Pepeta, who also has rooms at Netcare Greenacres Hospital. Also part of the heart rhythm team at the hospital is cardiologist and cardiac electrophysiologist Dr Neil Hendricks, who has been practising there since 2014.
Netcare Greenacres Hospital general manager, André Bothma, says that Dr Greyling makes an invaluable contribution not only to the multidisciplinary cardiac team at the hospital, but also to heart medicine in the Eastern Cape province. “South Africa’s first ever paediatric cardiologist to also specialise in heart rhythm disorders, and the country’s first woman electrophysiologist, Dr Greyling’s skills and wonderful passion for medicine have benefitted many patients.
“Dr Greyling is an inspirational cardiologist who is determined to contribute to tackling the twin problems of congenital heart disorders and rhythm disorders in the Nelson Mandela Bay area and Eastern Cape province. Netcare Greenacres Hospital cardiac centre is most grateful to offer her services and those of the other cardiac specialists practising at the hospital,” concludes Bothma.