Pediatric arrhythmology deals with studying of frequency and regularity of heart rhythm disorders in childhood. Rhythm disturbances (dysrhythmias, arrhythmias) occur as a result of disturbances in the creation or conduction of stimuli in the specific or working musculature of the heart. Simplifying the knowledge of everyday work on pediatric arrhythmias, they can originate from the atria of the heart when we speak about supraventricular arrhythmias or from the heart chambers when we talk about ventricular arrhythmias. There are currently three major problems that burden pediatric cardiologists and pediatric arrhythmologists, and which are the focus of interest in pediatrics as a whole. These are primarily sudden cardiac death in children (SCD), fetal arrhythmias (FA) and postoperative-incisional arrhythmias (IA). The development of pediatric arrhythmology is imperative in the development of pediatrics and pediatric cardiology.

Objective - The purpose of this investigation was to determine the frequencies and types of associated congenital heart disease and other cardiac lesions in children with congenital anomalies of the kidneys and urinary tract (CAKUT). Participants and method - This was a prospective cardiac evaluation of children with diagnosed CAKUT, conducted between January 2013 and December 2015 at the Department of Pediatrics of the University Clinical Hospital, Tuzla. All cases were reviewed for age, gender, consanguinity, occurrence of congenital heart disease (CHD) and CAKUT in family history. Cardiac examination included: physical examination, noninvasive blood pressure measurement, a twelve lead electrocardiogram and echocardiogram. Results - Complete cardiac examination was performed in 144 children with congenital anomalies of the kidneys and urinary tract. Clinically insignificant morphological or hemodynamical changes were noted in 13% or 9.0% children. Congenital heart disease was found in 32 (22.2%), hypertrophic cardiomyopathy in 2 and pulmonary hypertension in 1 of the 144 children. In 4 children congenital heart disease was part of other known genetic syndromes, and all of these cases had severe CHD. In twenty-six or 76.5% of the total of 32 patients it was already known, and in 6 (23.5%) CHD was discovered during this research. Ventricular septal defect was the most common malformation (13% or 40.6% of patients). Vesicoureteral reflux was the most frequent CAKUT associated with CHD. Conclusions - The results of this study showed a significant association between CAKUT and CHD. Therefore we suggest performing cardiac assessment of all children with CAKUT.

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.