ECG Screening for Sudden Cardiac Death in Children and Adolescents

Sudden cardiac death (SCD) in otherwise healthy children is tragic. Increasing attention has been paid to preventing these untimely events, particularly with regard to cardiac causes, because these are the most common causes, though not the exclusive ones. Interest has centered on sports participation, as about 25% of such events occur at this time,1 and the use of attention deficit hyperactivity disorder (ADHD) medication, which may or may not precipitate SCD in susceptible individuals. A recent National Heart, Lung and Blood Institute panel evaluated the evidence base for addressing the prevention of SCD and found too many gaps in evidence to formulate general recommendations for SCD prevention in the young.2 Particular concerns surround: lack of knowledge of the true incidence of SCD; absence of a pilot ECG screening program to test the effectiveness of various screening methodologies; identification of the most effective screening strategy (the most useful screening method, and selective screening in high-risk individuals versus universal screening at a specific age); and limited knowledge of the impact of a screening program on the both the quality of life and clinical outcomes of the asymptomatic individuals and families screened. The report states “before a significant public health investment is made in large scale ECG screening, it would be ideal to empirically demonstrate a link between screening and improved health outcomes.”Article see p 2621To fill a critical gap in the evidence, Leslie and colleagues3 have performed a detailed analysis of the cost and benefits of combined history, physical and ECG screening for the more common causes of SCD in children age 8, who are initiating stimulant therapy for ADHD, and adolescents age 14, who are participating in high school sports. Although their analyses and algorithms are necessarily complex, they have attempted to focus the problem by …