Health & Medical Heart Diseases

Heart Screening for Sudden Cardiac Arrest in Healthy Children

Heart Screening for Sudden Cardiac Arrest in Healthy Children

Abstract and Introduction

Abstract


Background In children, sudden cardiac arrest (SCA) is associated with structural and electrical cardiac abnormalities. No studies have systematically screened healthy school children in the United States for conditions leading to SCA to identify those at risk.
Methods From June 2006 to June 2007, we screened 400 healthy 5- to 19-year-olds (11.8 ± 3.9 years) in clinical offices at The Children's Hospital of Philadelphia using a medical and family history questionnaire, weight, height, blood pressure, heart rate, cardiac examination, electrocardiogram (ECG), and echocardiogram (ECHO). Our goals were to determine the feasibility of adding an ECG to history and physical examination and to identify a methodology to be used in a larger multicenter study. A secondary objective was to compare identification of cardiovascular abnormalities by history and physical examination, ECG, and ECHO.
Results Previously undiagnosed cardiac abnormalities were found in 23 subjects (5.8%); an additional 20 (5%) had hypertension. Potentially serious cardiac conditions were identified in 10 subjects (2.5%); 7 were suspected or identified by ECG and 3 more only by ECHO. Only 1 of the 10 had symptoms (previously dismissed); none had a positive family history.
Conclusions It is feasible to screen for conditions associated with SCA in healthy children by adding ECG to history and physical examination. In this nongeneralizable sample, ECG identified more cases compared to history and physical examination alone, with further augmentation from ECHOs. Improvements in ECG and echocardiographic normative standards, representing age, gender, race, and ethnicity, are needed to increase the efficacy of screening in a young population.

Introduction


Conditions associated with sudden cardiac arrest (SCA) in children include hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy, coronary artery anomalies, Marfan syndrome, congenital heart defects, long QT syndrome (LQTS), and other primary electrical abnormalities such as the Brugada and Wolff-Parkinson-White (WPW) syndromes. These conditions result in an undetermined number of childhood deaths yearly in the United States, estimated from 100 to >1000. In countries that include electrocardiographic screening in preparticipation evaluations, the electrocardiogram (ECG) is more sensitive in identifying those at risk for SCA than history or physical examination alone. Reports suggest that the ECG can help identify youth with undiagnosed conditions predisposing to SCA with subsequent prevention of SCA and death.

No studies have systematically screened healthy school-aged children in the United States to identify those with conditions that may result in SCA. The best method to identify those children at risk for SCA and the best population to target through primary screening is currently controversial.

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