Elsevier

American Heart Journal

Volume 161, Issue 5, May 2011, Pages 1000-1006.e3
American Heart Journal

Clinical Investigation
Pediatrics
A pilot study of the feasibility of heart screening for sudden cardiac arrest in healthy children

https://doi.org/10.1016/j.ahj.2011.01.022Get rights and content

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.

Section snippets

Current screening recommendations

In Europe, a common screening program based on the 12-lead ECG in addition to the focused history and physical examination has been recommended.9 Under the American Heart Association guidelines, the United States only recommends screening competitive athletes using history and physical examination but not an ECG.10 Data are needed to evaluate the efficacy of the current US screening compared to ECG and/or echocardiographic screening.

Rationale for heart screening in healthy children

Mass cardiovascular screening of school children in Japan has been mandatory since 1973; reports indicate that screening including an ECG has a greater sensitivity compared to history and physical examination alone.11 Studies from Italy have shown that the ECG is 3 times more likely to identify those at risk than the history and physical examination alone, with a sensitivity of 98.8%.12, 13 Recent screening in the United Kingdom and Netherlands showed that most abnormalities identified would

Study group

The institutional review board of The Children's Hospital of Philadelphia (CHOP) approved our pilot Heart Health Screening Study. Eligible subjects were 5- to 19-year-olds with no known cardiac conditions or previous cardiac evaluations. Parental written consent was obtained with assent in children >12 years. Subjects were recruited from CHOP-affiliated community pediatric practices. This sampling was considered acceptable because this study was not intended to represent a generalizable

Results

Table I shows the age, gender, and racial distributions of the study population of 400 children and adolescents. Previously undiagnosed cardiac abnormalities were found in 23 subjects (5.8%); an additional 20 (5%) had hypertension, defined for this study as 2 blood pressures >95th percentile. Potentially serious conditions were identified in 10 subjects (2.5%). Electrocardiogram identified prolonged QT interval/LQTS (2), WPW anomaly (1), complex ventricular ectopy (2), ostium primum atrial

Discussion

This study reports a pilot cardiac screening experience in healthy school-aged children. We found that it was feasible to use the ECG to screen school-aged children to improve the likelihood of finding cardiovascular abnormalities. The ECHO further enhanced the identification of abnormalities. In our study, the ECG outperformed the history and physical examination and found previously unidentified potentially serious abnormalities in children that would not have been identified by history and

Summary and conclusions

Our pilot study demonstrates that it is feasible to screen children and adolescents with ECG in addition to history and physical examination. We have provided a methodology for this type of screening. We have shown that the ECG has the potential to identify serious cardiovascular abnormalities, many of which will not be recognized by history and physical examination in healthy school-aged children. Echocardiogram further improves the identification of abnormalities such as coronary artery

Disclosures

Funding sources: supported by the Chair's Initiative of the Department of Pediatrics of The Children's Hospital of Philadelphia and the Evelyn R. Tabas Chair in Pediatric Cardiology. No extramural funding was used to support this work.

Acknowledgements

We wish to thank the ECG technicians and the ECG administrative staff and echosonographers from the ECG and Echocardiographic Laboratories of The Children's Hospital of Philadelphia for their assistance in collecting ECG and echocardiographic data.

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