Pediatric Screening Detects Potentially Serious Heart Conditions

A new study in healthy children and adolescents shows that adding an electrocardiogram (ECG) to a regular examination can identify unsuspected cases of potentially serious heart conditions that increase the risk of sudden cardiac arrest (SCA).

Researchers at the Children's Hospital of Philadelphia (CHOP; PA, USA) screened 400 healthy 5-19 year-olds between June 2006 to June 2007 using a medical and family history questionnaire, weight, height, blood pressure, heart rate, cardiac examination, an electrocardiogram (ECG), and an echocardiogram (ECHO). The goal of the study was to determine the feasibility of adding an ECG to a medical 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.

The results showed that 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 of the subjects (2.5%); seven of these were suspected or identified by ECG, and three more only by ECHO. Only 1 of the 10 had symptoms (previously dismissed), and none of them had a positive family history. The study was published early online on March 15, 2011, in the American Heart Journal.

"Performing the ECG and its interpretation added less than 10 minutes to each subject's total evaluation," said lead author Victoria Vetter, MD, MPH, a pediatric cardiologist at CHOP. "Our pilot study showed that adding ECG to the currently recommended guideline of history and physical examination is feasible for screening children and adolescents, and offers the potential to identify serious cardiovascular abnormalities.”

SCA in children is caused by structural or electrical abnormalities in the heart that frequently cause no symptoms, and may go undiagnosed. It results in an estimated 100 to 1,000 or more annual deaths in childhood in the United States. While in the US, American Heart Association (AHA) guidelines recommend screening only competitive athletes, researchers in Italy and Japan--which have compulsory screening of all athletes or schoolchildren--have found that adding an ECG to the history and physical examination increases the likelihood of detecting children at risk for SCA.

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