Preventing sudden cardiac death in the young: Is electrocardiogram screening the most effective means?

Gow, Robert M.

doi:10.1093/pch/14.3.185

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…It is important to note that there is still significant controversy surrounding the appropriateness of screening for cardiac conditions with the risk of sudden death. There are both supporters and detractors, mainly because there are unresolved and unsecured aspects of the criteria for implementing a screening program regarding entities that can cause sudden death [ 13 , 32 , 33 ]. One of these criteria is that there must be a simple, safe, precise, and validated screening test.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the ECG in paediatrics is a simple, quick, inexpensive, painless, and accessible test, in both primary and hospital care, and its demonstrated sensitivity and specificity are greater than 90% [ 11 , 12 ]. In conclusion, the factors associated with SCD risk could be detected by a primary care paediatrician by means of the medical record, physical examination, and ECG reading during a routine consultation [ 13 ]. Knowing these factors, more effective ways of screening for these conditions could be established.…”

Section: Introductionmentioning

confidence: 99%

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Can we screen for heart disease in children at public health centres? A multicentre observational study of screening for heart disease with a risk of sudden death in children

Greciano Calero,

Escribá Bori,

Costa Orvay

et al. 2024

Eur J Pediatr

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Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP’s skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP’s workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen’s kappa coefficient was 31.2% (CI 95%: 13.8–48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%. Conclusions: This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs. What is Known:• In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4, 5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians. What is New:• We did not know whether—in our setting, at present—the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians’ skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can we screen for heart disease in children at public health centres? A multicentre observational study of screening for heart disease with a risk of sudden death in children

Greciano Calero,

Escribá Bori,

Costa Orvay

et al. 2024

Eur J Pediatr

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show abstract

“…Since many of the diseases involve a disturbance in the electrical conductance of the heart, this diagnostic tool can provide tremendous insight into the pathology of the disease and its progression. (Gow 2009). ECG testing can provide insight into the etiology which is potentially placing the patient at risk for SCD.…”

Section: Diagnosis and Screening Of Patients At Risk Of Scdmentioning

confidence: 99%

“…ECG testing can provide insight into the etiology which is potentially placing the patient at risk for SCD. ARVD is classically characterized by inverted T-waves in the mid-precordial leads, widened or fragmented QRS complexes, and abnormal complexes on the S wave on the right chest leads (Gow 2009). Patients who are diagnosed with ARVD are often further assessed for comorbidities and the potential risk for SCD.…”

Section: Diagnosis and Screening Of Patients At Risk Of Scdmentioning

confidence: 99%