A study published in the American Heart Journal has shown that one should screen all healthy children and adolescents with an ECG to detect undiagnosed heart conditions that increase the risk of sudden cardiac arrest.
The current American Heart Association guidelines recommend screening only for competitive athletes, not all children, with an additional ECG. Only in Italy and Japan there is compulsory screening of all athletes or schoolchildren with ECG.
The study evaluated the feasibility of adding an ECG to cardiac screening of healthy school–aged children. In children, sudden cardiac arrest is caused by structural or electrical abnormalities in the heart that frequently cause no symptoms and may go undiagnosed. It results in an estimated over 1000 annual deaths in childhood in the U.S alone.
The current study included 400 healthy subjects, 5 to 19 years old with a medical family history questionnaire, a physical examination and an ECG. The study team identified previously undiagnosed cardiac abnormalities in 23 subjects, and hypertension in an additional 20. Ten of the 400 subjects (2.5%) had potentially serious cardiac conditions. Of those 10 subjects, only one had experienced transient symptoms, which was dismissed as unrelated. None of the 10 subjects had a family history of sudden cardiac arrest. It was the ECG who outperformed the history and physical examination and found previously unidentified potentially serious abnormalities that would not have been identified by history and physical examination alone.
Children screened were not all high school athletes, and most would not have undergone athletic cardiac screening. Regular physical examinations by primary care physicians had not detected the cardiac conditions found in the current study.