番茄社区

Implementing large-scale ECG screening before high school sport participation could detect heart abnormalities that carry the risk of sudden cardiac death if left unchecked, a researcher reported.

Among 5,877 middle and high school students in Brevard County, Florida, ECG screening detected abnormalities requiring follow-up care in 199 (3%), and critical heart disease carrying a risk for sudden cardiac death in eight (0.1%), reported Gabriel S. Krivenko, of the University of Central Florida in Orlando.

Of the eight children who screened positive for critical heart disease, six underwent an ablation procedure for Wolff-Parkinson-White syndrome, one had gene positive long QTc, and one underwent genetic evaluation for hypertrophic cardiomyopathy, Krivenko said at the American Academy of Pediatrics (AAP) virtual meeting.

"ECG screening programs are feasible in large school districts for student athletes and they can be done at a low cost when given sufficient manpower and appropriate access to follow-up care," Krivenko said during the AAP presentation.

About one in 40,000 children will undergo sudden cardiac arrest, and one in five carry a gene that predisposes them to sudden cardiac arrest. The U.S. does not currently have a national mandate requiring ECG screening for school athletes, although some states, such as Texas, have recently passed laws mandating pre-sports screening.

The after a young athlete named Cody Stephens died from sudden cardiac arrest. The program in this study was also implemented after student , age 15 years, died in Cocoa Beach, Florida while playing soccer, said co-author Gul H. Dadlani, MD, of Nemours Cardiac Center in Orlando.

"Both communities and states have rallied after a child has passed away from sudden cardiac death," Dadlani told 番茄社区. "We hope with this information, school districts and states can implement screening programs, at a low cost with the available manpower, on a large scale to be able to do school-wide or statewide screening proactively, before a child passes away."

Pre-sports ECG screening has been controversial, with critics argue that screening can be costly and for the relatively low rate of sudden cardiac arrest.

There is also considerable variability in cardiologists' readings of ECGs, commented Ritu Sachdeva, MD, of Emory University School of Medicine in Atlanta, during a discussion of the research.

"One third of ECGs were called abnormal because there was ventricular conduction delay, and many of us will call it a benign or normal variant," Sachdeva said. She noted that a looser definition of abnormal ECGs could lead to a high rate of echocardiograms and other testing, placing a large burden on the healthcare system.

The pilot study involved two to three screening events hosted throughout the school year across the district's 32 schools. ECGs were provided by a nonprofit organization, , for $20, and three local pediatric cardiologists volunteered to read and refer abnormal screens. Follow-up care was offered at a free cardiology clinic for families who were uninsured or underinsured.

Overall, a majority of the cohort was male (55%), and white (69%). Most students played soccer (14%), basketball (14%), or football (12%), Krivenko reported.

Other abnormalities detected in the ECG screenings included conduction delays (27%), arrhythmias (25%), ventricular hypertrophy (13%), ST or T-wave abnormalities (11%), prolonged QTc intervals (8%), Wolff-Parkinson-White syndrome (6%), and axis deviation (4%), according to the study.

This study was performed before the pandemic, but Dadlani said preventive screening has become even more important because myocarditis associated with the COVID-19 infection can be a cause of sudden cardiac arrest.

The AAP recently recommended prior to returning to school sports if they have a positive cardiac screen.

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