ECG screening for sudden cardiac death in children and adolescents: is it money well spent? Is there an optimal age for screening?

Sudden cardiac death (SCD) in otherwise healthy children is tragic. Increasing attention has been paid to preventing these untimely events, particularly with regard to cardiac causes, because these are the most common causes, though not the exclusive ones. Interest has centered on sports participation, as about 25% of such events occur at this time,1 and the use of attention deficit hyperactivity disorder (ADHD) medication, which may or may not precipitate SCD in susceptible individuals. A recent National Heart, Lung and Blood Institute panel evaluated the evidence base for addressing the prevention of SCD and found too many gaps in evidence to formulate general recommendations for SCD prevention in the young.2 Particular concerns surround: lack of knowledge of the true incidence of SCD; absence of a pilot ECG screening program to test the effectiveness of various screening methodologies; identification of the most effective screening strategy (the most useful screening method, and selective screening in high-risk individuals versus universal screening at a specific age); and limited knowledge of the impact of a screening program on the both the quality of life and clinical outcomes of the asymptomatic individuals and families screened. The report states “before a significant public health investment is made in large scale ECG screening, it would be ideal to empirically demonstrate a link between screening and improved health outcomes.”