Mandatory ECG screening identifies student-athletes at risk for sudden cardiac arrest
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After a school district mandated ECGs for all students wishing to participate in sports, the screenings uncovered nearly 200 children with abnormal findings, including eight who were at risk for sudden cardiac arrest, study findings showed.
The study summarized results of ECGs administered during a 9-month period from April 1 to Dec. 31, 2019, after they were mandated by a school board in Brevard County, Florida. The findings were presented during the AAP National Conference & Exhibition.
According to Gul H. Dadlani, MD, a pediatric cardiologist at Nemours Children’s Hospital in Orlando, Florida, and colleagues, among the 5,877 ECG screenings conducted, 199 (3%) showed an abnormality. Of the 199 children with abnormalities, 30% (n = 60) had ventricular conduction, 26% (n = 51) had arrhythmias, 13% (n = 25) had ventricular hypertrophy/chamber enlargement, 11% (n = 21) had ST-T abnormalities, 8% (n = 16) had prolonged QTc, 6% (n = 12) had Wolff-Parkinson-White syndrome and 4% (n = 7) had atrioventricular conduction and axis deviation. Eight children had critical heart disease with a risk for sudden cardiac arrest, the researchers said.
“Sudden cardiac death occurs in approximately one in 40,000 high school athletes — there is no national registry,” Dadlani told Healio. “Approximately one in 300 athletes will have a cardiovascular disorder that may predispose to sudden cardiac arrest — hypertrophic cardiomyopathy (HCM) is the leading cause of sudden death in athletes, and one in 500 people in the community will carry a gene that predisposes to HCM. EKGs have an approximately 95% sensitivity rate for detection of HCM.”
Nemours Children’s Hospital published guidelines for student athletes returning to sports during the COVID-19 pandemic because the disease poses a risk for myocarditis.
According to the guidelines, if a student athlete is positive for SARS-CoV-2 but is asymptomatic, they should not participate in physical activity or competitive sports for 14 days after the last positive COVID-19 test. Students who test positive and have cardiopulmonary symptoms that are being monitored at home, or who have been admitted for any noncardiopulmonary symptoms, should not participate in physical activity or sports until they are asymptomatic for at least 14 days after a positive test.
Students who have tested positive for COVID-19 and were admitted to a hospital with cardiopulmonary symptoms or end-organ dysfunction or who have conditions that put them at a higher risk, such as obesity or asthma, should not participate in any physical activity until they are asymptomatic “with resolution of end-organ dysfunction and cleared by medical professionals,” according to the guidelines. This is a minimum of 14 days and could be up to 3 to 6 months, if the child was diagnosed with myocarditis.
The AAP said recently that some children with COVID-19 may need an ECG before returning to play sports, given evidence that SARS-CoV-2 infection can damage the heart.
References:
- Nemours. Managing return to sports evaluations in the in the age of COVID-19. https://www.nemours.org/health-professionals/covid-info-for-community-physicians.html. Accessed Oct. 3, 2020.
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Dadlani GH, et al. Feasibility of electrocardiogram screening in Central Florida prior to high school sport participation. Presented at: AAP National Conference & Exhibition; Oct. 2-5, 2020; virtual.
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