Prediction and prevention of sudden death in young populations: the role of ECG screening

Abstract

Sudden cardiac death (SCD), particularly when it affects a child or a young athlete who is presumed to be healthy, is an emotionally charged event that has a widespread impact. An effective ECG screening strategy for this population is intuitively appealing. The primary objective of ECG screening is to detect occult cardiovascular conditions likely to manifest with SCD. Such an endeavor is only effective if it is highly sensitive with an acceptably low false-positive rate. It also must be accompanied by an intervention that reduces the risk of SCD and improves outcomes. Despite significant advancements, considerable knowledge gaps remain about the etiology of SCD and the frequency with which SCD occurs. Reports of screening programs that have reduced the incidence of SCD have limited generalizability based on program design and the populations studied. Within the USA, considerable gaps in knowledge exist related to the frequency of SCD in youth and to the incremental predictive value of an ECG when added to a standardized history and physical examination. The strategy of ECG screening of young populations needs careful consideration based on principles of effective screening and evidence-based medicine. From a health policy perspective, additional data are needed from robust registries and carefully designed trials before advancing ECG screening in youth.