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Multicenter Study
. 2025 Mar-Apr;45(2):69-78.
doi: 10.5144/0256-4947.2025.69. Epub 2025 Apr 3.

Electrocardiogram screening for school children: a cross-sectional, population-based study

Ali A Alakhfash  1 , Abdulrahman Al Mesned  1 , Waleed Al-Manea  2 , Abdulla Al Qwaee  1 , Zuhair Nasser Al-Hassnan  3
Affiliations
Multicenter Study

Electrocardiogram screening for school children: a cross-sectional, population-based study

Ali A Alakhfash et al. Ann Saudi Med. 2025 Mar-Apr.

Abstract

Background: Identification of life-threatening arrhythmogenic disorders, which may present during infancy, childhood, or later stages, enables the early initiation of effective preventive therapies. Electrocardiogram (ECG) screening may detect conditions that elevate risk of sudden cardiac death (SCD) at an early stage.

Objectives: This study aims to assess the prevalence, clinical significance, and characteristics of ECG abnormalities in a large population of schoolchildren. It also aims to determine whether ECGs performed during childhood can aid in the early detection of conditions associated with the risk of SCD.

Design: Population-based cross-sectional study.

Setting: A multicenter study conducted at King Faisal Specialist Hospital & Research Centre (KFSHRC) in Riyadh and Prince Sultan Cardiac Center-Qassim (PSCC-Q), Qassim, Saudi Arabia.

Methods: The study analyzed 12-lead ECGs performed on elementary school students 6-15 years old in Buraidah, Qassim region, Saudi Arabia. ECGs were recorded and interpreted following international standards. Children with abnormal ECG results were referred for full pediatric cardiology evaluation.

Main outcome measures: Prevalence of normal and abnormal ECG findings, including long QT intervals.

Sample size: 14 403 students.

Results: During the study period, ECGs were performed on 14 403 students (53.8% females). The mean age was 9.5±1.9 years, and the mean weight was 32.1±16.1 kg. Abnormal ECGs were identified in 468 students (3.3%), 271 of whom had complete clinical evaluation, including repeat ECG and echocardiography. The most common ECG abnormality was a prolonged QTc interval. The overall prevalence of abnormal ECG findings ranged from 0.7% to 2.04%, with long QTc intervals (460 msec or more) found in 0.4% to 1.6% of students.

Conclusions: Long QTc intervals (460 msec or more) were the most common ECG abnormality in school children, with an estimated prevalence of 0.4% to 1.6%. This study may serve as a model for large-scale, community-based, 12-lead ECG screening programs for children.

Limitations: Causality cannot be derived given the design, the potential for false positive and false-negative results, and the lack of genetic studies for children with prolonged QT intervals.

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Conflict of interest statement

CONFLICT OF INTEREST: None.

Figures

Figure 1.
Figure 1.
Flow algorithm of the research design and management of ECG screening and its results and follow-up.
Figure 2.
Figure 2.
low algorithm of the overall results of primary ECG screening performed in the schools and the repeated ECGs in the clinic.
See this image and copyright information in PMC

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