Rationale and Objectives for ECG Screening in Infancy.

Heart Rhythm. 2014 Sep 16. pii: S1547-5271(14)01039-X. doi: 10.1016/j.hrthm.2014.09.047. [Epub ahead of print] Philip Saul J, Schwartz PJ, Ackerman MJ, Triedman JK.

Abstract

Electrocardiographic (ECG) screening of infants and children who may be at risk for sudden cardiac death is controversial, and both rational and emotional arguments have often been given similar weights. The authors each have direct experience in this field, but have different backgrounds and have expressed divergent views on this topic. We attempted to build consensus among ourselves based on the available facts, in hopes of providing an unbiased review of the relevant science and policy issues in favor of or against ECG screening in infants and children. This report presents our shared view on this medically and societally important topic. The long QT syndrome (LQTS) satisfies several criteria that may make ECG screening worthwhile: it is not rare (~1 in 2,000 births); ECG diagnosis is feasible and can be used to trigger appropriate genetic testing; it causes approximately 10% of cases of sudden infant death syndrome as well as deaths in childhood and later in life, and effective treatments are available. By stimulating cascade screening of family members, diagnosis of affected infants may also prompt identification of asymptomatic but affected individuals. Neonatal screening is cost-effective using conventional criteria, and with a QTc cutoff of 460 ms in two different ECGs the number of false positives is estimated to be low (~1 in 1,000). It is our conclusion that parents of newborn children should be informed about LQTS, a life-threatening but very treatable disease of significant prevalence that may be diagnosed by a simple ECG.

Copyright © 2014. Published by Elsevier Inc.

KEYWORDS:
ECG screening; infants; long QT syndrome; sudden cardiac death