Key result
ADHD medications cause no adverse cardiac symptoms in healthy children screened with baseline ECG.
Why the study?
Routine screening electrocardiograms before starting medications for ADHD remain controversial.
Does routine baseline ECG screening detect clinically significant cardiac abnormalities before initiating ADHD medications in healthy children?
Cohort (n=362)
No
Does routine baseline ECG screening detect clinically significant cardiac abnormalities before initiating ADHD medications in healthy children?
Routine baseline ECG screening prior to ADHD medication initiation in healthy children yielded an extremely low rate of clinically significant QTc prolongation (0.3%) and no adverse cardiac events, suggesting such screening may not be necessary in patients without a cardiac history.
Baseline ECG rarely flags QTc prolongation in healthy children starting ADHD meds; leaves open whether routine screening improves cardiac safety.
BACKGROUND/OBJECTIVES: Routine screening electrocardiograms (ECGs) prior to starting medications for attention-deficit/hyperactivity disorder (ADHD) remain controversial. This real-world study assessed corrected QT (QTc) interval data from pediatric patients who had a baseline ECG performed prior to initiating treatment with ADHD medications and ≥6 months of clinical follow-up. METHODS: A retrospective chart review of children aged 2-18 years diagnosed with ADHD with/without autism spectrum disorder (ASD) at child neurology clinics in Jordan (June 2019 and June 2021) was performed, and children were prescribed with ADHD medications to manage symptoms. Patients had ≥6 months of follow-up and no known cardiac disease/family history. A baseline ECG and regular clinical exams were performed for each child. RESULTS: Of 458 patients with baseline ECGs, 362 met the study inclusion criteria. Overall, 286 (79.0%) patients were diagnosed with ASD/comorbid ADHD and 76 (21.0%) with ADHD alone; 61 (16.9%) were prescribed atomoxetine, 38 (10.5%) methylphenidate, 134 (37.0%) risperidone, and 129 (35.6%) aripiprazole. The patients' mean ± SD age was 6.4 ± 3.5 years, and most were male (n = 268, 74.0%). The mean baseline QTc interval was 400 ± 22 ms (median, 400 ms); one patient had a QTc interval >460 ms and was excluded from initiating treatment with any ADHD medications. During the ≥6-month follow-up, none of the patients had any signs or symptoms of adverse cardiac effects. CONCLUSIONS: Routine screening ECGs prior to treatment with ADHD medications may not be necessary in healthy children with no family history of cardiac disease. However, further studies are needed to evaluate the long-term effects of ADHD medications in low-risk pediatric patients.
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Alsayouf et al. (2024) conducted a cohort in Attention-deficit/hyperactivity disorder (ADHD) with or without autism spectrum disorder (ASD) (n=362). ADHD medications and baseline screening ECG was evaluated on Incidence of drug-related cardiac side effects (tachycardia, chest pain, palpitations, dyspnea, abnormal breathing patterns, or fatigue). Among 362 healthy children, only one patient had a baseline QTc interval >460 ms, and zero patients experienced any signs or symptoms of adverse cardiac effects during ≥6 months of ADHD medication treatment.
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