Electrocardiogram screening in asymptomatic children demonstrated high sensitivity and negative predictive value for detecting hypertrophic cardiomyopathy (AUC 0.91) and long QT syndrome (AUC 0.92).
Meta-Analysis
Does electrocardiogram (ECG) screening accurately detect disorders that cause sudden cardiac death (HCM, LQTS, WPW) in asymptomatic children?
ECG screening in asymptomatic children has high sensitivity and negative predictive value for detecting conditions associated with sudden cardiac death, but low disease prevalence leads to variable positive predictive values and false-positive rates.
BACKGROUND AND OBJECTIVES: Pediatric sudden cardiac death (SCD) occurs in an estimated 0.8 to 6.2 per 100 000 children annually. Screening for cardiac disorders causing SCD in asymptomatic children has public appeal because of its apparent potential to avert tragedy; however, performance of the electrocardiogram (ECG) as a screening tool is unknown. We estimated (1) phenotypic (ECG- or echocardiogram ECHO-based) prevalence of selected pediatric disorders associated with SCD, and (2) sensitivity, specificity, and predictive value of ECG, alone or with ECHO. METHODS: We systematically reviewed literature on hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Wolff-Parkinson-White syndrome, the 3 most common disorders associated with SCD and detectable by ECG. RESULTS: We identified and screened 6954 abstracts, yielding 396 articles, and extracted data from 30. Summary phenotypic prevalences per 100 000 asymptomatic children were 45 (95% confidence interval CI: 10-79) for HCM, 7 (95% CI: 0-14) for LQTS, and 136 (95% CI: 55-218) for Wolff-Parkinson-White. The areas under the receiver operating characteristic curves for ECG were 0.91 for detecting HCM and 0.92 for LQTS. The negative predictive value of detecting either HCM or LQTS by using ECG was high; however, the positive predictive value varied by different sensitivity and specificity cut-points and the true prevalence of the conditions. CONCLUSIONS: Results provide an evidence base for evaluating pediatric screening for these disorders. ECG, alone or with ECHO, was a sensitive test for mass screening and negative predictive value was high, but positive predictive value and false-positive rates varied.
Rodday et al. (Tue,) conducted a meta-analysis in Disorders causing sudden cardiac death in asymptomatic children. Electrocardiogram (ECG) screening was evaluated on Phenotypic prevalence of selected pediatric disorders associated with SCD, and sensitivity, specificity, and predictive value of ECG. Electrocardiogram screening in asymptomatic children demonstrated high sensitivity and negative predictive value for detecting hypertrophic cardiomyopathy (AUC 0.91) and long QT syndrome (AUC 0.92).