Skip to main content
Top
Published in: Pediatric Cardiology 1/2016

01-01-2016 | Review Article

The Impending Dilemma of Electrocardiogram Screening in Athletic Children

Authors: Laure Léger, Boris Gojanovic, Nicole Sekarski, Erik J. Meijboom, Yvan Mivelaz

Published in: Pediatric Cardiology | Issue 1/2016

Login to get access

Abstract

Sudden cardiac death (SCD) affects 2/100,000 young, active athletes per year of which 40 % are less than 18 years old. In 2004, the International Olympic Committee accepted the Lausanne Recommendations, including a 12-lead electrocardiogram (ECG), as a pre-participation screening tool for adult Olympic athletes. The debate on extending those recommendations to the pediatric population has recently begun. The aims of our study were to highlight the characteristics of the young athlete ECG, phenotypical manifestations of SCD-related disease in children, and challenges of implanting ECG screening in athletic children. A systematic review of the literature is performed. We searched available electronic medical databases for articles relevant to SCD, ECG, silent cardiac diseases, and athletic children. We focused on ECG screening and description in a pediatric population. We identified 2240 studies. Sixty-two relevant articles and one book were selected. In children, prepubertal ECG and the ECG phenotype of most SCD-related diseases differ notably from adults. The characteristics of the prepubertal ECG and of the phenotypical manifestation of SCD-related disease in children will result in less specific and less sensitive ECG-based screening programs. Those limitations advise against extending the adult recommendation to children, without further studies. Until then, history and physical exam should remain the cornerstone of screening for SCD-related pathologies in children.
Literature
1.
go back to reference Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (2013) Moss and Adams’ heart disease in infants, children, and adolescents. Lippincott Williams & Wilkins Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (2013) Moss and Adams’ heart disease in infants, children, and adolescents. Lippincott Williams & Wilkins
2.
go back to reference Antzelevitch C, Brugada P, Borggrefe M et al (2005) Brugada syndrome: report of the second consensus conference. In: Heart rhythm. pp 429–440 Antzelevitch C, Brugada P, Borggrefe M et al (2005) Brugada syndrome: report of the second consensus conference. In: Heart rhythm. pp 429–440
6.
go back to reference Basavarajaiah S, Boraita A, Whyte G et al (2008) Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 51:2256–2262. doi:10.1016/j.jacc.2007.12.061 CrossRefPubMed Basavarajaiah S, Boraita A, Whyte G et al (2008) Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 51:2256–2262. doi:10.​1016/​j.​jacc.​2007.​12.​061 CrossRefPubMed
8.
go back to reference Basso C, Maron BJ, Corrado D, Thiene G (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493–1501CrossRefPubMed Basso C, Maron BJ, Corrado D, Thiene G (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493–1501CrossRefPubMed
17.
go back to reference Corrado D (2004) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524. doi:10.1093/eurheartj/ehi108 CrossRef Corrado D (2004) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524. doi:10.​1093/​eurheartj/​ehi108 CrossRef
18.
go back to reference Corrado D, Basso C, Nava A, Thiene G (2001) Arrhythmogenic right ventricular cardiomyopathy: current diagnostic and management strategies. Cardiol Rev 9:259–265CrossRefPubMed Corrado D, Basso C, Nava A, Thiene G (2001) Arrhythmogenic right ventricular cardiomyopathy: current diagnostic and management strategies. Cardiol Rev 9:259–265CrossRefPubMed
19.
go back to reference Corrado D, Basso C, Buja G et al (2001) Right bundle branch block, right precordial st-segment elevation, and sudden death in young people. Circulation 103:710–717CrossRefPubMed Corrado D, Basso C, Buja G et al (2001) Right bundle branch block, right precordial st-segment elevation, and sudden death in young people. Circulation 103:710–717CrossRefPubMed
24.
go back to reference De Ambroggi L, Francia P, De Ambroggi G (2007) Repolarization abnormalities and arrhythmogenesis in hypertrophic myocardium. Anadolu Kardiyol Derg 7(Suppl 1):71–72PubMed De Ambroggi L, Francia P, De Ambroggi G (2007) Repolarization abnormalities and arrhythmogenesis in hypertrophic myocardium. Anadolu Kardiyol Derg 7(Suppl 1):71–72PubMed
26.
go back to reference Dennison BA, Straus JH, Mellits ED, Charney E (1988) Childhood physical fitness tests: predictor of adult physical activity levels? Pediatrics 82:324–330PubMed Dennison BA, Straus JH, Mellits ED, Charney E (1988) Childhood physical fitness tests: predictor of adult physical activity levels? Pediatrics 82:324–330PubMed
34.
go back to reference Frias PA (2005) Hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia in young patients. Semin Pediatr Neurol 12:25–31CrossRefPubMed Frias PA (2005) Hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia in young patients. Semin Pediatr Neurol 12:25–31CrossRefPubMed
35.
go back to reference Fuller CM (2000) Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 32:887–890CrossRefPubMed Fuller CM (2000) Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 32:887–890CrossRefPubMed
36.
go back to reference Global Advocacy Council for Physical Activity International Society for Physical Activity and Health (2010) The Toronto charter for physical activity: a global call for action. J Phys Act Health 7(Suppl 3):S370–S385 Global Advocacy Council for Physical Activity International Society for Physical Activity and Health (2010) The Toronto charter for physical activity: a global call for action. J Phys Act Health 7(Suppl 3):S370–S385
37.
go back to reference Gojanovic B, Feihl F, Gremion G, Waeber B (2007) Sudden death in young athletes. Praxis (Bern 1994) 96:189–198CrossRef Gojanovic B, Feihl F, Gremion G, Waeber B (2007) Sudden death in young athletes. Praxis (Bern 1994) 96:189–198CrossRef
38.
go back to reference Goldberg B, Saraniti A, Witman P et al (1980) Pre-participation sports assessment—an objective evaluation. Pediatrics 66:736–745PubMed Goldberg B, Saraniti A, Witman P et al (1980) Pre-participation sports assessment—an objective evaluation. Pediatrics 66:736–745PubMed
39.
go back to reference Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging* *Developed in accordance with the principles and methodology outlined by ACCF. J Am Coll Cardiol 48:1475–1497. doi:10.1016/j.jacc.2006.07.003 CrossRefPubMed Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging* *Developed in accordance with the principles and methodology outlined by ACCF. J Am Coll Cardiol 48:1475–1497. doi:10.​1016/​j.​jacc.​2006.​07.​003 CrossRefPubMed
45.
go back to reference Kwon DH, Setser RM, Popović ZB et al (2008) Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study. Int J Cardiovasc Imaging 24:617–625. doi:10.1007/s10554-008-9292-6 CrossRefPubMed Kwon DH, Setser RM, Popović ZB et al (2008) Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study. Int J Cardiovasc Imaging 24:617–625. doi:10.​1007/​s10554-008-9292-6 CrossRefPubMed
47.
49.
go back to reference Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320PubMed Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320PubMed
51.
go back to reference Maron BJ, Thompson PD, Ackerman MJ et al (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1655. doi:10.1161/CIRCULATIONAHA.107.181423 CrossRefPubMed Maron BJ, Thompson PD, Ackerman MJ et al (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1655. doi:10.​1161/​CIRCULATIONAHA.​107.​181423 CrossRefPubMed
52.
go back to reference Maron BJ, Friedman RA, Kligfield P et al (2014) Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation 130:1303–1334. doi:10.1161/CIR.0000000000000025 CrossRefPubMed Maron BJ, Friedman RA, Kligfield P et al (2014) Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation 130:1303–1334. doi:10.​1161/​CIR.​0000000000000025​ CrossRefPubMed
53.
go back to reference McRae AT, Chung MK, Asher CR (2001) Arrhythmogenic right ventricular cardiomyopathy: a cause of sudden death in young people. Cleve Clin J Med 68:459–467CrossRefPubMed McRae AT, Chung MK, Asher CR (2001) Arrhythmogenic right ventricular cardiomyopathy: a cause of sudden death in young people. Cleve Clin J Med 68:459–467CrossRefPubMed
55.
go back to reference Mivelaz Y, Di Bernardo S, Pruvot E et al (2006) Brugada syndrome in childhood: a potential fatal arrhythmia not always recognised by paediatricians. A case report and review of the literature. Eur J Pediatr 165:507–511. doi:10.1007/s00431-006-0150-z CrossRefPubMed Mivelaz Y, Di Bernardo S, Pruvot E et al (2006) Brugada syndrome in childhood: a potential fatal arrhythmia not always recognised by paediatricians. A case report and review of the literature. Eur J Pediatr 165:507–511. doi:10.​1007/​s00431-006-0150-z CrossRefPubMed
56.
go back to reference Munger TM, Packer DL, Hammill SC et al (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation 87:866–873CrossRefPubMed Munger TM, Packer DL, Hammill SC et al (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation 87:866–873CrossRefPubMed
57.
go back to reference Ng B, Maginot KR (2007) Sudden cardiac death in young athletes: trying to find the needle in the haystack. WMJ 106:335–342PubMed Ng B, Maginot KR (2007) Sudden cardiac death in young athletes: trying to find the needle in the haystack. WMJ 106:335–342PubMed
58.
go back to reference Pagon RA, Adam MP, Ardinger HH et al (1993) Catecholaminergic polymorphic ventricular tachycardia. University of Washington, Seattle Pagon RA, Adam MP, Ardinger HH et al (1993) Catecholaminergic polymorphic ventricular tachycardia. University of Washington, Seattle
60.
go back to reference Park MK, Guntheroth WG (2006) How to read pediatric ECGs. Elsevier Health Sciences Park MK, Guntheroth WG (2006) How to read pediatric ECGs. Elsevier Health Sciences
61.
go back to reference Pelliccia A, Di Paolo FM, Maron BJ (2002) The athlete’s heart: remodeling, electrocardiogram and preparticipation screening. Cardiol Rev 10:85–90CrossRefPubMed Pelliccia A, Di Paolo FM, Maron BJ (2002) The athlete’s heart: remodeling, electrocardiogram and preparticipation screening. Cardiol Rev 10:85–90CrossRefPubMed
66.
go back to reference Richter S, Sarkozy A, Paparella G et al (2010) Number of electrocardiogram leads displaying the diagnostic coved-type pattern in Brugada syndrome: a diagnostic consensus criterion to be revised. Eur Heart J 31:1357–1364. doi:10.1093/eurheartj/ehq049 CrossRefPubMed Richter S, Sarkozy A, Paparella G et al (2010) Number of electrocardiogram leads displaying the diagnostic coved-type pattern in Brugada syndrome: a diagnostic consensus criterion to be revised. Eur Heart J 31:1357–1364. doi:10.​1093/​eurheartj/​ehq049 CrossRefPubMed
69.
go back to reference Sharma S (2003) Athlete’s heart-effect of age, sex, ethnicity and sporting discipline. Exp Physiol 88:665–669CrossRefPubMed Sharma S (2003) Athlete’s heart-effect of age, sex, ethnicity and sporting discipline. Exp Physiol 88:665–669CrossRefPubMed
70.
71.
go back to reference Sharma S, Maron BJ, Whyte G et al (2002) Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 40:1431–1436CrossRefPubMed Sharma S, Maron BJ, Whyte G et al (2002) Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 40:1431–1436CrossRefPubMed
72.
go back to reference Snoek JA, Jongman JK, Brandon T et al (2013) Performance of the Lausanne questionnaire and the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Eur J Prev Cardiol. doi:10.1177/2047487313506827 PubMed Snoek JA, Jongman JK, Brandon T et al (2013) Performance of the Lausanne questionnaire and the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Eur J Prev Cardiol. doi:10.​1177/​2047487313506827​ PubMed
77.
go back to reference Wever-Pinzon OE, Myerson M, Sherrid MV (2009) Sudden cardiac death in young competitive athletes due to genetic cardiac abnormalities. Anadolu Kardiyol Derg 9(Suppl 2):17–23PubMed Wever-Pinzon OE, Myerson M, Sherrid MV (2009) Sudden cardiac death in young competitive athletes due to genetic cardiac abnormalities. Anadolu Kardiyol Derg 9(Suppl 2):17–23PubMed
79.
go back to reference Wilson JM, Jungner YG (1968) Principles and practice of mass screening for disease. Bol Oficina Sanit Panam 65:281–393PubMed Wilson JM, Jungner YG (1968) Principles and practice of mass screening for disease. Bol Oficina Sanit Panam 65:281–393PubMed
Metadata
Title
The Impending Dilemma of Electrocardiogram Screening in Athletic Children
Authors
Laure Léger
Boris Gojanovic
Nicole Sekarski
Erik J. Meijboom
Yvan Mivelaz
Publication date
01-01-2016
Publisher
Springer US
Published in
Pediatric Cardiology / Issue 1/2016
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1239-9

Other articles of this Issue 1/2016

Pediatric Cardiology 1/2016 Go to the issue