A discussion of electrocardiographic screening and sudden cardiac death prevention:  evidence and consensus.
OBJECTIVE
Frequent media reports of sudden cardiac arrest or death (SCA/SCD) keep alive a debate as to how best to prevent these tragedies. Several new studies in the past 2 years serve as an impetus to reframe the debate into a reasonable discussion that seeks to obtain more evidence wherever needed and to develop a consensus wherever possible.


RESULTS
Since the report from Italy of the 89% decrease in SCD over 25 years of an ECG-based cardiovascular screening program, proponents and opponents of ECG screening have been busily debating. Multiple studies on screening have shown that adding an ECG to a history and physical examination is more sensitive than history and physical examination alone in identifying those potentially at risk. A major gap exists regarding managing these new 'patients' as their clinical course is not known. Reports, without data, have warned of unintended or harmful consequences of ECG screening. Economic models have shown cost-effectiveness of ECG screening to be variable.


CONCLUSIONS
Studies suggest that adding an ECG to the screening is a very reasonable effort that will identify at-risk youth and prevent SCD, but more information is needed. If data support the addition of an ECG, efforts should be made to make this opportunity available.
Perelman School of Medicine at the University of Pennsylvania, Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. vetter@email.chop.edu
Victoria L
VL
Vetter
Noreen P
NP
Dugan
D002648:Child; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D004562:Electrocardiography; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000706:statistics & numerical data*; D018803:Models, Economic; D015995:Prevalence; D013177:Sports