Feasibility of electrocardiogram screening in the USA prior to high school sport participation

Abstract

BackgroundSudden cardiac death in young athletes is a catastrophic event with an incidence of 1:40,000–1:80,000. Pre-participation sport screening utilizes a 14-point targeted evaluation. Recently, some states have added an ECG to the traditional history and physical. ObjectivesThe study describes a large-scale ECG screening program for middle and high school students. The aim is to depict important components, partners, and plans that can be adopted by other municipalities to help prevent sudden cardiac arrest in this population. MethodsIn 2019, Brevard County School Board in Florida mandated ECGs before participation in middle and high school sports. They partnered with a non-profit group that provides ECGs for a $20.00 fee. Volunteer pediatric cardiologists interpreted the ECGs. Results were emailed to participants, and abnormal results received a phone call to ensure appropriate follow-up care. ResultsThere were 5877 ECG screenings between 4/1/19–12/31/19 with 3% (199/5877) abnormal: 30% (60/199) ventricular conduction, 26% (51/199) arrhythmias, 13% (25/199) ventricular hypertrophy/chamber enlargement, 11% (21/199) ST-T abnormalities, 8% (16/199) prolonged QTc, 6% (12/199) WPW syndrome, and 4% (7/199) AV conduction and axis deviation. The incidence of critical heart disease with a risk of sudden cardiac arrest was 0.1% (8/5877) in those with a confirmed final diagnosis: 6 who underwent an ablation procedure for WPW syndrome, 1 with gene-positive long QTc, and 1 with left ventricular hypertrophy who is undergoing genetic evaluation for hypertrophic cardiomyopathy. ConclusionsTo our knowledge, this is the first large school district in Florida to mandate this level of cardiovascular screening. This pilot project demonstrates that large volume ECG screening prior to school sport participation is feasible at a low cost when utilizing appropriate manpower and providing access to follow up-care.