Wolff-Parkinson-White Research Articles

Association of T-box gene polymorphisms with the risk of Wolff-Parkinson-White syndrome in a Han Chinese population.

Abnormal development of the atrioventricular ring can lead to the formation of a bypass pathway and the occurrence of Wolff–Parkinson–White (WPW) syndrome. The genetic mechanism underlying the sporadic form of WPW syndrome remains unclear. Existing evidence suggests that both T-box transcription factor 3 (TBX3) and T-box transcription factor 2 (TBX2) genes participate in regulating annulus fibrosus formation and atrioventricular canal development. Thus, we aimed to examine whether single-nucleotide polymorphisms (SNPs) in the TBX3 and TBX2 genes confer susceptibility to WPW syndrome in a Han Chinese Population. We applied a SNaPshot SNP assay to analyze 5 selected tagSNPs of TBX3 and TBX2 in 230 patients with sporadic WPW syndrome and 231 sex- and age-matched controls. Haplotype analysis was performed using Haploview software. Allele C of TBX3 rs1061657 was associated with a higher risk of WPW syndrome (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.08–1.83, P = .011) and left-sided accessory pathways (OR = 1.40, 95% CI: 1.07–1.84, P = .016). However, allele C of TBX3 rs8853 was likely to reduce these risks (OR = 0.71, 95% CI: 0.54–0.92, P = .011; OR = 0.70, 95% CI: 0.53–0.92, P = .011, respectively). The data revealed no association between TBX3 rs77412687, TBX3 rs2242442, or TBX2 rs75743672 and WPW syndrome. TBX3 rs1061657 and rs8853 are significantly associated with sporadic WPW syndrome among a Han Chinese population. To verify our results, larger sample sizes are required in future studies.

<I>PRKAG2</I>-associated hypertrophic cardiomyopathy

Mutations in the PRKAG2 gene lead to hypertrophic cardiomyopathy in combination with Wolff—Parkinson—White syndrome. The cause of the development of heart damage is the deposition of glycogen in the myocardium and the conduction system of the heart with a violation of the metabolism of adenosine monophosphate-activated protein kinase. A feature of PRKAG2 hypertrophic cardiomyopathy is progressive conduction disturbances with the development of atrioventricular blockade and ventricular preexcitation syndrome with a high frequency of paroxysmal supraventricular tachycardia against the background of additional atrioventricular fenestrations (Wolff—Parkinson—White syndrome). Progressive heart failure, high frequency of sudden cardiac death at a young age are characteristic. The features of diagnosis and treatment are considered.

A Wolff-Parkinson-White syndrome revealed by the event of heat stroke.

A Wolff-Parkinson-White syndrome revealed by the event of heat stroke.

Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children.

Fasciculoventricular fiber (FVF) that does not cause tachyarrhythmia is a rare form of ventricular preexcitation, which is important to distinguish from Kent fibers. Although, adenosine and some electrocardiographic features are important in the differentiation of Wolff Parkinson White (WPW) than FVF, a clear distinction may not always be possible without an electrophysiological study (EPS). In this study, we aimed to present the clinical and electrophysiological features of our pediatric patients with fasciculoventricular fiber. Between October 2013 and September 2021, 565 patients who underwent electrophysiological studies due to ventricular preexcitation in our clinic were screened in the study, and 27 (4.7%) patients with fasciculoventricular fiber were included. The data of the patients were obtained from the file records using the electronic internet database system Filemaker® . Electrophysiological study age, weight, gender, symptom, and presence of congenital heart disease of the patients were obtained from the file records. Accessory pathway localization was evaluated according to the modified Arruda algorithm in pre-procedural electrocardiography. In addition, delta wave amplitudes were measured in the first 40ms from the surface ECG. PR interval, QRS interval, and delta wave amplitude were recorded before and after ablation in patients with additional accessory pathways. Post-procedure values were included in the FVF group. The mean age of the patients was 11.47±4.25 years. All 70.4% of the reasons for admission were symptoms such as palpitations and syncope. Two patients had hypertrophic cardiomyopathy and 1 patient had ccTGA. In the electrophysiological study, additional manifest WPW was found in 9 (33%) patients (3 patients with high risk, 6 patients with orthodromic supraventricular tachycardia), focal atrial tachycardia in a patient, and atrioventricular nodal reentry tachycardia in a patient. While the delta wave amplitude was found to be 2.56±1.38(1-5.5) mm in the first 40ms in surface electrocardiography in 9 patients with additional accessory pathway, it was found to be 1.64±0.67(0.5-3) mm in the FVF group. There was no statistically significant difference between the 2 groups (p=.398). Delta wave amplitude>3.5mm was not detected in any patient with isolated FVF. Interestingly, delta wave amplitude was<3.5mm in 7 (78%) of 9 patients who were identified and ablated with an additional accessory pathway. Total 19 of the patients (59.3%) were adenosine-responsive (18 isolated FVF, 1 manifest AP+FVF adenosine-responsive. 8 patients with other manifest AP + FVF had no pre-procedural adenosine-asystole response, and all of them QRS were expanded). Although, the fasciculoventricular fibers themselves are not the cause of tachyarrhythmia, the accessory pathway and other tachyarrhythmia substrate frequency accompanying these cases are quite high (approximately 40%) in EPS. The delta wave characteristics of ablated patients are very similar to FVF patients. While all patients with isolated FVF were adenosine responsive, most of those with additional manifest WPW were unresponsive. Therefore, performing EPS in patients with suspected FVF based on surface ECG features seems to be important for the detection of additional tachyarrhythmias and risky accessory pathways.

Simple electrocardiography algorithm for localizing accessory pathway in patients with Wolff–Parkinson–White syndrome

Background Existing algorithms to predict the location of an accessory pathway (AP) in Wolff–Parkinson–White Syndrome (WPW) have good sensitivity and specificity but complex with various accuracy and inter-observer agreement rates. A simple algorithm with high accuracy and inter-observer agreement rates is needed. Methods This was a cross-sectional and retrospective diagnostic study. The data were collected by total population sampling from January 2015 to January 2017. Forty-seven patients were included in the study. Data collected were pre-ablation 12-lead ECGs and ablation reports. These ECGs were evaluated by two independent observers using the simplified algorithm and compared with ablation results. Results The algorithm had a sensitivity of 45% on the left free wall, 80% on septal, 92% on the right free wall, and the specificity of 96% on the left free wall, 69% on the septal, 85% on the right free wall for AP prediction. The positive predictive value was 90% on the left free wall, 55% on the septal, and 67% on the right free wall APs. The negative predictive value was 70% on the left free wall, 88% on the septal, and 97% on right free wall AP. The positive likelihood ratio was 11.23 on the left free wall, 2.23 on septal and 6.57 on right free wall APs, and the negative likelihood ratio was 0.57 on left free wall APs, 0.28 on septal, and 0.09 on the right free wall APs. Algorithm accuracy varied from 73–87%. Inter-observer agreement calculation was kappa 0.93 for left free wall AP, 0.78 for septal AP, and 0.74 for right free wall AP. Conclusion This simple algorithm has a remarkable accuracy and inter-observer agreement; therefore, it may prove to be helpful even to non-electrophysiologists and has the potential to be integrated into clinical practice

Perioperative Management in a Patient with WPW Syndrome undergoing Plastic Surgery.

Perioperative management of patients with preexcitation may become quite challenging, especially if there is no time for adequate preoperative investigation and clinical optimisation, as in emergencies, or even worse, in undiagnosed cases. It is possible that the poorly controlled or unknown underlying electrophysiological abnormality will become unmasked during anaesthesia and surgery, giving rise to potentially life-threatening arrhythmias.&#x0D; In the literature, pre-excitation syndromes have been mainly approached from the view of the disease (i.e., presentation, diagnosis, treatment), while anaesthetic data are scarce.&#x0D; This case report aims to focus on the perioperative management of patients with WPW.&#x0D; Conclusion; Managing such cases provides an opportunity to revisit important considerations on Wolff-Parkinson-White syndrome Avoiding neuromuscular blockers may make a difference in avoiding arrhythmias when laryngeal mask airway / general anaesthesia is required in patients with Wolff-Parkinson-White syndrome. Sympathetic stimulation should be avoided as it may shorten the refractory period of AP and alleviate life-threatening arrhythmias.

Opinions of cardiologists on class II recommendations in current European Society of Cardiology 2018-2020 guidelines: YELLOW BOX

Objectives: We planned our survey study to evaluate the opinion of cardiologists about the class II recommendations on levels of evidence in the current European Society of Cardiology Guidelines (ESC). Our aim is to determine which diagnosis or treatment option most prefer by cardiologist when guidelines do not make clear recommendations. Methods: The survey was conducted on September 2020 with the participation of cardiologists (n = 102). Our survey covers ESC's guidelines published in 2018-2020 on diagnosis and treatment strategies in coronary artery disease, diabetes, heart valve disease, arrhythmia, dyslipidemia and heart failure. Our survey consisting of 40 questions was shared with the cardiologists via e-mail. Results: Participants answered all of the survey questions. The majority of the participants (79.41%) did not consider the addition of a second long-term antithrombotic medication in addition to aspirin for secondary prevention in diabetes mellitus (DM) and coronary artery disease (CAD) patients who are not at high risk of bleeding. The lowest low density lipoprotein (LDL) value achieved by the participant physicians with treatment in their practices was &amp;lt; 40 mg/dl in 32 (31.37%) participants . One of the striking results of the survey was that 51.96% of the participants stated that it was not possible to measure the lipoprotein a (Lp(a)) level in the center where they were carrying out their practices, and 34.31% did not consider the Lp(a) level in the treatment of dyslipidemia in terms of directing the treatment. As for patients with asymptomatic Wolff-Parkinson-White (WPW) syndrome, 58.82% of the participants considered catheter ablation therapy. Conclusions: Although there were different opinions on some recommendations, the participants were mostly in agreement. We think that these survey results, which were mostly based on expert opinions, may contribute to the guidelines to be published in the future with the increase of survey studies on these issues.

Wolff–Parkinson–White syndrome with supraventricular tachycardia

Abstract Wolff–Parkinson–White (WPW) syndrome is a congenital abnormality of the cardiac conducting system. In the general population, its prevalence is 0.15%–0.3%, with supraventricular tachycardia (SVT) being the most common rhythm disorder associated with it. SVT is the most common cardiac arrhythmia in children that requires therapy. It occurs because an accessory conduction pathway allows atrioventricular impulses to reenter the normal conduction pathway, thus completing a circuit that stimulates the atrium and ventricle at a rapid rate. Symptoms are nonspecific but could be life-threatening in infants, necessitating prompt intervention and prophylaxis. Cardioversion by pharmacologic or synchronized direct current (DC) is indicated in life-threatening or refractory arrhythmias. We report a 16-month-old Nigerian girl who had WPW syndrome and developed SVT that required synchronized DC cardioversion.

A history of collaboration between electrophysiologists and arrhythmia surgeons.

Introduction: The notion that medically‐refractory arrhythmias might one day be amenable to interventional therapy slowly began to appear in the early 1960's. At that time, there were no “interventional electrophysiologists” or “arrhythmia surgeons” and there was little appreciation of the relationship between anatomy and electrophysiology outside the heart's specialized conduction system. Methods: In this review, we describe the evolution of collaboration between electrophysiologists and surgeons. Results: Although accessory atrio‐ventricular (AV) connections were first identified in 1893 and the Wolff‐Parkinson‐White (WPW) syndrome was described 37 years later (1930), it was another 37 years (1967) before those anatomic AV connections were proven to be responsible for the clinical syndrome. The success of the subsequent surgical procedures for the WPW syndrome, AV node reentry tachycardia, automatic atrial tachycardias, ischemic and non‐ischemic ventricular tachycardias and atrial fibrillation over the next two decades depended on a close, sometimes daily, collaboration between electrophysiologists and surgeons. In the past two decades, that tight collaboration was largely abandoned until the recent introduction of “hybrid procedures” for the treatment of atrial fibrillation. Conclusions: A retrospective assessment of the 50 years of interventional therapy for arrhythmias clearly demonstrates the clinical benefits of a close collaboration between electrophysiologists and arrhythmia surgeons, regardless of which one is actually performing the intervention.

A Wolff-Parkinson-White (WPW) Electrocardiographic Pattern in Asymptomatic Patient – State-of-the-Art-Review

A comprehensive approach to asymptomatic adults with Wolff-Parkinson-White (WPW) pattern discovered incidentally on routine electrocardiography (ECG) is debatable. The objective of this review article is to update the most recent evidence on the management of young patients with asymptomatic WPW patterns. A substantial proportion of adults with WPW patterns on ECG may remain asymptomatic but the lifetime risk for fatal arrhythmias still exists. The inherent properties of the accessory pathway determine the risk of sudden cardiac death. A low-risk pathway is considered when the pre-excitation is intermittent on ambulatory monitoring or when it disappears completely or abruptly during exercise testing. On the other hand, a high-risk pathway in EP study is suggested by the presence of the shortest pre-excited RR interval (SPERRI) during atrial fibrillation of ≤ 250 ms or accessory pathway effective refractory period (APERP) ≤ 240 ms. The cardiac evaluation may thus be considered in asymptomatic patients with WPW to determine the individual risk for future symptomatic arrhythmia. A shared-decision making must be performed before offering catheter ablation whose procedural success rate is high.

The Risk of Sudden Death Associated with Symptomatic and Asymptomatic Ventricular Pre-excitation in Athletes

Abstract Sudden death (SD) in athletes is a potential avoidable dramatic scenario. When done regularly, cardiological evaluation increases the chances of diagnosing ventricular pre-excitation. Consequently, the following question arises: what is the real incidence of SD risk in athletes with Wolff-Parkinson-White (WPW) syndrome/pattern? This study included 84 consecutive patients diagnosed with WPW and was designed as a retrospective analysis of data acquired between 2011 and 2021 to answer this question. The patients were evaluated using a 12-lead electrocardiogram (ECG), echocardiography, stress test, and electrophysiological study (EPS). The SD risk linked to WPW was defined as ≥ 1 of the following: the anterograde effective refractory period (AERP) of the accessory pathway (AP) ≤ 250 ms, atrial fibrillation (AF) with the shortest RR pre-excited interval ≤ 250 ms, syncope during AF or atrioventricular reentry tachycardia. The athletes with WPW pattern (n=25) or syndrome (n=59) at risk of SD were identified and treated with radiofrequency ablation (RFA). The mean age was 19.83 (10–29) years; 66.6% were men. Seventeen athletes (n=17; 20.23%) were found with SD risk: 15 (n=15; 17.85%) in the WPW syndrome group and 2 (n=2; 2.38%) in the WPW pattern group. During the EPS, n=4 developed syncope: 1 during antidromic tachycardia and 3 during pre-excited AF. RFA was curative in 96.42% of cases. The EPS is mandatory to identify athletes with short AERP APs linked to an increased risk of SD. RFA is the intervention that settles the patients into a risk-free area, allowing resumption of sports shortly afterward.

Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation

PurposePatients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation.MethodsThis retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3–89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization.ResultsA total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P < 0.001).ConclusionThe results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.

Wolff-Parkinson-White Syndrome during Pregnancy, What Risk and What Management: About 03 Cases with Literature Review

Wolff-Parkinson-White (WPW) syndrome is a relatively rare cardiac rhythm disorder entity encountered during pregnancy. However, its exacerbation under this physiological condition could be responsible, in certain cases, for life-threatening arrhythmias compromising both maternal and foetal prognosis. We report the observations of 03 pregnant women, without past medical history, presenting to the emergency room for palpitations related to a Wolff-Parkinson-White syndrome, complicated in one case with foetal death. The substantial severity of the WPW syndrome during pregnancy requires a prompt and adequate management strategy, based on a multidisciplinary cooperation between obstetricians, cardiologists and neonatologists.

Prevalence and outcomes of WPW pattern in the young: a report from a nationwide cardiac screening programme

Abstract Funding Acknowledgements Type of funding sources: None. Background Individuals with accessory pathways, also referred as the Wolff-Parkinson-White pattern (WPWp), are usually asymptomatic and fatal arrhythmias may be the first presentation. Risk stratification is recommended, with electrophysiological study (EPS) being the gold standard. Catheter ablation offers a widely available, curative option, and provides incentive for screening, particularly in high-risk populations such as athletes. Purpose We sought to assess the prevalence, real-world clinical practice and outcomes of WPWp in young individuals identified through a nationwide cardiac screening programme. Method Between 2008 and 2018, 113,209 consecutive individuals (14 to 35 years old, 38% female) underwent cardiac screening with a health questionnaire, 12-lead electrocardiogram (ECG) and cardiology consultation. Individuals with suspected cardiac disease were referred for further investigations as necessary. Clinical outcomes were obtained via an online questionnaire and matched de-identified records from the Office of National Statistics database. Individuals were classified as elite athletes, non-elite athletes and non-athletes. Results A total of 214 (0.2%) individuals were referred for secondary evaluation with a suspected WPWp (Figure 1). Clinical outcomes were unavailable for 30 (14%) individuals. Follow-up confirmed an additional 13 individuals with a WPWp who were deemed to have normal investigations at screening, of which 8 (61%) had reported cardiovascular symptoms on their HQ and, in retrospect, 4 (30%) demonstrated subtle WPWp on their ECG. A WPWp was confirmed in 187 individuals (0.2%), of which 149 (80%) individuals were considered non-athletes, 114 (61%) reported cardiovascular symptoms, 116 (62%) underwent risk stratification with an EPS and 95 (43%) underwent catheter ablation. Report of palpitation was significantly greater in non-athletes than athletes (p=0.034). In asymptomatic individuals, those engaging in sports at elite level were more likely to be referred for an EPS (p=0.04). Four adverse cardiac events were reported over a follow up period of 7.4 years (IQR 4.9 to 9.2), including 3 individuals (16 years, 20 years, 40 years) with life-threatening arrhythmic events (LAE) requiring cardioversion, and 1 individual (20 years) with sudden cardiac death. Of these 4 individuals, only 1 with a LAE had undergone risk stratification with EPS. Conclusions The incidence of SCD in this young screened population was 0.72 per 1000 person-years. Clinical practice was variable and EPS was not offered to a significant proportion of patients, despite inadequate non-invasive risk stratification. The indication to EPS was driven by the athletic status in the asymptomatic individuals. The WPW syndrome may manifest with subtle ECG changes, posing a diagnostic challenge to interpreting physicians.

Narrow vs Wide QRS Complex Tachycardia in a Patient With Wolf-Parkinson-White Syndrome.

Narrow vs Wide QRS Complex Tachycardia in a Patient With Wolf-Parkinson-White Syndrome.

PO-685-08 INCIDENCE OF LIFE-THREATENING EVENTS IN ADULTS WITH PRE-EXCITATION SYNDROME: NATIONAL DATABASE ANALYSIS 2016-2019

The outcomes of patients with Wolf Parkinson White (WPW) pattern are usually benign. However, a small subset has atrial fibrillation/flutter (AF), which may progress into ventricular fibrillation leading to cardiac arrest/sudden cardiac death. Data on outcomes among AF patients with WPW is limited to single-center studies.

Abstract #1180270: Medically refractory Graves’ disease (GD) with Wolff-Parkinson-White (WPW) syndrome: A therapeutic challenge

Reported cases of coexistent GD and WPW syndrome are limited in medical literature. Beta blocker therapy is the first line rate controlling agent in thyrotoxicosis with or without atrial fibrillation (AF). Beta blockers need to be used cautiously in pre-excited syndromes.

Atrial Fibrillation with Ventricular Pre-Excitation: A Diagnosis That Must Not Be Missed

Wolff-Parkinson-White (WPW) syndrome is caused by an accessory pathway that communicates between the atria and ventricles known as the Bundle of Kent. The development of atrial fibrillation, can result in the atrial impulses all being conducted via the accessory pathway and result in a sinister, board complex, irregular tachycardia, with varying QRS morphology (known as pre-excited atrial fibrillation) Adenosine is a potent atrioventricular node blocker, which can be used in the treatment of supraventricular tachycardias, but also has diagnostic utility, particularly in differentiating between supraventricular tachycardia with aberrant conduction (which would often terminate) and a ventricular tachycardia (which would not respond to adenosine). However, the administration of adenosine in pre-excited atrial fibrillation can precipitate 1:1 atrial to ventricular conduction, which can degenerate into life-threatening ventricular arrythmias. This case describes a patient who presented with pre-excited atrial fibrillation and received intravenous adenosine that resulted in development of broad complex tachycardia with haemodynamic compromise. In patients with pre-exited atrial fibrillation, AV nodal blocking agents should be avoided and direct current cardioversion should be utilised.

Successful Radiofrequency Ablation of the Right Lateral Accessory Pathway with Modified Carpentier Reconstruction Surgery in a Patient with Ebstein Anomaly Concomitant of Secundum Atrial Septal Defect, Atrial Fibrillation, and Wolff–Parkinson–White Syndrome

Ebstein anomaly (EA) results from the failure of proper delamination of the tricuspid valve leaflets from the right ventricle (RV) myocardium. The severity of EA occurs on a spectrum that results in varying degrees of tricuspid regurgitation, atrial dilation, RV dilation, and dysfunction. These effects have the potential to create substrates that can give rise to atrial arrhythmia, ventricular arrhythmia, and a greater incidence of Wolff–Parkinson–White (WPW) syndrome Wackel et al. (2018) accounting for 0.5% of all congenital heart diseases (Oh et al. 1985). In the case of atrial fibrillation and WPW, it is very dangerous for the patient because of hemodynamic compromise, syncope, and sudden death. In this case report, we share our experience in using radiofrequency ablation to ablate right lateral accessory pathway, with modified Carpentier technique in operation to treat an adult patient diagnosed with Ebstein anomaly, atrial septal defect, atrial fibrillation, and WPW syndrome.

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

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.