08:40 〜 10:40
[AJS-03] Heart Examination and Sudden Cardiac Death
Sudden cardiac death in children is rare, but devastating. The annual incidence in pediatric population beyond infancy is estimated from 0.8 to 6.2 per 100,000. The scenario includes 1) previously known, diagnosed heart disease, 2) previously diagnosed or more likely unrecognized, undiagnosed heart disease (structural heart diseases, WPW syndrome, channelopathy, etc) and 3) without an underlying heart disease (commotio cordis, drug abuse, etc).
A general school survey or athlete’s pre-participation survey is often applied to detect the undiagnosed risk of SCD during school activities. Recommended modalities include history taking or questionnaire, physical examination (sometimes aided by phonography) and EKG (4- versus 12-leads). Echocardiography is generally done at referral. Unlike “typical” screening programs that value detecting those who may have the disease (ie, sensitivity), the school survey, when phenotypic prevalence of the diseases with risk of SCD is low, prioritizing specificity over sensitivity can improve the positive predictive value while not affecting the negative predicting value.
Data concerning the efficacy of SCD reduction by cardiac screening are still limited, and mostly limited to pre-participation athlete screening. The pre-participation screening in Italy, which requires physician-led screening with history, physical, and ECG, revealed a 89% absolute risk reduction in SCD risk for competitive athletes, such that the total SCD risk for screened athletes is now comparable to that of contemporary, age matched non-athletes. As for the general school survey, the incidence of identifying disease with SCD risk was 3.47/1000000 from Taipei survey (EKG). But, the risk reduction during the school activities remains still unclear.
A general school survey or athlete’s pre-participation survey is often applied to detect the undiagnosed risk of SCD during school activities. Recommended modalities include history taking or questionnaire, physical examination (sometimes aided by phonography) and EKG (4- versus 12-leads). Echocardiography is generally done at referral. Unlike “typical” screening programs that value detecting those who may have the disease (ie, sensitivity), the school survey, when phenotypic prevalence of the diseases with risk of SCD is low, prioritizing specificity over sensitivity can improve the positive predictive value while not affecting the negative predicting value.
Data concerning the efficacy of SCD reduction by cardiac screening are still limited, and mostly limited to pre-participation athlete screening. The pre-participation screening in Italy, which requires physician-led screening with history, physical, and ECG, revealed a 89% absolute risk reduction in SCD risk for competitive athletes, such that the total SCD risk for screened athletes is now comparable to that of contemporary, age matched non-athletes. As for the general school survey, the incidence of identifying disease with SCD risk was 3.47/1000000 from Taipei survey (EKG). But, the risk reduction during the school activities remains still unclear.