Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. 408-409 (doi:10.1542/10.1542/peds.2006-3170)

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LETTER TO THE EDITOR

Preventing Pediatric Sudden Cardiac Death: In Reply

Robert M. Campbell, MD
Sibley Heart Center
Children's Healthcare of Atlanta
Emory University School of Medicine
Atlanta, GA 30341

Stuart Berger, MD
Herma Heart Center
Children's Hospital of Wisconsin
Milwaukee, WI 53201-1997

We thank Dr Yabek for his letter in response to our recent commentary about pediatric sudden cardiac death (SCD).¹ To date, we are not aware of any prospective evaluation of a standardized preparticipation-evaluation form (such as currently proposed by the American Academy of Pediatrics) for screening of patients and families at risk for SCD. Other studies in the literature^2,3 have been retrospective but reported a relatively high incidence of patient symptoms and positive family history for patients who suffered sudden cardiac arrest episodes. We do not believe that the estimate of 40% of pediatric SCD victims being identified through comprehensive, diligent personal and family history is unreasonable, although it may represent the upper end of the spectrum. Remembering that many of the causes of pediatric SCD are genetic, the identification of even the first affected family member can help to unravel extensive family involvement.

We endorse use of the American Academy of Pediatrics' (or a similarly comprehensive standardized) preparticipation-evaluation form. For this approach to be successful, the form must be used conscientiously and consistently, and the data requested must be thorough. The thoroughness of the data will require both family and care provider input. Clearly the use of a less-than-adequate questionnaire with poor attention to the above-mentioned details will only result in less-than-optimal outcome.

Although some have advocated the use of electrocardiogram and/or echocardiographic screening for athletes, these are expensive tests that have not yet proven to be truly cost-effective. The Italy experience⁴ is not completely applicable in the United States, and we believe that a recent editorial by Thompson and Levine⁵ illustrated many of the shortcomings of the Italian effort. Although we applaud any and all attempts to decrease SCD in our athletes and/or all pediatric patients, we must be realistic about cost and issues such as false-positive and false-negative results. Because there is no absolute gold standard for many of the rare diagnoses that cause SCD, we do not actually know the true sensitivity and/or specificity for electrocardiography or echocardiography. A negative screen result does not exclude diagnosis.

Although dealing exclusively with patients >18 years of age, a recent article from Müller et al⁶ raised the issue that many episodes of adult SCD occur after a period of typical warning symptoms. They question whether SCD is actually sudden. An increased level of awareness of signs and symptoms may help to prevent pediatric SCD episodes. Likewise, we would suggest that more attention to the details of a careful and thorough patient and family history may yield better screening than we have seen by previous retrospective studies. This is an inexpensive approach that can be widely applied (any provider, any patient, any time, any setting). Perhaps a controlled multicenter trial to assess the efficacy of this approach is indicated.

REFERENCES

1. Campbell RM, Berger S. Preventing pediatric sudden cardiac death: where do we start? Pediatrics. 2006;118 :802 –804[Free Full Text]
2. Wisten A, Messner T. Symptoms preceding sudden cardiac death in the young are common but often misinterpreted. Scand Cardiovasc J. 2005;39 :143 –149[CrossRef][Web of Science][Medline]
3. Basso C, Maron BJ, Corrado D, Thiene G. 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. 2000;35 :1493 –1501[Abstract/Free Full Text]
4. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296 :1593 –1601[Abstract/Free Full Text]
5. Thompson PD, Levine BD. Protecting athletes from sudden cardiac death. JAMA. 2006;296 :1648 –1650[Free Full Text]
6. Müller D, Agrawal R, Arntz H. How sudden is sudden cardiac death? Circulation. 2006;114 :1146 –1150[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Campbell, R. M. Articles by Berger, S. Search for Related Content PubMed Articles by Campbell, R. M. Articles by Berger, S. Related Collections Heart & Blood Vessels Social Bookmarking                         What's this?