Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-12-01T00:23:28.388Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreased false-positive adolescent pre-athletic screening with Seattle Criteria-interpreted electrocardiograms

Published online by Cambridge University Press:  20 June 2016

Jamie N. Colombo ,
Ricardo A. Samson ,
Santiago O. Valdes ,
Omar Meziab ,
David Sisk  and
Scott E. Klewer
Jamie N. Colombo*
Affiliation:
Department of Pediatrics, University of Arizona, Tucson, Arizona, United States of America
Ricardo A. Samson
Affiliation:
Department of Pediatric Cardiology, University of Arizona, Tucson, Arizona, United States of America
Santiago O. Valdes
Affiliation:
Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Omar Meziab
Affiliation:
University of Arizona, Tucson, Arizona, United States of America
David Sisk
Affiliation:
Department of Pediatric Cardiology, University of Arizona, Tucson, Arizona, United States of America
Scott E. Klewer
Affiliation:
Department of Pediatric Cardiology, University of Arizona, Tucson, Arizona, United States of America
*
Correspondence to: J. N. Colombo, Department of Pediatrics, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America. Tel: 602 999 7377; Fax: 520-626-6571; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Sudden cardiac arrest is a rare but devastating cause of death in young adults. Electrocardiograms may detect many causes of sudden cardiac arrest, but are not routinely included in pre-athletic screening in the United States of America partly because of high rates of false-positive interpretation. To improve electrocardiogram specificity for identifying cardiac conditions associated with sudden cardiac arrest, an expert panel developed refined criteria known as the Seattle Criteria. Ours is the first study to compare standard electrocardiogram criteria with Seattle Criteria in 11- to 13-year-olds. In total, 1424 students completed the pre-athletic screening and electrocardiogram; those with a positive screen or abnormal electrocardiogram interpreted by a paediatric electrophysiologist completed further work-up. Electrocardiograms referred for additional evaluation were re-interpreted by a paediatric electrophysiologist using Seattle Criteria. Electrocardiogram abnormalities were identified in 98 (6.9%); Seattle Criteria identified 28 (2.0%). Formal evaluation confirmed four students at risk for sudden cardiac arrest (0.3%): long QT syndrome (n=2), Wolff–Parkinson–White (n=1), and pulmonary hypertension (n=1). All students with at-risk phenotypes for sudden cardiac arrest were identified by both standard electrophysiologist and Seattle Criteria. The false-positive interpretation rate decreased from 6.6 to 1.7% with Seattle Criteria. Downstream costs associated with screening using standard paediatric electrocardiogram interpretations and Seattle Criteria were projected at $24 versus $7, respectively. In conclusion, using Seattle Criteria for electrocardiogram interpretation decreases the rate of false-positive results compared with standard interpretation without omitting true-positive electrocardiogram findings. This may decrease unnecessary referrals and costs associated with formal cardiology evaluation.

Keywords

Electrocardiogrampre-athletic screeningsudden cardiac arrestSeattle Criteria
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 512 - 517
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Harmon, K, Asif, IM, Klossner, D, Drenzer, JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 2011; 123: 1594–1600.CrossRefGoogle ScholarPubMed
2. Kaltman, JR, Thompson, PD, Lantos, J, et al. Screening for sudden cardiac death in the young. Circulation 2011; 123: 1911–1918.CrossRefGoogle ScholarPubMed
3. Maron, BJ, Friedman, RA, Kligfield, P, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general population of young people (12-25 years of age). J Am Coll Cardiol 2014; 64: 1479–1514.CrossRefGoogle ScholarPubMed
4. Maron, B, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to pre-participation screening cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity and Metabolism: endorsed by the American College of Cardiology. Circulation 2007; 115: 1643–1655.CrossRefGoogle Scholar
5. Meyer, L, Stubbs Bm Fahrenbruch, C, Maeda, C, Harmon, K, Eisenber, M, Drenzer, J. Incidence, causes and survival trends from cardiovascular-related sudden cardiac arrest in childhood and young adults 0 to 35 years of age: a 30-year review. Circulation 2012; 126: 1363–1372.CrossRefGoogle Scholar
6. Pickham, D, Zarafshar, S, Sani, D, Kumar, N, Froelicher, V. Comparison of three electrocardiogram criteria for athlete pre-participation screening. J Electrocardiol 2014; 47: 769–774.CrossRefGoogle ScholarPubMed
7. Schoenbaum, M, Denchev, P, Vitiello, B, Kaltman, J. Economic evaluation of strategies to reduce sudden cardiac death in young athletes. Pediatrics 2012; 130: 380–389.CrossRefGoogle ScholarPubMed
8. Chandra, N, Bastianenen, R, Papadakis, M, et al. Prevalence of electrocardiographic anomalies in young individuals. J Am Coll Cardiol 2014; 63: 2028–2034.CrossRefGoogle ScholarPubMed
9. Corrado, D, Pelliccia, A, Bjornstad, H, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J 2005; 26: 516–524.CrossRefGoogle ScholarPubMed
10. Toresdahl, BG, Rao, AL, Harmon, KG, Drezner, JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 2014; 11: 1190–1194.CrossRefGoogle ScholarPubMed
11. Vetter, VL, Elia, J, Erickson, C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008; 117: 2407–2423.CrossRefGoogle Scholar
12. Chandra, N, Bastianenen, R, Papadakis, M, Sharma, S. Sudden cardiac death in young athletes. J Am Coll Cardiol 2013; 61: 1027–1040.CrossRefGoogle ScholarPubMed
13. Ljunggvist, A, Jenoure, P, Engebretsen, L, et al. The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. Br J Sports Med 2009; 43: 631–643.CrossRefGoogle Scholar
14. Drezner, JA, Ackerman, MJ, Anderson, J, et al. Electrocardiographic interpretation in athletes: the “Seattle Criteria”. Br J Sports Med 2013; 47: 122–124.CrossRefGoogle ScholarPubMed
15. CMS.gov Centers for Medicare and Medicaid Services (n.d.). How to use the searchable medicare physician fee schedule (MPFS). Retrieved March 28, 2016, from https://www.cms.gov/.Google Scholar
16. Curtis, A, Bourji, M. ECG screening is not warranted for the recreational athlete. J Am Coll Cardiol 2014; 63: 2035–2036.CrossRefGoogle Scholar
17. Berge, HM, Gjesdal, K, Anderson, TE, Solberg, EE, Steine, K. Prevalence of abnormal ECGs in male soccer players decreases with the Seattle Criteria, but is still high. Scand J Med Sci Sports 2015; 4: 501–508.CrossRefGoogle Scholar
18. Bessem, B, deBruijn, MC, Nieuwland, W. The ECG of high-level junior soccer players: comparing the ESC vs. the Seattle Criteria. Br J Sports Med 2014; 1–7. doi:10.1136/bjsports-2013-093245.Google ScholarPubMed
19. Sheikh, N, Papadakis, M, Ghani, S, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129: 1637–1649.CrossRefGoogle ScholarPubMed
20. Brosnan, M, La Gerche, A, Kalman, J, et al. The Seattle Criteria increase the specificity of pre-participation electrocardiogram screening among elite athletes. Br J Sports Med 2013; 1–8.Google Scholar
21. U. S. Census Bureau. American FactFinder fact sheet: Flowing Wells CDP, Arizona, 2009–2013. Retrieved December 16, 2014, from http://factfinder.census.gov/rest/dnldController/deliver?_ts=436836398160.Google Scholar