Feasibility and findings of large-scale electrocardiographic screening in young adults: Data from 32,561 subjects

BACKGROUND Large-scale electrocardiographic (ECG) screening of young athletes has been shown to reduce the incidence of sudden cardiac death in Italy. Debate exists regarding the feasibility and benefits of such a program in the United States. OBJECTIVE The purpose of this study was to describe implementation and results of a large-scale high school ECG screening program (Young Hearts for Life [YH4L]) developed in the Chicago area. METHODS A retrospective cohort study of 32,561 high school students from 38 ECG screenings was performed between September 2006 and May 2009. Screenings were performed by the YH4L program, which consisted of a core group of administrators, cardiologists, and community volunteers who underwent specialized training and quality review. The rates of abnormal ECGs requiring further evaluation and unacceptable ECGs due to poor quality were determined. RESULTS Of the 32,561 students screened, 817 (2.5%) had abnormal ECGs requiring further evaluation. The majority of abnormal ECGs occurred in males (66%). Only 0.81% of ECGs were determined to be technically inadequate, requiring repeat ECGs on the same day of the screening. The prevalence of left ventricular hypertrophy and abnormal ST-T wave changes was lower in our study than in the rates reported in an Italian registry, possibly due to the lower frequency of men and highly trained athletes in our study. CONCLUSION Large-scale ECG screening of U. S. high school students is feasible and identifies ECGs requiring further evaluation in 2.5% of individuals. These findings have implications for implementing screening and preventing sudden cardiac death in U.S. youth.