Some investigators have suggested that children receiving stimulant medications to
manage attention-deficit hyperactivity disorder should undergo screening electrocardiography
to identify asymptomatic cardiac disease. However, no study to date has examined the
efficacy and costs of this strategy. In the present study we sought to determine the
utility of electrocardiographic screening in children with attention-deficit hyperactivity
disorder. We reviewed the clinical experience of electrocardiographic screening of
subjects with attention-deficit hyperactivity disorder <21 years of age from April
to September 2008. Additional cardiac care and testing that resulted from an abnormal
initial electrocardiogram were recorded. Screening electrocardiograms were obtained
in 1,470 children with attention-deficit hyperactivity disorder and were interpreted
as abnormal in 119 subjects (8.1%). Further evaluation of these 119 subjects included
63 transthoracic echocardiograms, 5 stress tests, and 9 Holter monitor studies. Cardiac
disease was identified in 5 subjects (0.3% of entire cohort), yielding a positive
predictive value of 4.2%. Cardiac diagnoses included ventricular pre-excitation syndrome
(n = 2), bicuspid aortic valve (n = 2), and moderate secundum atrial septal defect
(n = 1). The mean cost of electrocardiographic screening including further testing
for subjects with abnormal initial screen results was $58 per child. The mean cost
to identify a true-positive result was $17,162. In conclusion, electrocardiographic
screening for children with attention-deficit hyperactivity disorder can successfully
identify cardiac disease in otherwise asymptomatic subjects, although the positive
predictive value is low. Ongoing studies are needed to know what role electrocardiographic
screening should play in the management of children with attention-deficit hyperactivity
disorder.
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References
- Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs: 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
- (Accessed October 10, 2008.)
- Employment and earnings, 2007 annual averages and the monthly labor review.(Accessed November 1, 2007)
- Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder.Pediatrics. 2008; 122: 451-453
- Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening.Eur Heart J. 2007; 28: 2006-2010
- Heart diseases discovered by mass screening in the schools of Shimane Prefecture over a period of 5 years.Jpn Circ J. 1986; 50: 1325-1329
- Garson A.J. Bricker J. Fisher D. Neish S. Electrocardiography in the Science and Practice of Pediatric Cardiology. Williams and Wilkins, Baltimore1998
- Evaluation of computerized interpretation of the pediatric electrocardiogram.J Electrocardiol. 2007; 40: 139-143
- Diagnostic miscues in congenital long-QT syndrome.Circulation. 2007; 115: 2613-2620
- Health Canada suspends the market authorization of ADDERALL XR®, a drug prescribed for attention deficit hyperactivity disorder (ADHD) in children.(Accessed February 9, 2005.)
- Atrioventricular nodal re-entrant tachycardia associated with stimulant treatment.J Child Adolesc Psychopharmacol. 1999; 9: 125-128
- Inherited arrhythmias: a National Heart, Lung, and Blood Institute and Office of Rare Diseases workshop consensus report about the diagnosis, phenotyping, molecular mechanisms, and therapeutic approaches for primary cardiomyopathies of gene mutations affecting ion channel function.Circulation. 2007; 116: 2325-2345
- ADHD and the rise in stimulant use among children.Harv Rev Psychiatry. 2008; 16: 151-166
Article Info
Publication History
Accepted:
June 19,
2009
Received in revised form:
June 19,
2009
Received:
April 29,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
