Electrocardiogram Screening

Background

The electrocardiogram (ECG) may offer diagnostic information to guide clinical decision making. However, there is minimal evidence for the value of obtaining a screening ECG in asymptomatic individuals with or without SCD to detect abnormalities such as prolonged corrected QT interval (QTc), ST-T segment abnormalities, and electrocardiographic cardiac enlargement.

Although observational studies of the prevalence of ECG abnormalities in persons with SCD have been done, they reveal abnormalities that are of unknown clinical significance. Studies found that the prevalence of cardiac enlargement ranged between 22 percent and 76 percent, and ventricular hypertrophy prevalence was found to be between 28 percent and 37 percent. The presence of nonspecific S-T abnormalities was found to be between 18.5 percent and 52 percent. First-degree atrioventricular block was found in 8 percent of people in one study, and intra ventricular conduction delay was found in 4 percent of people in another study.

Prolonged QTc ranged between l5 percent and 50 percent prevalence. Overall, there was no significant difference in the prevalence of prolonged QTc between people with and without SCD, and the presence of prolonged QTe did not significantly affect mortality

Summary of the Evidence
Fourteen observational studies (4 longitudinal and 10 cross-sectional) described the use of ECG as a screening test in people with SCD; however, all of the studies focused on estimating the prevalence of ECG abnormalities of unknown clinical significance. No study evaluated the utility of ECG screening or compared an approach of ECG screening versus no screening, and no data exist about the effect of obtaining a screening ECG on clinical outcomes in people with SCD. There were no data on screening intervals or diagnostic accuracy of the test, and the overall quality of the evidence supporting screening using ECG was very low.

The USPSTF recommends against routine screening with resting electrocardiography, exercise treadmill test (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at low risk for CHD events (Gradmoderate to high certainty that the benefits do not outweigh the harms).

Recommendations
1. Routine ECG screening is not recommended in children and adults with SCD.(Weak Recommendation, Low-Quality Evidence}