P3A349: A Cross-sectional Study: To Determine the Prevalence of Abnormal Electrocardiograms in Young Athletes with CVS Signs/disease at Risk of Sudden Cardiac Death (SCD) Identified During Routine pre-participation Sport Physicals

Background: In the US, the CDC estimates that ~1500 people < 25 years of age die each year of SCD1. However, whether exercise and athletic activity increases the risk of SCD is uncertain2. AAP does not recommend routine EKG screening for all young athletes3. Our rationale is to determine the burden of abnormal EKGs amongst "At risk of SCD" groups.

Methods: This cross-sectional study data was generated from Nextgen EMR; from Omni family health, Bakersfield, California, an FQHC. Data analysis was by Microsoft Excel.

Inclusion criteria: Athletes aged 6-17 years with High-risk signs of SCD (Vasovagal-syncope, exertional chest pain, palpitations, heart murmur, Hypertension, a prior history of sports restriction due to CV-related disease), 1st-2nd degree family history of SCD < 50 years, family/personal history of Cardiomyopathies, LQTS, ion-channelopathies, Marfan or arrhythmias3 that had sports physicals during Jan.- Dec. 2019.

Primary outcomes- dysrhythmias/abnormal EKG at pre-participation sports physicals with primary care provider.

Results: 780 individuals aged 6-17 years had sports physicals in 2019 at our facility, from which 44 met eligibility criteria. Prevalence of "at risk of SCD"- 0.06%

However, only 5/44 (11%) had EKGs done. 3/5 (60%) had “Normal” EKGs ( with underlying ICD diagnoses: "innocent murmur", “palpitations” and "heart murmur") . Conversely, the participant with "palpitations" was subsequently diagnosed with dysrhythmias on Holter-monitor by Cardiology.

A participant with “family history of cardiomyopathy” referred to cardiology for “abnormal EKG”, on review had sinus arrhythmia (physiologic condition). Consequently, only 1/35 had “abnormal EKG” confirmed by "irregular rhythm" findings.

The incidence of “abnormal EKG” in the at risk of SCD group- 1/44 (2.3%) which is low. Amongst the 35/44 (79.5%) that had "No EKGs done" only 1 participant was subsequently diagnosed by Cardiology with WPW syndrome, Noteworthy, he had presented with PCP with only “Hypertension”. Of the other 10/35 seen by cardiology; all were cleared with 4 having benign findings: PVCs, PFO, innocent murmur. However, another with "pathologic murmur" was lost to cardiology referral. 4 individuals had incomplete encounters.

Based on 2x2 table (fig.1); The prevalence rate ratio- 3.3 (>1), Prevalence ratio- 13 and Prevalence difference-0.74 (74 per 100).

The burden of At risk for SCD in our facility during this period (0.06%), is lower than national prevalence of 0.5%3. Small sample size of participants makes generalizability prone to bias. Selection bias due to "healthier" total population in an FQHC.

Inferably, participants that had EKG done had 13 times prevalence of CVS disease compared to those that had none; with excess of 74 cases per 100 compared to "no EKG" group within period of 2019.

Further analytical studies is needed. Existing Confounders: hyperthyroidism & obesity .

Conclusion: Universal EKG screening for young athletes at risk of SCD may be beneficial.