Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Pediatric Sudden Cardiac Arrest

“…Recent reassessment of ECG "normal" values has helped to decrease falsepositive findings. 53 Competitive athletes are known to have unusual but occasionally benign ECG findings, consistent with "athlete's heart," that must be differentiated from ECG findings attributable to pathologic conditions. 54 The role of routine ECG screening in the United States to prevent SCA is not settled and will require more data and debate.…”

Preventing sudden cardiac death in the young: Is electrocardiogram screening the most effective means?

“…Although there is a wide range of estimates of the incidence of SCD in the young population -ranging from 0.8 per 100,000 to 6.2 per 100,000 -the majority of deaths in the young are both not sudden and noncardiac (1,4,5). Population-based studies (6)(7)(8) show that SCDs usually account for less than 20% of the total, with only approximately 10% of these being due to previously undiagnosed cardiac disease.…”

“…Factors contributing to the increasing profile are the long-standing debates over preparticipation screening for young athletes, the apparent success of this screening in some jurisdictions, as well as concerns about the possible risk of stimulant medication for attention-deficit hyperactivity disorder. In fact, this latter consideration resulted in a recent document (1) from the American Heart Association that devoted a large portion to discussion of the issues related to the usefulness of electrocardiogram (ECG) screening.…”

Cardiac risk assessment before the use of stimulant medications in children and youth: A joint position statement by the Canadian Paediatric Society, the Canadian Cardiovascular Society, and the Canadian Academy of Child and Adolescent Psychiatry

“…However, recent regulatory decisions regarding ADHD drug licensing and labeling (Health Canada, 2006;U.S. Food and Drug Administration, Drug Safety and Risk Management Advisory Committee, 2006), along with a recent American Heart Association statement (Vetter, V. L., Elia, J., Erickson, C., et al, 2008), its correction and a response (clarification) by the American Academy of Pediatrics (Perrin, J. M., Friedman, R. A., & Knilans, T. K., 2008; American Academy of Pediatrics/American Hear t Association, 2008), have raised questions about ADHD evaluation and therapy among Canadian practitioners. Current Canadian practice in the area of ADHD drug treatment and cardiovascular screening is mixed, with little agreement on the appropriate evaluation of children before starting ADHD medication (Conway, J., Wong, K. K., O'Connell, C., & Warren, A. E., 2008).…”