The role of EKG in identification of congenital cardiac defects

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Some congenital cardiac defects may go unrecognized in the clinical setting. This is particularly true of atrial septal defects. It is not clear if more routine use of EKG as a screening tool in children would be beneficial in detecting those abnormalities. In this issue of The Journal, Chiu et al report on a school-based study using a simplified 4 lead EKG in first and fourth grade elementary school students and junior high school students in Taiwan. After excluding those with known heart disease, the prevalence of conduction defects was 0.75%. Among those students with conduction defects, 39 students with previously undetected atrial septal defects were found. An additional 15 students were found to have potentially important cardiac rhythm disturbance. These results confirm that there are undiagnosed cardiac abnormalities among school children. However, we do not yet have sufficient evidence to support using EKG as a routine screening test in children. Further studies will be necessary to develop on evidence base to support this.