Screening Programmes to Prevent Sudden Cardiac Death in Young Individuals: A Systematic Review

Abstract

Background: Juvenile sudden cardiac death (SCD) frequently results from inherited diseases, such as channelopathies and cardiomyopathies, or congenital heart conditions. Despite effective screening programmes for competitive athletes, juvenile SCD remains a public health concern, particularly among non-athletes. Current international guidelines do not endorse mass screening, but they highlight the need for further research to address this evidence gap.

Methods: This systematic review aimed to evaluate the effectiveness of large-scale mass screening programmes (involving 1,000 or more participants) in identifying conditions linked to SCD in young individuals. Nineteen studies were analysed, encompassing 1,079,781 participants across various countries. 

Findings: Most studies (68%) were published after 2010, primarily conducted in schools targeting children and adolescents (aged 6–19 years), and with a low risk of bias (63%). Screening methods included electrocardiography (ECG) alone (26·3%), questionnaires alone (5·3%), or a combination (68·4%), with the combined method demonstrating the highest sensitivity. Clinical p from questionnaires (family history of SCD or symptoms such as syncope, palpitation or chest pain) were identified in 4% of participants, while ECG abnormalities were detected in 5·2%. After second or third-line investigations, the overall diagnostic yield for SCD-related conditions was 0·15%. The most frequently identified conditions were Wolff-Parkinson-White syndrome, long QT syndrome, and hypertrophic cardiomyopathy. Post-diagnosis, preventive strategies included lifestyle changes, medication, transcatheter ablation, and implantable cardioverter-defibrillator (ICD) placement. However, comprehensive long-term follow-up was uncommon, and only one study indicated potential cost-effectiveness for juvenile screening.

Interpretation: These findings highlight the potential value of systematic screening for enhancing early detection and implementing timely interventions to prevent juvenile SCD. Nevertheless, further research is crucial to refine screening protocols, evaluate long-term outcomes, assess cost-effectiveness and feasibility, and establish clear guidelines. Such evidence is essential for creating robust health policies aimed at reducing the impact of SCD among children and adolescents.

Keywords: Sudden Cardiac Death, Cardiomyopathy, Channellopathy, Congenital Heart Disease, Pediatric Cardiology, Preventive Cardiology, Screening