Don’t order a screening ECG prior to initiation of attention-deficit/hyperactivity disorder therapy in asymptomatic, otherwise healthy pediatric patients with no personal or family history of cardiac disease.

Rationale and Comments

Many pediatricians obtain ECGs in healthy patients with no personal or family history* of cardiac disease prior to initiating stimulant therapy for attention-deficit/hyperactivity disorder out of fear of triggering an adverse cardiovascular event or worsening a previously undiagnosed cardiovascular disease. However, the probability that such screening will lead to the diagnosis of cardiac disease is low. Furthermore, when ECG abnormalities are identified, they rarely warrant a change in planned attention-deficit/hyperactivity disorder therapy. As a result, obtaining the ECG increases health care costs and can increase stress for both the patient and family. If there is concern based on the history and physical examination, then a pediatric cardiology referral is a reasonable consideration. (*Family history should assess specifically for the following types of cardiovascular diseases: connective tissue disorders; cardiomyopathies; arrhythmias, including need for pacemaker or defibrillator implantation; storage diseases; sudden unexplained death; premature cardiovascular disease prior to the age of 50 years.)

Sponsoring Organizations

American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery

Sources

American Academy of Pediatrics guidelines

Disciplines

Cardiovascular
Pediatric

References

Cooper WO, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med. 2011;365(20):1896-1904.
Mahle WT, et al. Electrocardiographic screening in children with attention-deficit hyperactivity disorder. Am J Cardiol. 2009;104(9):1296-1299.
Perrin JM, et al.; American Academy of Pediatrics, Black Box Working Group, Section on Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008;122(2):451-453.
Shahani SA, et al. Attention deficit hyperactivity disorder screening electrocardiograms: a community-based perspective. Pediatr Cardiol. 2014;35(3):485-489.
American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022.