{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T19:37:36Z","timestamp":1769110656218,"version":"3.49.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Atrial septal defect (ASD) is a congenital heart disease that often presents without symptoms or murmurs. If left untreated, children with ASD can develop comorbidities in adulthood. In Japan, school electrocardiography (ECG) screening has been implemented for all 1st, 7th, and 10th graders. However, the impact of this program in detecting children with ASD is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study that analyzed consecutive patients with ASD who underwent catheterization for surgical or catheter closure at \u226418 years of age during 2009\u20132019 at a tertiary referral center in Japan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the overall 116 patients with ASD (median age: 3.0 years of age at diagnosis and 8.9 years at catheterization), 43 (37%) were prompted by the ECG screening (Screening group), while the remaining 73 (63%) were by other findings (Non-screening group). Of the 49 patients diagnosed at \u22656 years of age, 43 (88%) were prompted by the ECG screening, with the 3 corresponding peaks of the number of patients at diagnosis. Compared with the non-screening group, the screening group exhibited similar levels of hemodynamic parameters but had a lower proportion of audible heart murmur, which were mainly prompted by the health care and health checkups in infancy or preschool period. Patients positive for a composite parameter (rsR' type of iRBBB, inverted T in V4, or ST depression in the aVF lead) accounted for 79% of the screening group at catheterization, each of which was correlated with hemodynamic parameters in the overall patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present study shows that school ECG screening detects otherwise unrecognized ASD, which prompted the diagnosis of the majority of patients at school age and &amp;gt;one-third of overall patients in Japan. These findings suggest that ECG screening program could be an effective strategy for detecting hemodynamically significant ASD in students, who are asymptomatic and murmurless.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2024.1396853","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T04:29:10Z","timestamp":1717388950000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["School electrocardiography screening program prompts the detection of otherwise unrecognized atrial septal defect in children in Japan"],"prefix":"10.3389","volume":"12","author":[{"given":"Noriko","family":"Yodoya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirofumi","family":"Sawada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihide","family":"Mitani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Ohashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Tsuboya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunobu","family":"Ohya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mami","family":"Takeoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidetoshi","family":"Hayakawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Hirayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1016\/s0735-1097(02)01886-7","article-title":"The incidence of congenital heart disease","volume":"39","author":"Hoffman","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1007\/s00246-005-0969-5","article-title":"Presentation of atrial septal defect in the pediatric population","volume":"26","author":"Christensen","year":"2005","journal-title":"Pediatr Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1016\/S0140-6736(13)62145-5","article-title":"Atrial septal defects","volume":"383","author":"Geva","year":"2014","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1111\/j.1651-2227.2008.01152.x","article-title":"Congenital heart disease in 111 225 births in Belgium: birth prevalence, treatment and survival in the 21st century","volume":"98","author":"Moons","year":"2009","journal-title":"Acta Paediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jpeds.2017.07.037","article-title":"Clinical detection of hemodynamically significant isolated secundum atrial septal defect","volume":"190","author":"Geggel","year":"2017","journal-title":"J Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2660","DOI":"10.1093\/eurheartj\/ehab646","article-title":"Atrial septal defect in adulthood: a new paradigm for congenital heart disease","volume":"43","author":"Brida","year":"2022","journal-title":"Eur Heart J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1056\/NEJM199012133232401","article-title":"Long-term outcome after surgical repair of isolated atrial septal defect. 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