We applaud any and all sincere efforts to prevent pediatric sudden cardiac death. Our high school athletes represent a group of children at higher risk for sudden cardiac death due to their athletic participation ("A deadly sport at heart," Page One, March 14).

However, what about our other children? Not all children are athletes, but all are active and athletic. Most high school students will not undergo this type of echocardiogram screening since they do not participate in high school sports. Even many high school athletes use their pre-participation evaluation screen as their only medical evaluation, which is generally inadequate.

Children's Healthcare of Atlanta's Project S.A.V.E. has proposed the use of a pediatric sudden cardiac death risk assessment form for any child of any age by any medical provider.

This form, which inquires about signs and symptoms that may be present in patients or families at risk for pediatric sudden cardiac death, can be updated periodically. Patient and family history findings are subject to change at any time, and may provide the first clue that a patient and their family members are affected by one of the rare cardiac diseases that can lead to sudden cardiac death.

In addition, the importance of steps that can be taken in the school setting to prevent pediatric sudden cardiac death —- early recognition of cardiac arrest, early CPR, early defibrillation and early access to advanced care —- should not be ignored. This is critical because we will never be able to diagnose all potential victims before sudden cardiac arrest occurs.

Deployment of automated external defibrillators, appropriate training of emergency responders, awareness of all staff and a practiced emergency response will put schools in the best position to be able to respond successfully to medical emergencies such as sudden cardiac arrest.

Project S.A.V.E. has been assisting Georgia schools with implementation of comprehensive programs for the past three years and has recognized more than 500 schools for their efforts. A bill pending in the Georgia Legislature, HB 1031, is also increasing awareness by calling for implementation of on-site automated external defibrillators in all high schools with interscholastic programs.

While hypertrophic cardiomyopathy is by most reports the single most common cause of pediatric and young adult sudden cardiac death, it is by no means the only cause. Many of the other causes are associated with normal EKGs. Therefore, a normal EKG does not exclude risk for sudden cardiac death.

Published data now well support the fact that warning signs and symptoms are present in many patients and families who might suffer sudden cardiac arrest. Many of the rare diseases that lead to sudden cardiac death are in fact genetic or familial and therefore further stress the need to identify even a first asymptomatic family member. Thorough evaluation of families suspected of being at risk may unravel an extensive family history.

EKG screening for athletes is controversial and costly. The use of a detailed periodic patient and family questionnaire, and careful cardiovascular exam by qualified examiners, can be much more widely applied at less cost. We should not underestimate the basics of history and physical examinations as we try to prevent sudden cardiac death.

> Dr. Robert Campbell is medical director of the Children's Healthcare of Atlanta Sibley Heart Center. Alison Ellison is program coordinator for Project S.A.V.E.