| ADHD and Arrhythmias: What SADS Recommends |
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Recently, the American Heart Association released a new recommendation stating that “children diagnosed with ADHD should have a thorough heart work-up, including an electrocardiogram, before taking stimulants such as Ritalin to treat the condition.” The recommendation of an electrocardiogram (ECG) is a new one. There are 2.5 million children in the United States with attention deficit and hyperactivity disorder (ADHD) that are taking stimulant medications. Dr. Michael J. Ackerman, President of the Sudden Arrhythmia Death Syndromes (SADS) Foundation, states that “unfortunately, the evidence to establish this new ECG recommendation as a necessary and prudent one to save lives is still missing. This is a very complex issue.” Regardless of this new AHA recommendation, families with a SADS condition (especially long QT syndrome) know that most of the medications used to treat children with ADHD can be found on the list of Drugs To Avoid (www.qtdrugs.org). However, the evidence justifying their listing has largely been “guilt by association rather than true evidence” asserts Dr. Ackerman. That is, since many long QT syndrome triggering events are related to exertion, excitement, adrenalin, therefore adrenalin-like agents (i.e. ADHD stimulants) may be potentially dangerous. SADS has always recommended that stimulant therapy may be reasonable for some individuals with both long QT syndrome and ADHD. It is all about risks and benefits. In these settings, it is critical that the family, their heart rhythm or long QT specialist, and their ADHD specialist work closely together to determine what is in the best interest for that child/family. For all children, SADS continues to recommend a thorough history and physical (see our Risk Assessment Form) by the child’s doctor every few years at these times: preschool, before/during middle school, before/during high school and before participating in organized sports. If this assessment reveals a possible risk, then an ECG should be performed, carefully interpreted, and if necessary, a proper referral to a pediatric heart rhythm specialist should be made. Please visit the following links to view clarifications and corrections on the original statement from the American Heart Association: AHA Corrections to Original Statement
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