Related Experiment Video
Updated: Mar 15, 2026
Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges
Published on: February 25, 2016
Is Routine Electrocardiography Necessary Before Initiation of Propranolol for Treatment of Infantile Hemangiomas?
Kevin B Yarbrough1,2, Megha M Tollefson3, Alfons L Krol2
1Phoenix Children's Hospital, Phoenix, AZ.
Insights
Routine pre-treatment ECGs are not necessary for infants receiving propranolol for infantile hemangiomas (IHs). The study found no cases where ECGs altered treatment decisions or prevented adverse effects, suggesting it may not be helpful.
Area of Science:
- Pediatric Dermatology
- Cardiology
- Pharmacology
Background:
- Propranolol is the standard treatment for infantile hemangiomas (IHs).
- Clinical practice varies regarding pre-treatment evaluations for propranolol therapy.
- The role of routine electrocardiograms (ECGs) before propranolol initiation for IHs is unclear.
Purpose of the Study:
- To evaluate the effectiveness of routine pre-treatment ECGs in screening infants for systemic propranolol treatment of IHs.
- To determine if ECG findings impact treatment decisions or patient safety.
Main Methods:
- Retrospective study of 162 infants treated with propranolol for IHs from 2008-2013.
- Included patients from pediatric dermatology and multidisciplinary vascular anomaly clinics.
- Analyzed ECGs obtained prior to propranolol initiation and subsequent cardiology consultations.
Main Results:
- 43% of routine ECGs were abnormal, prompting cardiology consultations.
- No patients were excluded from propranolol treatment due to abnormal ECG findings.
- No adverse events occurred that could have been predicted or prevented by pre-treatment ECGs.
Conclusions:
- Routine pre-treatment ECGs are likely unnecessary for most infants receiving propranolol for IHs.
- ECG screening did not alter treatment decisions or improve safety outcomes in this cohort.
- Further investigation may not be warranted for routine ECG use in this patient population.
Background:
In recent years propranolol has become the treatment of choice for infantile hemangiomas (IHs). There is broad variation in the approach to propranolol initiation in clinical practice. This retrospective study explored the effectiveness of routine pre-treatment ECG in screening infants being considered for systemic treatment with propranolol.
Methods:
All patients seen in the outpatient pediatric dermatology clinics at Oregon Health and Sciences University (OHSU) and The Mayo Clinic Rochester (MCR), as well as those seen in multidisciplinary vascular anomalies clinics, who had ECGs obtained prior to planned initiation of propranolol for treatment of IH from 2008 to 2013, were identified. A total of 162 patients were included in the study.
Results:
We found that 43% (69) of routine ECGs were read as abnormal, leading to 28 formal consultation appointments with pediatric cardiologists. After either formal consultation or informal discussion with cardiology, no patients with initially "abnormal" ECGs were ultimately excluded from treatment with propranolol based on routine ECG findings. Additionally no patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG prior to initiation of the propranolol.
Conclusion:
Our findings suggest that routine ECG may not be necessary or helpful in the vast majority of patients treated with propranolol for IHs.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers