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Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile
James D Phillips1, Tyler Merrill2, J Reed Gardner2
1Vanderbilt University Medical Center, Department of Otolaryngology Head and Neck Surgery, 1215 21st Ave S, Nashville, TN 37232, USA.
Insights
Screening electrocardiograms (ECG) in infants with problematic infantile hemangioma (PIH) show abnormalities in nearly 14% of cases. However, these ECG findings rarely prevent propranolol treatment, suggesting limited value for routine screening.
Area of Science:
- Pediatric Cardiology
- Dermatology
Background:
- Low-dose propranolol is effective for problematic infantile hemangioma (PIH).
- Screening electrocardiograms (ECG) are standard before propranolol initiation to detect potential heart block.
- The clinical impact of ECG findings on propranolol management for PIH is not well-defined.
Purpose of the Study:
- To evaluate the utility of pre-propranolol ECG screening in infants with PIH.
- To determine how ECG results influence propranolol therapy decisions and patient management.
- To assess the rate of abnormal ECG findings and their clinical significance in this population.
Main Methods:
- Retrospective chart review of infants treated for PIH with propranolol (2 mg/kg/day) from 2008-2015.
- Analysis of demographic, clinical, ECG, and echocardiographic data.
- ECGs interpreted by a pediatric cardiologist.
Main Results:
- 333 infants received propranolol; ECG data available for 317 (95%).
- Abnormal ECG findings were noted in 13.9% (44/317), most commonly ventricular hypertrophy criteria.
- No patient was denied propranolol due to ECG findings; 2.9% required cardiology follow-up.
Conclusions:
- Pre-propranolol ECGs reveal abnormalities in a significant minority of infants with PIH.
- These screening ECGs are unlikely to preclude necessary propranolol therapy.
- Routine ECG screening may have limited value for otherwise healthy infants with PIH lacking prior cardiac history.
Objective:
Low-dose nonselective β blockade is an effective treatment for problematic infantile hemangioma (PIH). Screening electrocardiograms (ECG) are performed prior to the initiation of propranolol to minimize the risk of exacerbating undiagnosed heart block. How ECG results affect subsequent propranolol usage and patient management remains unclear. We examined the value of ECG prior to propranolol therapy in a quaternary pediatric hospital.
Methods:
A retrospective chart review was performed on all infants who received propranolol (2 mg/kg/day divided three times daily) to treat PIH at Arkansas Children's Hospital from Sept. 2008 to Sept. 2015. All available demographic, historical, and clinical data were obtained. ECGs and echocardiographic data were reviewed and summarized. A pediatric cardiologist read all ECGs.
Results:
A total of 333 patients (75% female) received propranolol therapy. ECG information was available for 317 (95%). Abnormal findings were present on 44/317 (13.9%) of study ECGs. The most common abnormal finding was "voltage criteria for ventricular hypertrophy" (n = 35, 76.1%). Two patients had abnormal rhythms; one had first-degree atrioventricular (AV) block, and one had occasional premature atrial contractions. Of the 31 patients who underwent echocardiograms, 20 (35%) were abnormal. 2.9% of infants with PIH treated with propranolol required a follow-up with a cardiologist. No patient was precluded from taking propranolol due to the findings on screening ECG.
Conclusions:
Screening ECGs prior to propranolol therapy are abnormal in nearly 14% of patients with PIH but are unlikely to preclude therapy. In the absence of prior cardiac history, this cohort offers further evidence suggesting that screening ECGs may be of limited value in determining the safety of propranolol in otherwise healthy infants with PIH.
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