Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas
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 pr...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | International Journal of Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2021/6657796 |
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| author | James D. Phillips Tyler Merrill J. Reed Gardner R. Thomas Collins Jenika Sanchez Adam B. Johnson Brian K. Eble Larry D. Hartzell Jay M. Kincannon Gresham T. Richter |
| author_facet | James D. Phillips Tyler Merrill J. Reed Gardner R. Thomas Collins Jenika Sanchez Adam B. Johnson Brian K. Eble Larry D. Hartzell Jay M. Kincannon Gresham T. Richter |
| author_sort | James D. Phillips |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-70d7818fd6424d85901600c1cfedbad6 |
| institution | Kabale University |
| issn | 1687-9740 1687-9759 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Pediatrics |
| spelling | doaj-art-70d7818fd6424d85901600c1cfedbad62025-02-03T05:52:38ZengWileyInternational Journal of Pediatrics1687-97401687-97592021-01-01202110.1155/2021/66577966657796Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile HemangiomasJames D. Phillips0Tyler Merrill1J. Reed Gardner2R. Thomas Collins3Jenika Sanchez4Adam B. Johnson5Brian K. Eble6Larry D. Hartzell7Jay M. Kincannon8Gresham T. Richter9Vanderbilt University Medical Center, Department of Otolaryngology Head and Neck Surgery, 1215 21st Ave S, Nashville, TN 37232, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAStanford Children’s Health, Department of Pediatrics, Cardiology Division, 725 Welch Rd. #120 Palo Alto, CA 94304, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAUniversity of Arkansas for the Medical Sciences, Department of Pediatrics, Cardiology Division, 1 Children’s Way Little Rock, AR 72205, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAUniversity of Arkansas for the Medical Sciences, Department of Dermatology, 4301 W Markham Little Rock, AR 72205, USAUniversity of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USAObjective. 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.http://dx.doi.org/10.1155/2021/6657796 |
| spellingShingle | James D. Phillips Tyler Merrill J. Reed Gardner R. Thomas Collins Jenika Sanchez Adam B. Johnson Brian K. Eble Larry D. Hartzell Jay M. Kincannon Gresham T. Richter Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas International Journal of Pediatrics |
| title | Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas |
| title_full | Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas |
| title_fullStr | Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas |
| title_full_unstemmed | Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas |
| title_short | Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas |
| title_sort | clinical significance of screening electrocardiograms for the administration of propranolol for problematic infantile hemangiomas |
| url | http://dx.doi.org/10.1155/2021/6657796 |
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