Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas

James D Phillips; Tyler Merrill; J Reed Gardner; R Thomas Collins 2nd; Jenika Sanchez; Adam B Johnson; Brian K Eble; Larry D Hartzell; Jay M Kincannon; Gresham T Richter

doi:10.1155/2021/6657796

Clinical Significance of Screening Electrocardiograms for the Administration of Propranolol for Problematic Infantile Hemangiomas

Int J Pediatr. 2021 Feb 23:2021:6657796. doi: 10.1155/2021/6657796. eCollection 2021.

Affiliations

¹ Vanderbilt University Medical Center, Department of Otolaryngology Head and Neck Surgery, 1215 21st Ave S, Nashville, TN 37232, USA.
² University of Arkansas of the Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, 4301 W Markham St Little Rock, AR 72205, USA.
³ Stanford Children's Health, Department of Pediatrics, Cardiology Division, 725 Welch Rd. #120 Palo Alto, CA 94304, USA.
⁴ University of Arkansas for the Medical Sciences, Department of Pediatrics, Cardiology Division, 1 Children's Way Little Rock, AR 72205, USA.
⁵ University of Arkansas for the Medical Sciences, Department of Dermatology, 4301 W Markham Little Rock, AR 72205, USA.

Abstract

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.