Safety and efficacy of a drug regimen to control heart rate during 64-slice ECG-gated coronary CTA in children.
BACKGROUND
The adult practice for ECG-gated single-source 64-slice coronary CTA (CCTA) includes administering beta-blockers to reduce heart rate. There are limited data on this process in children.


OBJECTIVE
To evaluate the safety and efficacy of a drug regimen to decrease heart rate before performing CCTA in children.


METHODS
IV remifentanil and esmolol infusion were chosen to decrease heart rate in 41 children (mean age 6.5 years) while they were under general anesthesia (GA) for CCTA. Drug doses, changes in heart rate and procedural complications were recorded. CCTA image quality was graded on a scale of 1 to 5. The relationships between image quality and heart rate and image quality and age were evaluated. Patient effective radiation doses were calculated.


RESULTS
Heart rates were lowered utilizing esmolol (4 children), remifentanil (2 children) or both (35 children); 26 children received nitroglycerin for coronary vasodilation. The mean decrease in heart rate was 26%. There were no major complications. The average image-quality score was 4.4. Higher heart rates were associated with worse image quality (r = 0.67, P < 0.0001). Older age was associated with better image quality (r = 0.66, P < 0.0001). Effective radiation doses were 0.7 to 7.0 mSv.


CONCLUSIONS
Heart rate reduction for pediatric CCTA can be safely and effectively achieved while yielding high-quality images.
Rigsby
Cynthia K
CK
Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA. crigsby@childrensmemorial.org
deFreitas
R Andrew
RA
Nicholas
Angela C
AC
Leidecker
Christianne
C
Johanek
Andrew J
AJ
Anley
Peter
P
Wang
Deli
D
Uejima
Tetsu
T
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000187:drug effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D000319:Adrenergic beta-Antagonists