Is Routine Electrocardiography Necessary Before Initiation of Propranolol for Treatment of Infantile Hemangiomas?
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.


CONCLUSIONS
Our findings suggest that routine ECG may not be necessary or helpful in the vast majority of patients treated with propranolol for IHs.
Phoenix Children's Hospital, Phoenix, AZ.|Oregon Health and Science University, Portland, OR.
Kevin B
KB
Yarbrough
Mayo Clinic, Rochester, MN.
Megha M
MM
Tollefson
Oregon Health and Science University, Portland, OR.
Alfons L
AL
Krol
Oregon Health and Science University, Portland, OR.
Sabra L
SL
Leitenberger
Oregon Health and Science University, Portland, OR.|Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Julianne A
JA
Mann
Oregon Health and Science University, Portland, OR.
Carol J
CJ
MacArthur
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004562:Electrocardiography; D006391:Hemangioma; D018324:Hemangioma, Capillary / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D010045:Outpatients; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol