Pretreatment ECG unwarranted for most infantile hemangioma patients starting propranolol

Pretreatment ECG screening is unnecessary for most infants with infantile hemangioma who are prescribed propranolol therapy, reported Emily B. Lund, MD, of the University of Chicago, and her associates.

This finding supports previously published studies that pretreatment ECG is not necessary, despite consensus guidelines published in 2013 that recommend ECG screening of high-risk infants presenting with below-normal heart rate, arrhythmia, or family history of either arrhythmia or congenital heart disease.

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Among the 6% of patients included in the study who had a positive personal cardiac history, congenital heart disease was most common; coronary artery disease was most prevalent among the 41% with a positive family cardiac history. Baseline vital signs revealed no hypotension or bradycardia.

All patients prescribed propranolol were routinely screened with ECG prior to therapy during the study period. Baseline heart rate and blood pressure were observed for abnormalities; patients also were observed during follow-up for possible propranolol side effects.

A total of 43% of ECG screenings performed were found to be abnormal; left ventricular hypertrophy was the most common abnormality. Despite further cardiac evaluation of all but one patient with abnormal ECG, no contraindications to treatment were identified, Dr. Lund and her colleagues reported in Pediatric Dermatology.

Ultimately, 96% of patients observed started treatment with propranolol; of the remaining 4% who did not, the authors cited parental preference and lack of follow-up as the primary reasons for nontreatment.