From the Journals

Pretreatment ECG unwarranted for most infantile hemangioma patients starting propranolol


Key clinical point: There was no association between side effects, abnormal ECG, and personal or family history of cardiac problems in children with infantile hemangioma who underwent propranolol therapy.

Major finding: Despite the fact that 43% of ECG screenings were abnormal, 96% of patients started treatment with propranolol, with no side effects related to abnormal ECG or to personal or family history of cardiac problems.

Study details: A retrospective chart review of 272 patients with infantile hemangioma.

Disclosures: The researchers reported no relevant financial disclosures.

Source: Lund EB et al. Ped Dermatol. 2018. doi: 10.1111/pde.13508.



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.

infantile hemangioma Courtesy
Dr. Lund and her associates conducted a retrospective chart review of 272 patients with infantile hemangioma seen in the Lurie Children’s Dermatology Clinic in Chicago between Jan. 1, 2010, and Jan. 1, 2015. Of the patients evaluated, 71% were female, and 75% had been carried to term.

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.

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