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Research Letter |

Reevaluating the Need for Electrocardiograms Prior to Initiation of Treatment With Propranolol for Infantile Hemangiomas

Jenna L. Streicher, MD1; E. Brooks Riley, BA2; Leslie A. Castelo-Soccio, MD, PhD1,2
[+] Author Affiliations
1Section of Dermatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
JAMA Pediatr. 2016;170(9):906-907. doi:10.1001/jamapediatrics.2016.0824.
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This study evaluates the cost of routine pretreatment electrocardiogram screening and determines whether testing led to significant management changes for 198 patients evaluated for initiation of treatment with propranolol over a 2-year period.

Infantile hemangioma (IH) is a benign vascular tumor, which is usually managed conservatively. However, in approximately 24% of cases, complications such as ulceration, functional impairment, or cosmetic deformity necessitate evaluation for systemic therapy.1 Propranolol hydrochloride is a first-line treatment for complicated IHs. Guidelines regarding initiation, treatment indications, and safety monitoring have been established; however, there was no consensus on whether an electrocardiogram (ECG) should be part of the pretreatment evaluation.2 A survey of prescribers of propranolol for IH showed that 81% of prescribers ordered an ECG before initiating treatment with propranolol.2 A cohort study to evaluate the necessity of a cardiovascular evaluation prior to initiating therapy with β-blockers found ECG abnormalities in 6.5% of patients, but none of these findings were contraindications to β-blocker therapy.3 We sought to evaluate the cost of routine pretreatment ECG screening and determine whether testing led to significant management changes for 198 patients evaluated for initiation of treatment with propranolol over a 2-year period at our institution.

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Figure.
Flow Diagram of Study Patients

The flow diagram outlines the cardiac screening for patients in our study population requiring treatment of complicated infantile hemangiomas (IHs) with propranolol hydrochloride. A total of 198 patients received propranolol treatment. Four patients with PHACE syndrome were excluded from the study. There were no patients who did not receive propranolol treatment owing to an electrocardiogram (ECG) screening. ECHO indicates echocardiogram; NSR, normal sinus rhythm; and PDA, patent ductus arteriosus.

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