Study: Pretreatment ECG not always needed in babies with hemangiomas

Routine ECG screening in infants before they receive propranolol for hemangiomas is “not likely to be an effective screening tool in patients with otherwise normal physical examination and family history” and may even cause harmful delays in treatment, study authors concluded.

“As previously published guidelines suggest, it is likely that an indication-driven ECG strategy is a better approach, because there is a low incidence of ECG abnormalities that would limit propranolol use in children,” wrote Kevin B. Yarbrough, MD, a dermatologist at Phoenix Children’s Hospital, and his associates. The results “support published guidelines for propranolol initiation and are congruent with findings from other investigators” (Pediatr Dermatol. 2016 Nov;33[6]:615-20).

In the retrospective study, Dr. Yarbrough and his associates tracked 162 patients (median age, 5.2 months) who underwent routine ECG screening at several clinics before propranolol treatment for hemangiomas from 2008 to 2013. The ECGs were read as abnormal in 69 cases (43%); the most common abnormality was left ventricular hypertrophy (16 patients), followed by right ventricular hypertrophy (8), sinus bradycardia (6), and sinus tachycardia (5).

Cardiologists cleared all 69 patients for propranolol treatment, which they received. “No patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG before initiation of the propranolol,” the authors wrote.

“Routine ECG adds to the cost of treating hemangiomas and leads to unnecessary consultations and testing. Even more importantly, abnormalities detected on ECG can lead to delays in treatment initiation, which in turn can lead to greater patient morbidity, as seen in the case of our patient whose hemangioma ulcerated while awaiting cardiology consultation,” they added.

Still, they noted that ECG tests should still be performed on “infants with bradycardia or cardiac arrhythmia found during initial physical examination, a family history of congenital heart disease or arrhythmias, and a maternal history of connective tissue disease.”

Study funding information was not provided. One of the study authors reported that he was a clinical investigator for Pierre Fabre Dermatologie, the manufacturer of the oral propranolol product Hemangeol.

Routine ECG screening in infants before they receive propranolol for hemangiomas is “not likely to be an effective screening tool in patients with otherwise normal physical examination and family history” and may even cause harmful delays in treatment, study authors concluded.

“As previously published guidelines suggest, it is likely that an indication-driven ECG strategy is a better approach, because there is a low incidence of ECG abnormalities that would limit propranolol use in children,” wrote Kevin B. Yarbrough, MD, a dermatologist at Phoenix Children’s Hospital, and his associates. The results “support published guidelines for propranolol initiation and are congruent with findings from other investigators” (Pediatr Dermatol. 2016 Nov;33[6]:615-20).

In the retrospective study, Dr. Yarbrough and his associates tracked 162 patients (median age, 5.2 months) who underwent routine ECG screening at several clinics before propranolol treatment for hemangiomas from 2008 to 2013. The ECGs were read as abnormal in 69 cases (43%); the most common abnormality was left ventricular hypertrophy (16 patients), followed by right ventricular hypertrophy (8), sinus bradycardia (6), and sinus tachycardia (5).

Cardiologists cleared all 69 patients for propranolol treatment, which they received. “No patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG before initiation of the propranolol,” the authors wrote.

“Routine ECG adds to the cost of treating hemangiomas and leads to unnecessary consultations and testing. Even more importantly, abnormalities detected on ECG can lead to delays in treatment initiation, which in turn can lead to greater patient morbidity, as seen in the case of our patient whose hemangioma ulcerated while awaiting cardiology consultation,” they added.

Still, they noted that ECG tests should still be performed on “infants with bradycardia or cardiac arrhythmia found during initial physical examination, a family history of congenital heart disease or arrhythmias, and a maternal history of connective tissue disease.”

Study funding information was not provided. One of the study authors reported that he was a clinical investigator for Pierre Fabre Dermatologie, the manufacturer of the oral propranolol product Hemangeol.

Routine ECG screening in infants before they receive propranolol for hemangiomas is “not likely to be an effective screening tool in patients with otherwise normal physical examination and family history” and may even cause harmful delays in treatment, study authors concluded.

“As previously published guidelines suggest, it is likely that an indication-driven ECG strategy is a better approach, because there is a low incidence of ECG abnormalities that would limit propranolol use in children,” wrote Kevin B. Yarbrough, MD, a dermatologist at Phoenix Children’s Hospital, and his associates. The results “support published guidelines for propranolol initiation and are congruent with findings from other investigators” (Pediatr Dermatol. 2016 Nov;33[6]:615-20).

In the retrospective study, Dr. Yarbrough and his associates tracked 162 patients (median age, 5.2 months) who underwent routine ECG screening at several clinics before propranolol treatment for hemangiomas from 2008 to 2013. The ECGs were read as abnormal in 69 cases (43%); the most common abnormality was left ventricular hypertrophy (16 patients), followed by right ventricular hypertrophy (8), sinus bradycardia (6), and sinus tachycardia (5).

Cardiologists cleared all 69 patients for propranolol treatment, which they received. “No patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG before initiation of the propranolol,” the authors wrote.

“Routine ECG adds to the cost of treating hemangiomas and leads to unnecessary consultations and testing. Even more importantly, abnormalities detected on ECG can lead to delays in treatment initiation, which in turn can lead to greater patient morbidity, as seen in the case of our patient whose hemangioma ulcerated while awaiting cardiology consultation,” they added.

Still, they noted that ECG tests should still be performed on “infants with bradycardia or cardiac arrhythmia found during initial physical examination, a family history of congenital heart disease or arrhythmias, and a maternal history of connective tissue disease.”

Study funding information was not provided. One of the study authors reported that he was a clinical investigator for Pierre Fabre Dermatologie, the manufacturer of the oral propranolol product Hemangeol.