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Research Letter
September 2016

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

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

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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