Experience with Holter monitoring during propranolol therapy for infantile hemangiomas

J Am Acad Dermatol. 2015 Aug;73(2):255-7. doi: 10.1016/j.jaad.2015.05.015. Epub 2015 Jun 6.

Abstract

Background: Although adverse events in children treated with propranolol have proven rare, the appropriate methods of assessing cardiovascular risk and monitoring for toxicity when the medication is used for infantile hemangiomas remain unclear.

Objective: We sought to analyze Holter monitor reports of otherwise healthy patients on propranolol for infantile hemangiomas to determine the incidence of sustained arrhythmias and to evaluate the utility of Holter monitoring in the outpatient setting.

Methods: We retrospectively reviewed the charts of patients with infantile hemangioma who underwent 24-hour Holter monitoring after initiation or dose escalation of propranolol between 2011 and 2014.

Results: In all, 43 patients aged 1.8 to 36.2 months, with 44 Holter monitor reports, were included in the study. No sustained arrhythmias were revealed. The treatment plan was not altered in any patient based on the Holter monitor report.

Limitations: This was a retrospective study design.

Conclusion: Our study suggests that Holter monitoring may be unnecessary in otherwise healthy patients with infantile hemangioma older than 12 weeks who are treated with propranolol in the outpatient setting.

Keywords: infantile hemangiomas; medication safety; pediatric dermatology; propranolol; systemic therapies; vascular lesions.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects
  • Age Factors
  • Ambulatory Care / methods
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / epidemiology
  • Child, Preschool
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Electrocardiography, Ambulatory / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Hemangioma, Capillary / diagnosis
  • Hemangioma, Capillary / drug therapy*
  • Humans
  • Incidence
  • Infant
  • Male
  • Neoplastic Syndromes, Hereditary / diagnosis
  • Neoplastic Syndromes, Hereditary / drug therapy*
  • Patient Safety
  • Propranolol / administration & dosage*
  • Propranolol / adverse effects
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy*
  • United States
  • Unnecessary Procedures*

Substances

  • Adrenergic beta-Antagonists
  • Propranolol

Supplementary concepts

  • Hemangioma, capillary infantile