Safety and efficacy of a drug regimen to control heart rate during 64-slice ECG-gated coronary CTA in children

• Published in: Pediatric radiology Vol. 40; no. 12; pp. 1880 - 1889
• Main Authors: Rigsby, Cynthia K., deFreitas, R. Andrew, Nicholas, Angela C., Leidecker, Christianne, Johanek, Andrew J., Anley, Peter, Wang, Deli, Uejima, Tetsu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2010; Springer Nature B.V
• Subjects: Adolescent; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Cardiac-Gated Imaging Techniques - methods; Child; Child, Preschool; Children & youth; Coronary Angiography - drug effects; Coronary Artery Disease - diagnostic imaging; Drug dosages; Electrocardiography - drug effects; Female; Heart; Heart rate; Heart Rate - drug effects; Humans; Imaging; Infant; Infant, Newborn; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Radiographic Image Enhancement - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasound; Children; Esmolol; ECG-gated coronary CTA; Coronary arteries
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-010-1711-x

Background The adult practice for ECG-gated single-source 64-slice coronary CTA (CCTA) includes administering beta-blockers to reduce heart rate. There are limited data on this process in children. Objective To evaluate the safety and efficacy of a drug regimen to decrease heart rate before performing CCTA in children. Materials & methods IV remifentanil and esmolol infusion were chosen to decrease heart rate in 41 children (mean age 6.5 years) while they were under general anesthesia (GA) for CCTA. Drug doses, changes in heart rate and procedural complications were recorded. CCTA image quality was graded on a scale of 1 to 5. The relationships between image quality and heart rate and image quality and age were evaluated. Patient effective radiation doses were calculated. Results Heart rates were lowered utilizing esmolol (4 children), remifentanil (2 children) or both (35 children); 26 children received nitroglycerin for coronary vasodilation. The mean decrease in heart rate was 26%. There were no major complications. The average image-quality score was 4.4. Higher heart rates were associated with worse image quality ( r  = 0.67, P  < 0.0001). Older age was associated with better image quality ( r  = 0.66, P  < 0.0001). Effective radiation doses were 0.7 to 7.0 mSv. Conclusion Heart rate reduction for pediatric CCTA can be safely and effectively achieved while yielding high-quality images.