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

Cynthia K. Rigsby, R. Andrew Defreitas, Angela C. Nicholas, Christianne Leidecker, Andrew J. Johanek, Peter Anley, Deli Wang, Tetsu Uejima

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1880-1889
Number of pages10
JournalPediatric radiology
Volume40
Issue number12
DOIs
StatePublished - Dec 2010

Keywords

  • Children
  • Coronary arteries
  • ECG-gated coronary CTA
  • Esmolol

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

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