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. 2026 Feb 6;3(3):qyag023.
doi: 10.1093/ehjimp/qyag023. eCollection 2025 Aug.

Heart rate control in paediatric coronary CT angiography using phenylephrine

Yosef A Cohen  1   2 , Luca Bremner  3 , Mrinali Shetty  4 , Charissa J Chou  3 , Michelle Castillo  1 , Margarita Chernovolenko  1   5 , Kanwal M Farooqi  6 , Amee M Shah  6 , Anjali Chelliah  6   7 , Andrew J Einstein  1   5
Affiliations

Heart rate control in paediatric coronary CT angiography using phenylephrine

Yosef A Cohen et al. Eur Heart J Imaging Methods Pract. .

Abstract

Aims: Obtaining images of diagnostic quality using coronary CT angiography (CCTA) depends, in part, upon a patient's heart rate (HR) at time of scanning. HR reduction is most commonly achieved with beta blockers. In the paediatric population, the effectiveness of beta blockers is limited by hypotensive effects. Phenylephrine, a pure alpha agonist, raises blood pressure and causes reflex bradycardia so it could be used to reduce patients' HRs.

Methods and results: We retrospectively reviewed all children at a single centre who underwent sedated CCTA study using phenylephrine between 2019 and 2024. In 25 children (mean age 5.3 ± 2.5 years), HR was reduced from a mean of 94.1 to 73.8 beats per minute (bpm). No adverse effects were reported. Images of diagnostic quality were obtained in all patients.

Conclusion: In this first-of-its-kind study we found that phenylephrine was effective at reducing patients' HRs prior to CCTA, with an average reduction of 20 bpm.

Keywords: CCTA; heart rate; paediatrics; phenylephrine.

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Conflict of interest statement

Conflict of interest: The authors have no disclosures related to the present article. Unrelated disclosures are as follows. A.J.E. reports receiving a speaker’s fee from Ionetix, consulting fees from W. L. Gore & Associates, authorship fees from Wolters Kluwer Healthcare—UpToDate, and serving on a scientific advisory board for Canon Medical Systems USA; his institution has grants/grants pending from Alexion Pharmaceuticals, Attralus, BridgeBio, Canon Medical Systems USA, GE HealthCare, Intellia Therapeutics, Ionis Pharmaceuticals, Neovasc, Pfizer, Roche Medical Systems, and W. L. Gore & Associates. None of the other authors reported any disclosures. The data underlying this article cannot be shared publicly due to HIPAA-protected patient-level information but may be available from the corresponding author upon reasonable request and with appropriate institutional approvals.

Figures

Graphical Abstract
Graphical Abstract
(A) Schematic illustration of the mechanism of action of phenylephrine, a selective alpha adrenergic agonist which induces systemic vasoconstriction via activation of alpha-1-adrenergic receptors resulting in increased arterial blood pressure. This pressor response is sensed by carotid baroreceptors and triggers a compensatory, parasympathetically medicated reflex bradycardia. Illustration created with Canva graphic design platform (Canva Pty Ltd., Sydney, Australia). (B) Paired heart rate measurements at baseline and at coronary CT angiography acquisition following phenylephrine administration. Each line represents an individual patient. Phenylephrine exposure was associated with a significant reduction in heart rate (P = 0.0002).
Figure 1
Figure 1
Adjusted effects on heart rate changes from baseline to CT. Forest plot showing adjusted effect estimates for variables associated with change in heart rate (ΔHR, baseline to CT scan acquisition) among patients receiving phenylephrine. Negative values indicate a greater reduction in HR. The model was adjusted for age, baseline HR, and exposure to esmolol, dexmedetomidine, and propofol. Baseline HR was the strongest independent predictor of HR reduction, whereas exposure to other HR–active medications was not significantly associated with ΔHR.
See this image and copyright information in PMC

References

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