Key result
Consensus standards define best practices for hospital ECG monitoring of arrhythmia, ischemia, and QT intervals.
Why the study?
Hospital ECG monitoring goals have expanded to include complex arrhythmias, myocardial ischemia, and prolonged QT intervals, yet ST-segment monitoring is vastly underutilized, automated QT monitoring is unavailable, and randomized trials guiding best practices are almost nonexistent.
Provides expert consensus-based best practices for hospital ECG monitoring to improve the diagnostic accuracy of arrhythmias, ischemia, and QT prolongation.
May guide hospital ECG monitoring protocols; leaves open prospective validation of clinical outcomes.
The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.
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Drew et al. (2004) conducted a review in Arrhythmias, myocardial ischemia, and prolonged QT interval requiring hospital cardiac monitoring. Hospital electrocardiographic (ECG) monitoring was evaluated. Hospital ECG monitoring consensus standards provide best practices for arrhythmia, ischemia, and QT-interval monitoring in children and adults based on expert opinion.
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