Key result
Automated QT monitoring detects ~3x more prolonged QTc episodes than standard care with fewer ECGs.
Why the study?
QT interval monitoring gained interest during the COVID-19 pandemic due to QT-prolonging medications and concerns about viral transmission with serial ECGs.
Does continuous cardiac telemetry with automated QT monitoring improve detection of prolonged QT episodes in patients admitted with COVID-19 compared to standard of care?
Cohort (n=33)
Does continuous cardiac telemetry with automated QT monitoring improve detection of prolonged QT episodes in patients admitted with COVID-19 compared to standard of care?
Absolute Event Rate: 34% vs 11%
p-value: p=<0.0001
Continuous QT interval monitoring via telemetry improves detection of prolonged QTc episodes and reduces the need for serial ECGs in COVID-19 patients compared to standard of care.
May improve QTc detection efficiency in COVID-19 inpatients; hypothesis-generating pending randomized validation.
BackgroundQT interval monitoring has gained much interest during the COVID-19 pandemic because of the use of QT-prolonging medications and the concern about viral transmission with serial electrocardiograms (ECGs). We hypothesized that continuous telemetry-based QT monitoring is associated with better detection of prolonged QT episodes.MethodsWe introduced continuous cardiac telemetry (CCT) with an algorithm for automated QT interval monitoring to our designated COVID-19 units. The daily maximum automated heart rate-corrected QT (Auto-QTc) measurements were recorded. We compared the proportion of marked QTc prolongation (Long-QTc) episodes, defined as QTc ≥ 500 ms, in patients with suspected or confirmed COVID-19 who were admitted before and after CCT was implemented (control group vs CCT group, respectively). Manual QTc measurement by electrophysiologists was used to verify Auto-QTc. Charts were reviewed to describe the clinical response to Long-QTc episodes.ResultsWe included 33 consecutive patients (total of 451 monitoring days). Long-QTc episodes were detected more frequently in the CCT group (69/206 [34%] vs 26/245 [11%]; P < 0.0001) and ECGs were performed less frequently (32/206 [16%] vs 78/245 [32%]; P < 0.0001). Auto-QTc correlated well with QTc measurement by electrophysiologists with an excellent agreement in detecting Long-QTc (κ = 0.8; P < 0.008). Only 28% of patients with Long-QTc episodes were treated with recommended therapies. There was 1 episode of torsade de pointes in the control group and none in the CCT group.ConclusionsContinuous QT interval monitoring is superior to standard of care in detecting episodes of Long-QTc with minimal need for ECGs. The clinical response to Long-QTc episodes is suboptimal.
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Alqarawi et al. (2020) conducted a cohort in Suspected or confirmed COVID-19 (n=33). Continuous cardiac telemetry (CCT) with automated QT interval monitoring vs. Standard of care (admitted before CCT implementation) was evaluated on Proportion of marked QTc prolongation (Long-QTc) episodes (QTc ≥ 500 ms) (p=<0.0001). Continuous cardiac telemetry with automated QT monitoring detected significantly more prolonged QTc episodes compared to standard of care (34% vs 11%; P<0.0001) while requiring fewer ECGs.
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