The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study
Background: QT 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 be...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-11-01
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| Series: | CJC Open |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589790X20301074 |
| _version_ | 1818666472368504832 |
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| author | Wael Alqarawi, MD David H. Birnie, MBChB, MD Mehrdad Golian, MD Girish M. Nair, MBBS, MSc, FHRS Pablo B. Nery, MD Andres Klein, MD Darryl R. Davis, MD, FHRS Mouhannad M. Sadek, MD, FHRS David Neilipovitz, MD Christopher B. Johnson, MD Martin S. Green, MD Calum Redpath, MBChB, PhD |
| author_facet | Wael Alqarawi, MD David H. Birnie, MBChB, MD Mehrdad Golian, MD Girish M. Nair, MBBS, MSc, FHRS Pablo B. Nery, MD Andres Klein, MD Darryl R. Davis, MD, FHRS Mouhannad M. Sadek, MD, FHRS David Neilipovitz, MD Christopher B. Johnson, MD Martin S. Green, MD Calum Redpath, MBChB, PhD |
| author_sort | Wael Alqarawi, MD |
| collection | DOAJ |
| description | Background: QT 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. Methods: We 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. Results: We 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. Conclusions: Continuous 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. Résumé: Introduction: La surveillance de l’intervalle QT a suscité beaucoup d’intérêt durant la pandémie de la COVID-19 en raison de l’utilisation de médicaments prolongeant l’intervalle QT et les préoccupations quant à la transmission virale par les électrocardiogrammes (ECG) en série. Nous avons posé l’hypothèse que la surveillance en continu de l’intervalle QT par télémétrie était associée à une meilleure détection des épisodes de prolongation de l’intervalle QT. Méthodes: Nous avons introduit la télémétrie cardiaque en continu (TCC) à l’aide d’un algorithme de surveillance automatisée de l’intervalle QT dans nos unités de COVID-19. Les mesures automatisées quotidiennes de l’intervalle QT corrigé (auto-QTc) en fonction de la fréquence cardiaque maximale ont été enregistrées. Nous avons comparé la proportion des épisodes de prolongation marquée de l’intervalle QTc (QTc long), définie par un intervalle QTc ≥ 500 ms, chez les patients montrant une suspicion de COVID-19 ou ayant la COVID-19 qui avaient été admis avant et après la mise en place de la TCC (groupe témoin vs groupe de TCC, respectivement). La mesure manuelle de l’intervalle QTc par les électrophysiologistes a été utilisée pour vérifier les mesures auto-QTc. Nous avons passé en revue les dossiers pour décrire la réponse clinique aux épisodes de QTc long. Résultats: Nous avons sélectionné 33 patients consécutifs (total de 451 journées de surveillance). Les épisodes de QTc long étaient détectés plus fréquemment dans le groupe de TCC (69/206 [34 %] vs 26/245 [11 %]; p < 0,0001) et les ECG étaient moins fréquemment effectués (32/206 [16 %] vs 78/245 [32 %]; p < 0,0001). Les mesures auto-QTc corrélaient bien avec les mesures manuelles du QTc par les électrophysiologistes et montraient une excellente concordance dans la détection de QTc long (κ = 0,8; p < 0,008). Seuls 28 % des patients ayant des épisodes de QTc long ont reçu les thérapies recommandées. Il y a eu une épisode de torsade de pointes dans le groupe témoin et aucun dans le groupe de TCC. Conclusions: La surveillance en continu de l’intervalle QT est supérieure à la norme de soins dans la détection des épisodes de QTc long et exige peu d’ECG. La réponse clinique aux épisodes de QTc long est sous-optimale. |
| first_indexed | 2024-12-17T06:05:04Z |
| format | Article |
| id | doaj.art-cc5aa41b53cf462984adc1c861a77925 |
| institution | Directory Open Access Journal |
| issn | 2589-790X |
| language | English |
| last_indexed | 2024-12-17T06:05:04Z |
| publishDate | 2020-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CJC Open |
| spelling | doaj.art-cc5aa41b53cf462984adc1c861a779252022-12-21T22:00:46ZengElsevierCJC Open2589-790X2020-11-0126592598The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort StudyWael Alqarawi, MD0David H. Birnie, MBChB, MD1Mehrdad Golian, MD2Girish M. Nair, MBBS, MSc, FHRS3Pablo B. Nery, MD4Andres Klein, MD5Darryl R. Davis, MD, FHRS6Mouhannad M. Sadek, MD, FHRS7David Neilipovitz, MD8Christopher B. Johnson, MD9Martin S. Green, MD10Calum Redpath, MBChB, PhD11Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Corresponding author: Dr Wael Alqarawi, University of Ottawa Heart Institute, 40 Ruskin St, H-1285A, Ottawa, Ontario K1Y 4W7, Canada. Tel.: +613-696-7402; fax: +1-613-696-7123.Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaThe Ottawa Hospital, Ottawa, Ontario, CanadaDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaBackground: QT 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. Methods: We 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. Results: We 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. Conclusions: Continuous 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. Résumé: Introduction: La surveillance de l’intervalle QT a suscité beaucoup d’intérêt durant la pandémie de la COVID-19 en raison de l’utilisation de médicaments prolongeant l’intervalle QT et les préoccupations quant à la transmission virale par les électrocardiogrammes (ECG) en série. Nous avons posé l’hypothèse que la surveillance en continu de l’intervalle QT par télémétrie était associée à une meilleure détection des épisodes de prolongation de l’intervalle QT. Méthodes: Nous avons introduit la télémétrie cardiaque en continu (TCC) à l’aide d’un algorithme de surveillance automatisée de l’intervalle QT dans nos unités de COVID-19. Les mesures automatisées quotidiennes de l’intervalle QT corrigé (auto-QTc) en fonction de la fréquence cardiaque maximale ont été enregistrées. Nous avons comparé la proportion des épisodes de prolongation marquée de l’intervalle QTc (QTc long), définie par un intervalle QTc ≥ 500 ms, chez les patients montrant une suspicion de COVID-19 ou ayant la COVID-19 qui avaient été admis avant et après la mise en place de la TCC (groupe témoin vs groupe de TCC, respectivement). La mesure manuelle de l’intervalle QTc par les électrophysiologistes a été utilisée pour vérifier les mesures auto-QTc. Nous avons passé en revue les dossiers pour décrire la réponse clinique aux épisodes de QTc long. Résultats: Nous avons sélectionné 33 patients consécutifs (total de 451 journées de surveillance). Les épisodes de QTc long étaient détectés plus fréquemment dans le groupe de TCC (69/206 [34 %] vs 26/245 [11 %]; p < 0,0001) et les ECG étaient moins fréquemment effectués (32/206 [16 %] vs 78/245 [32 %]; p < 0,0001). Les mesures auto-QTc corrélaient bien avec les mesures manuelles du QTc par les électrophysiologistes et montraient une excellente concordance dans la détection de QTc long (κ = 0,8; p < 0,008). Seuls 28 % des patients ayant des épisodes de QTc long ont reçu les thérapies recommandées. Il y a eu une épisode de torsade de pointes dans le groupe témoin et aucun dans le groupe de TCC. Conclusions: La surveillance en continu de l’intervalle QT est supérieure à la norme de soins dans la détection des épisodes de QTc long et exige peu d’ECG. La réponse clinique aux épisodes de QTc long est sous-optimale.http://www.sciencedirect.com/science/article/pii/S2589790X20301074 |
| spellingShingle | Wael Alqarawi, MD David H. Birnie, MBChB, MD Mehrdad Golian, MD Girish M. Nair, MBBS, MSc, FHRS Pablo B. Nery, MD Andres Klein, MD Darryl R. Davis, MD, FHRS Mouhannad M. Sadek, MD, FHRS David Neilipovitz, MD Christopher B. Johnson, MD Martin S. Green, MD Calum Redpath, MBChB, PhD The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study CJC Open |
| title | The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study |
| title_full | The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study |
| title_fullStr | The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study |
| title_full_unstemmed | The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study |
| title_short | The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study |
| title_sort | clinical utility of continuous qt interval monitoring in patients admitted with covid 19 compared with standard of care a prospective cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S2589790X20301074 |
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