Portable single-lead electrocardiogram device is accurate for QTc evaluation in hospitalized patients

María Mónica Marín O; Ángel Alberto García P; Oscar Mauricio Muñoz V; Julio César Castellanos R; Edward Cáceres M; David Santacruz P

doi:10.1016/j.hroo.2021.06.005

Portable single-lead electrocardiogram device is accurate for QTc evaluation in hospitalized patients

Heart Rhythm O2. 2021 Aug;2(4):382-387. doi: 10.1016/j.hroo.2021.06.005. Epub 2021 Jun 28.

Authors

María Mónica Marín O¹, Ángel Alberto García P¹, Oscar Mauricio Muñoz V², Julio César Castellanos R³, Edward Cáceres M¹, David Santacruz P⁴

Affiliations

¹ Department of Cardiology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
² Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
³ Hospital Universitario San Ignacio, Bogotá, Colombia.
⁴ Division of the Cardiac Electrophysiology Training Program, Pontificia Universidad Javeriana, Bogotá, Colombia.

Abstract

Background: Many commonly used drugs can prolong the QTc interval (QTc), which can lead to potentially life-threatening arrhythmias. In the current era of the COVID-19 pandemic, it is worth mentioning that the disease itself and several drugs used for its treatment have been associated with QTc prolongation.

Objective: To evaluate the agreement and clinical precision of a portable single-lead electrocardiogram (ECG) device to measure the QTc interval compared to the standard 12-lead ECG.

Methods: In sequential tests, QTc of ECG recordings obtained with the KardiaMobile (KM-1L) device (AliveCor, San Francisco, CA) were compared to QTc obtained with conventional 12-lead ECG. Agreement was evaluated using Bland-Altman plots and Lin's concordance coefficient. Consistency between the 2 devices in determining QTc prolongation (QTc ≥470 ms in males or ≥480 ms in females) was evaluated with kappa statistics.

Results: A total of 128 patients with a presumed or confirmed diagnosis of COVID-19 admitted to a university hospital were included. QTc intervals measured with KM-1L were similar to QTc measured with conventional ECG (442.45 ± 40.5 vs 441.65 ± 40.3 ms, P = .15). Bland-Altman analysis showed no significant difference in QTc values (average difference of -0.797, 95% limits of agreement:-13.179; 11.585). Lin's concordance coefficient showed an excellent agreement (0.988, P < .001). Concordance between the 2 devices for determining QTc prolongation was excellent (kappa >0.90).

Conclusion: ECG recordings obtained with KM-1L allow an accurate QTc interval assessment. Considering its simplicity of use, this approach has advantages over conventional ECG and can provide an alternative for the evaluation of QTc in hospitalized patients, during the current time of the COVID-19 pandemic and beyond.

Keywords: COVID-19; Electrocardiography; KardiaMobile; Mobile applications; QT/QTc interval; Single-lead ECG device; Smartphone; Ventricular arrhythmias.