12-Lead ECG for All?
But the unprecedented volume of COVID-19 patients at hospitals makes it impossible to put them all on telemetry to monitor their QTc, Ackerman said, and scaling up the use of 12-lead ECG monitoring burdens already-stretched ECG technicians and other staff, worsens their chances of exposure to the virus, and uses up valuable personal protective equipment (PPE).
The 12-lead ECG “doesn’t make sense” for patients hospitalized with COVID-19, he said. “You’ve got a big machine that can get contaminated, you have exposure risk to the ECG professional coming in and out, combined with him or her wearing PPE and using that up. So it’s not a very practical way of obtaining the QTc measurement.”
So, he said, “if the QTc is an important vital sign in COVID-19, or, frankly, in any patient with [QTc prolongation] risk factors, then how do we start to obtain this vital sign more easily?”
A portable or even smartphone-based ECG monitor with QTc-measuring capabilities, of which several are available, may be one answer, Ackerman observed. His group’s guidance points out that the 6-lead ECG version of one of the best known of such devices, the KardiaMobile 6L (AliveCor), was recently cleared by the FDA for measuring QTc specifically in patients with COVID-19 receiving potentially QTc-prolonging agents.
“Similarly, many telemetry systems are equipped with real time QTc monitoring features which could be used for hospitalized patients,” the guidance observes.
(As the document notes, both Ackerman and the Mayo Clinic have a royalty agreement with AliveCor. Also, the Mayo Clinic has equity interest in the company.)
Applying a “Single-Lead” Handheld Device
Even the single-lead version of KardiaMobile may be useful for tracking QTc in patients, whether hospitalized for COVID-19 or if the patient is in a high-risk group for severe QTc prolongation, suggests a recent study in which the device was used off-label to capture three ECG vectors that are among the more useful for observing QTc prolongation.
“Generally, in a perfect world, they should all have a 12-lead ECG. And we don’t disagree, we think the 12-lead is probably the best way to go for evaluating the QT interval,” Christopher C. Cheung, MD, University of British Columbia, Vancouver, Canada, told theheart.org | Medscape Cardiology.