Enhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019
Shashank Jain1, Virginia Workman1, Raj Ganeshan1
1Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
Insights
A new process effectively monitored electrocardiograms (ECGs) in COVID-19 patients, identifying significant QT prolongation and guiding interventions to prevent dangerous arrhythmias.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Many COVID-19 treatments can prolong the QT interval, increasing arrhythmia risk.
- Electrocardiogram (ECG) monitoring is crucial for patient safety during COVID-19 treatment.
Purpose of the Study:
- To implement an improved ECG monitoring protocol for patients with COVID-19.
- To proactively identify and manage QT prolongation in hospitalized COVID-19 patients.
Main Methods:
- Developed a Situation Background Assessment Recommendation (SBAR) tool for ECG interpretation in COVID-19 patients.
- Defined criteria for QT prolongation (e.g., corrected QT > 470 ms).
- Established a system for prompt electrophysiology consultation upon identifying QT prolongation.
Main Results:
- Reviewed 2006 ECGs from 524 patients over two weeks.
- 19.7% of patients exhibited QT prolongation, often associated with intensive care unit (ICU) stays and intubation.
- The majority of patients with QT prolongation were on QT-prolonging medications, both COVID-19 related and others.
Conclusions:
- The enhanced ECG monitoring process was efficient and successful in identifying patients with QT prolongation.
- Interventions based on electrophysiology recommendations were implemented, and serious arrhythmias like torsades de pointes were avoided.
Background:
Many of the drugs being used in the treatment of the ongoing pandemic coronavirus disease 2019 (COVID-19) are associated with QT prolongation. Expert guidance supports electrocardiographic (ECG) monitoring to optimize patient safety.
Objective:
The purpose of this study was to establish an enhanced process for ECG monitoring of patients being treated for COVID-19.
Methods:
We created a Situation Background Assessment Recommendation tool identifying the indication for ECGs in patients with COVID-19 and tagged these ECGs to ensure prompt over reading and identification of those with QT prolongation (corrected QT interval > 470 ms for QRS duration ≤ 120 ms; corrected QT interval > 500 ms for QRS duration > 120 ms). This triggered a phone call from the electrophysiology service to the primary team to provide management guidance and a formal consultation if requested.
Results:
During a 2-week period, we reviewed 2006 ECGs, corresponding to 524 unique patients, of whom 103 (19.7%) met the Situation Background Assessment Recommendation tool-defined criteria for QT prolongation. Compared with those without QT prolongation, these patients were more often in the intensive care unit (60 [58.3%] vs 149 [35.4%]) and more likely to be intubated (32 [31.1%] vs 76 [18.1%]). Fifty patients with QT prolongation (48.5%) had electrolyte abnormalities, 98 (95.1%) were on COVID-19-related QT-prolonging medications, and 62 (60.2%) were on 1-4 additional non-COVID-19-related QT-prolonging drugs. Electrophysiology recommendations were given to limit modifiable risk factors. No patient developed torsades de pointes.
Conclusion:
This process functioned efficiently, identified a high percentage of patients with QT prolongation, and led to relevant interventions. Arrhythmias were rare. No patient developed torsades de pointes.
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