Annals of Noninvasive Electrocardiology (May 2024)
Use of portable single‐lead electrocardiogram device as an alternative for QTc monitoring in critically ill patients
Abstract
Abstract Purpose Acquired QT prolongation is frequent and leads to a higher mortality rate in critically ill patients. KardiaMobile 1L® (KM1L) is a portable, user‐friendly single lead, mobile alternative to conventional 12‐lead electrocardiogram (12‐L ECG) that could be more readily available, potentially facilitating more frequent QTc assessments in intensive care units (ICU); however, there is currently no evidence to validate this potential use. Methods We conducted a prospective diagnostic test study comparing QT interval measurement using KM1L with conventional 12‐L ECG ordered for any reason in patients admitted to an ICU. We compared the mean difference using a paired t‐test, agreement using Bland–Altman analysis, and Lin's concordance coefficient, numerical precision (proportion of QT measurements with <10 ms difference between KM1L and conventional 12‐L ECG), and clinical precision (concordance for adequate discrimination of prolonged QTc). Results We included 114 patients (61.4% men, 60% cardiovascular etiology of hospitalization) with 131 12‐L ECG traces. We found no statistical difference between corrected QT measurements (427 ms vs. 428 ms, p = .308). Lin's concordance coefficient was 0.848 (95% CI 0.801–0.894, p = .001). Clinical precision was excellent in males and substantial in females (Kappa 0.837 and 0.781, respectively). Numerical precision was lower in patients with vasoactive drugs (−13.99 ms), QT‐prolonging drugs (13.84 ms), antiarrhythmic drugs (−12.87 ms), and a heart rate (HR) difference of ≥5 beats per minute (bpm) between devices (−11.26 ms). Conclusion Our study validates the clinical viability of KM1L, a single‐lead mobile ECG device, for identifying prolonged QT intervals in ICU patients. Caution is warranted in patients with certain medical conditions that may affect numerical precision.
Keywords
