Introduction
During the ongoing COVID-19 pandemic, limitations in health care
resources and extensive protections against viral dissemination forced
novel approaches to previously routine patient management. Patients with
COVID-19 infection are at risk for various cardiovascular and arrhythmic
complications.1 In addition, medications indicated to
treat COVID-19 infection carry risk of cardiac complications,
particularly QT prolongation and ventricular
arrhythmia.2 Several of the most commonly utilized
medications at this time, such as chloroquine, hydroxychloroquine,
azithromycin, and famotidine, carry a risk of QT prolongation. This risk
is heightened when such medications are used concomitantly, in patients
with cardiac comorbidities, or in the setting of acute medical illness
such as sepsis.3
Hospitalized patients with COVID-19 infection have been monitored for QT
prolongation and arrhythmias through the use of serial ECGs, telemetry,
as well as ambulatory telemetry monitors.4 However,
limited availability of such resources due to high demand, and
precautions set in place to protect health care providers from contact
with contagious patients, has precluded standard monitoring even in
hospitalized patients. Furthermore, most patients with COVID-19
infection are treated as outpatients, employing self-isolation to reduce
the risk of nosocomial and community spread.5 There is
therefore a sudden and dramatic reliance on telehealth and remote ECG
monitoring to manage patients at home.
Wearable and “smart” cardiac monitoring devices, such as the Apple
Watch series 4 and the AliveCor Kardia system (AliveCor Inc. Mountain
View, California), have the ability to record a rhythm strip essentially
equivalent to lead I on a standard ECG, and allow for electronic
transmission of results. While these devices are validated for their
ability to monitor heart rates and differentiate sinus rhythm from
atrial fibrillation6, the accuracy for other ECG
interpretation purposes has not been well studied. The waveforms
produced have been shown to correlate reasonably well with standard ECG
intervals including QTc,7 and have previously been
used to detect drug-induced QT interval prolongation.8
As patients with COVID-19 infection continue to overwhelm our global
health care system and resources, the ability to remotely monitor
patients for cardiac complications of COVID-19 infection, and ensure
safety of pharmacologic treatment, has become increasingly important.
Currently available wearable cardiac monitoring devices, such as the
Apple Watch Series 4, and the Kardia system, may therefore have an
important role in the management of patients in this Pandemic.
We report herein a case of a patient with COVID-19 infection who was
treated with a QT prolonging medication and was able to be managed
remotely with the assistance of a smart device.