Introduction
Infection due to Severe Acute Respiratory Syndrome Coronavirus-2
(SARS-CoV-2) has infected over 5 million people worldwide, resulting in
over 300,000 deaths.1 The illness caused by
SARS-CoV-2, Coronavirus Disease 2019 (COVID-19) predominantly affects
the respiratory system, however increasing data suggest that
cardiovascular involvement is common and associated with poor
outcomes.2 Additionally, commonly used therapies to
treat COVID-19 may have unintended cardiovascular side effects such as
cardiac arrhythmias. Early in the pandemic, the treatment regimen of
hydroxychloroquine and azithromycin had been widely-adopted based on
early studies suggesting improved clinical outcomes and viral
clearance.3-5 Both of these medications are known to
prolong the QT interval, leading to concerns regarding an elevated risk
of arrhythmia, especially in patients with baseline electrocardiographic
(ECG) abnormalities.6
Given the cardiac implications of both the infection, associated
therapies, and underlying comorbid cardiovascular conditions, many
patients in the ICU require assessment and continued monitoring of ECG
parameters such as QT interval, ST segment changes, and QRS morphology,
typically using a standard 12-lead ECG. However, concerns regarding
healthcare provider exposure to COVID-19 and limited availability of
personal protective equipment have led providers to seek alternative
means to safely monitor patients while limiting the amount of time and
number of caregivers entering a room. Current telemetry systems have the
ability to produce a multi-lead ECG that is mathematically derived
utilizing fewer electrodes than the conventional 12-lead ECG. It is
unclear if derived technology may offer a safe and accurate means to
assess and monitor patients for ECG abnormalities or interval ECG
changes while minimizing provider exposure to COVID-19.
This study aims to compare ECG parameters measured from conventional
12-lead ECG to those derived from a telemetry-generated 7-lead or single
lead tracing to determine if the latter may be a reasonable alternative
for screening and monitoring patients, particularly during a pandemic.