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.