Ambulatory telemetry monitors may help arrhythmia management in COVID-19
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Ambulatory telemetry monitors for patients with COVID-19 being treated with hydroxychloroquine and/or azithromycin provided real-time alerts to electrophysiologists and may improve their ability to monitor QTc changes and arrhythmias, reduce the need for serial ECGs and better allocate resources, researchers reported.
Hydroxychloroquine and azithromycin are sometimes used to treat COVID-19, but both have been associated with QT prolongation, which could lead to arrhythmias or sudden cardiac death, according to the study background.
For a study conducted at North Shore University Hospital, New York, investigators placed ambulatory telemetry monitors (BioTelemetry) on 117 patients (mean age, 60 years; 41% women; 52% with hypertension; 1% with HF; 5% with CAD) who were receiving hydroxychloroquine and/or azithromycin on non-telemetry floors. Electrophysiologists at the hospital then received urgent alerts and twice-daily reports. Urgent alerts were defined as QTc greater than 500 milliseconds and arrhythmias.
According to results published in the Journal of the American College of Cardiology, the ambulatory telemetry monitors generated 28 urgent alerts among 18 patients. Atrial fibrillation with a rapid ventricular response accounted for 53.6% of the alerts, whereas 17.9% were for QTc greater than 500 milliseconds.
“Regarding this pandemic, about a month ago as cities were becoming hot spots, there were issues with hospital capacity being able to take in all the COVID-19 admissions and for our hospital system in New York, that definitely became an issue,” David Chang, MD, of the department of cardiology and division of electrophysiology at North Shore University Hospital, told Healio. “A lot of patients were getting new medications that puts patients at higher risk for heart rhythm issues and they were not being monitored on telemetry because we just simply ran out of monitors on the telemetry floors. Our approach was using an ambulatory telemetry monitor to ease the load effect and increase the capacity.
“Not only does it allow us to monitor rhythm issues from more patients, but it also provides a safer work environment for health care providers,” Chang said in an interview. “Using the system meant that the provider did not need to have a direct encounter with the patients to collect the data and then to determine if the patients were having any rhythm issues.”
In other findings, participants had a mean baseline QTc of 437.1 milliseconds and experienced an average QTc increase of 33.9 milliseconds. Moreover, the highest reported QTc was similar in patients who were treated with hydroxychloroquine compared with those who received hydroxychloroquine plus azithromycin (448.5 ms vs. 451.9 ms, respectively; P = .58). The change from baseline was also similar (32.1 ms vs. 35.7 ms, respectively; P = .66).
The researchers wrote that a limitation of ambulatory telemetry monitors is the devices were never approved to measure QTc for patients with AF or atrial flutter, QRS greater than 160 milliseconds or T-wave less than 5% of the peak QRS amplitude.
“A lot of these devices that are out there, under the category of ambulatory telemetry monitor, we have this mindset that these can only be used in an outpatient setting. Inpatient use is often listed as a contraindication,” Chang told Healio. “For instance, the system that we used, the MCOT, it specifically states that it's contraindicated for inpatient use as well as QT prolonging monitoring. But we went against that, we tried it and it actually worked. It's important for us to revisit that and not only look at the guidelines that currently do not recommend using ambulatory monitors in an inpatient setting, but taking that question further and asking ourselves, can we actually use it not only for this current pandemic, but also apply it in unique circumstances moving forward where we might have to use this approach.”
“The monitor protects the health care workers and by doing so it is also conserving a lot of protective gear and equipment that are at times very hard to find. I think it goes unnoticed many times how stressful it is for the health care workers, and their family members when they come back from work. There's this fear of others getting infected as well.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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