The missing link: Unlocking the power of cardiac rhythm monitoring device based QT interval detection

Abstract

Background:The QT interval is of high clinical value as QT prolongation can lead to Torsades de Pointes (TdP) and sudden cardiac death. Insertable cardiac monitors (ICMs) have the capability of detecting both absolute and relative changes in QT interval. In order to determine feasibility for long-term ICM based QT detection, we developed and validated an algorithm for continuous long-term QT monitoring in patients with ICM. Methods:The QT detection algorithm, intended for use in ICMs, is designed to detect T-waves and determine the beat-to-beat QT and QTc intervals. The algorithm was developed and validated using real-world ICM data. The performance of the algorithm was evaluated by comparing the algorithm detected QT interval with the manually annotated QT interval using Pearson's correlation coefficient and Bland Altman plot. Results:The QT detection algorithm was developed using 144 ICM ECG episodes from 46 patients and obtained a Pearson's coefficient of 0.89. The validation data set consisted of 136 ICM recorded ECG segments from 76 patients with unexplained syncope and 104 ICM recorded nightly ECG segments from 10 patients with diabetes and Long QT syndrome. The QT estimated by the algorithm was highly correlated with the truth data with a Pearson's coefficient of 0.93 (p < .001), with the mean difference between annotated and algorithm computed QT intervals of −7 ms.Conclusions: Long-term monitoring of QT intervals using ICM is feasible. Proof of concept development and validation of an ICM QT algorithm reveals a high degree of accuracy between algorithm and manually derived QT intervals.

Single intravenous dose ondansetron induces QT prolongation in adult emergency department patients: a prospective observational study

“…The QT interval duration depends on variety of factors, for which various formulas are described to interpret the corrected QT intervals (QTc) [ 7 – 10 ]. Most guidelines recommend QTc > 450, QTc > 480, and QTc > 500 msec as the absolute QTc prolongation based on the severity [ 7 , 9 , 11 – 13 ]. Several factors are associated with prolonged QTc, such as electrolyte imbalance and medications, particularly as a result of drug-drug interactions or the intake of QT prolonging drugs [ 9 , 14 , 15 ].…”

Single dose intravenous ondansetron induces QTc prolongation in adult emergency department patients: is it predictable and persistent? A prospective observational study

“…While several factors can lead to arrhythmias, one of the most important of which is the prolonged QT interval on the electrocardiogram (ECG) [5,6]. The QT interval duration depends on variety of factors, for which various formulas are described to interpret the corrected QT intervals (QTc) [7][8][9][10]. Most guidelines recommend QTc > 450, QTc > 480, and QTc > 500 msec as the absolute QTc prolongation based on the severity [7,9,[11][12][13], and several factors are associated with prolonged QTc, such as electrolyte imbalance and medications, particularly as a result of drug-drug interactions or the intake of QT prolonging drugs [9,14,15].…”