Correlation between mobile and 12-lead ECG among patients loading with intravenous sotalol: A PEAKS substudy

Abstract

Background

Electrocardiographic monitoring is performed during sotalol loading, primarily to assess QTc. Continuous telemetry increases resource utilization, generating interest in streamlining QTc monitoring through mobile technologies.

Objective

Assess feasibility and outcomes of mobile electrocardiogram (ECG) monitoring during intravenous sotalol loading.

Methods

In a substudy of the PEAKS (Prospective Evaluation Analysis and Kinetics of IV Sotalol) registry, AliveCor 6L mobile ECGs were recorded during intravenous sotalol loading, concomitantly with standard 12-lead ECGs. We calculated the correlation of heart rate and QTc between them.

Results

Overall, 77 patients were included: the median age was 68 years (interquartile range 63–73 years) and 20% were female. A total of 227 mobile recordings were performed within 30 minutes of 12-lead ECG, including baseline (8%), during infusion (54%), during oral dosing (35%), and during follow-up (0.4%). Half (51%) of 12-lead tracings were in atrial tachycardia (AT)/atrial fibrillation (AF), with a 93% correlation with automated mobile diagnostics. No mobile QTc values were available for recordings in AT/AF. The overall correlation between 12-lead ECG and mobile ECG was good for continuous heart rate (R > 0.8) but was poor for continuous QTc (R = 0.24). Most physiologic QTc values from the mobile ECGs were within 10% of the adjudicated 12-lead values (83%), with 53% within 5%. There were few false negative values for QTc >500 ms by mobile ECG (n = 2 of 58 [3.4%]).

Conclusion

Mobile ECGs can be performed during sotalol loading but are limited by the absence of QTc in AT/AF. While QTc values from automated mobile 6-lead ECGs appeared to detect cases of QTc prolongation in sinus rhythm, additional data are needed prior to use for routine clinical monitoring.

ClinicalTrials.gov ID

NCT05247320.