Telemedicine in the Era of a Pandemic: Usefulness of a Novel Three-Lead ECG

The 12-lead electrocardiogram (ECG) is a first-line diagnostic tool for patients with cardiac symptoms. As observed during the COVID-19 pandemic, the ECG is essential to the initial patient evaluation. The novel KardioPal three-lead-based ECG reconstructive technology provides a potential alternative to a standard ECG, reducing the response time and cost of treatment and improving patient comfort. Our study aimed to evaluate the diagnostic accuracy of a reconstructed 12-lead ECG obtained by the KardioPal technology, comparing it with the standard 12-lead ECG, and to assess the feasibility and time required to obtain a reconstructed ECG in a real-life scenario. A prospective, nonrandomized, single-center, adjudicator-blinded trial was conducted on 102 patients during the COVID-19 pandemic at the Dedinje Cardiovascular Institute in Belgrade. The KardioPal system demonstrated a high feasibility rate (99%), with high specificity (96.3%), sensitivity (95.8%), and diagnostic accuracy (96.1%) for obtaining clinically relevant matching of reconstructed 12-lead compared to the standard 12-lead ECG recording. This novel technology provided a significant reduction in ECG acquisition time and the need for personnel and space for obtaining ECG recordings, thereby reducing the risk of viral transmission and the burden on an already overwhelmed healthcare system such as the one experienced during the COVID-19 pandemic.

Smartphone-derived multichannel electrocardiogram for exercise stress testing

INTRODUCTION

The use of mobile devices for electrocardiogram (ECG) recording and the ability to use this technology to immediately review dynamic waveforms is growing tremendously. While over-the-counter ECG devices may display rhythm disorders and ST-segment changes at rest, changes during physical exercise have thus far not been evaluated. We compared a mobile device (smartphone/tablet)-enabled vectorial 4-electrode ECG system (SPE) with the current standard 12‑lead (STE) ECG both at rest and during exercise.

METHODS AND RESULTS

A total of 428 patients underwent simultaneous ECG testing with both technologies during rest and maximal exercise. The vectorial ECG was displayed as 12‑lead ECG, and diagnostic accuracy and ECG quality (independently judged by blinded cardiologists) were compared with the current standard. Signal quality was good with both ECG technologies. At rest, there was excellent agreement between SPE and STE regarding rhythm (98%), AV-conduction (97%), wave duration (90%), and electrical axis (88-97%). During exercise the presence or absence of ST-deviation (>0.1 mm) corresponded in 90% of cases with no statistically significant difference. The positive predictive value was 48.5% and the negative predictive value was 94%. For ST-deviations >0.2 mm the percentage match was 97% during exercise. For rhythm disorders and for intraventricular conduction (left- and right-bundle branch block detection) it was >90%.

CONCLUSION

A smart-device-enabled vectorial ECGs system using the CardioSecur system can be used in daily practice to reliably interpret an ECG at rest and during physical exercise, although it is less accurate with respect to the detection of ST-deviation.

Assessment of a Novel, 22-lead Mobile Electrocardiogram in Elite, Adolescent Footballers

The 12-lead electrocardiogram is a key component of cardiac screening in elite adolescent footballers. Current technology hampers mobile electrocardiogram monitoring that could reduce the time-to-diagnosis in symptomatic athletes. Recently, a 22-lead mobile electrocardiogram monitor, CardioSecur (Personal MedSystems GmbH), has been approved for use in adults. In this study, the differences in parameter accuracy between CardioSecur's 22-lead electrocardiogram and the gold standard 12-lead electrocardiogram were assessed in elite adolescent footballers (n=31) using Bland-Altman and paired t-tests/Wilcoxon analysis. Agreement between the two devices was clinically acceptable for heart rate (bias=- 0.633 bpm), PR Interval (bias=- 1.73 ms), Bazzett's corrected QTc interval (bias=2.03 ms), T-wave axis (bias=6.55°), P-wave duration (bias=- 0.941 ms), Q-wave amplitude (bias=0.0195 mV), Q-wave duration (bias=1.98 ms), rhythm (bias=0.0333), ST-segment (bias=- 0.0629), J-point analysis (bias=- 0.01) and extended T wave and QRS duration analysis. Unsatisfactory agreement was observed in QRS axis (bias=- 19.4°), P-wave axis (bias=- 0.670°), QRS amplitude (bias=- 0.660 mV), P-wave amplitude (bias=0.0400 mV) and T-wave amplitude (bias=- 0.0675 mV). CardioSecur's 22-lead electrocardiogram agrees with the gold standard in rhythm, durations, T-wave determination in all leads assessed, permitting its use in adolescent footballers for immediate pitch- or track-side analysis.

A 66-Year-Old Woman with Intermittent Chest Pain and Dyspnea Who Underwent Continued ST-Segment Monitoring to Identify Occult ST-Segment Elevation that Expedited Coronary Angiography and Revascularization

BACKGROUND In patients admitted to the hospital owing to suspected acute coronary syndrome and where the first electrocardiogram (ECG) is non-diagnostic of ST-elevated myocardial infarction (STEMI), international guidelines recommend that sequential ECGs are performed to identify new or intermittent ST-deviations. Continued monitoring for ST-segment alterations is rarely performed, in contrast to the continued monitoring for arrhythmias. Continued monitoring for ST-segment alteration may detect intermittent ST-segment elevations not captured by routine 12-lead ECGs. We present a case in which continued ST-segment monitoring revealed intermittent ST-segment elevations and led to expedited coronary angiography and revascularization. CASE REPORT A 66-year-old woman was admitted to a regional hospital in Denmark with intermittent retrosternal chest pain and dyspnea. Her risk profile included a family history of cardiovascular disease, hypercholesterolemia, active smoking, and obesity. The results of 3 sets of high-sensitivity cardiac troponins and sequential 12-lead ECG measurements were normal. Because of clinical suspicion of unstable angina, the patient remained admitted. Continued rhythm and ST-segment monitoring was initiated. During continued ST-segment monitoring, asymptomatic intermittent ST-elevations in the inferior leads were detected. The patient was referred for an acute coronary angiography at the nearest cardiac center. Coronary catheterization showed right coronary artery stenosis, and complete revascularization was obtained by percutaneous coronary intervention with stent implantation. CONCLUSIONS Continued ST-segment monitoring can detect intermittent ST-segment elevations and thereby substantiate the need for acute coronary angiography.