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In 85% of patients, adequate QT measurements were made using Apple Watch ECG tracings when the smartwatch was worn on the left wrist. However, in 94% of patients, adequate QT measurements were made using Apple Watch ECG tracings when the smartwatch was moved to alternative positions. Identifying the best smartwatch position at baseline may improve the accuracy of QT measurements.
Other ECG systems, such as the Kardia 6L system, may also be beneficial for the measurement of QT intervals. The authors conclude that the smartwatch technology can remotely monitor QT intervals, including in those patients who are quarantined and on QT-prolonging medications.
This abstract is available on the publisher's site.
Screening and monitoring for QT prolongation when initiating certain medications is routinely performed to avoid arrhythmic complications. However, the novel coronavirus disease (COVID-19) pandemic and its proposed treatments – including hydroxychloroquine and azithromycin, which are known to prolong the QT-interval1 – raise logistical and safety concerns with established QT monitoring strategies. Recently, the American College of Cardiology made recommendations for QT monitoring in outpatients with COVID-19 on hydroxychloroquine/azithromycin, suggesting that the use of direct-to-consumer mobile devices, such as the Apple Watch 1-lead ECG, could be considered in cases of resource constraints or quarantines.2 The Apple Watch ECG is FDA-cleared for detecting atrial fibrillation but has not been studied for QT monitoring. Lead I (the lead recorded by the Apple Watch) may be suboptimal for measuring this interval; however, other leads can be reproduced by placing the smartwatch on the left ankle or chest.3 We therefore sought to validate the use of the Apple Watch for QT measurement, including using non-standard smartwatch positions, in an unselected outpatient population.