• Enrique Calvo-Ayala, Vince Procopio, Hayk Papukhyan, and Girish B Nair.
• Enrique Calvo-Ayala is an attending physician, Division of Pulmonary, Critical Care and Sleep Medicine, William Beaumont Hospital, Royal Oak, Michigan and an assistant professor, Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan.
• Am. J. Crit. Care. 2021 Nov 1; 30 (6): 466-470.

BackgroundQT prolongation increases the risk of ventricular arrhythmia and is common among critically ill patients. The gold standard for QT measurement is electrocardiography. Automated measurement of corrected QT (QTc) by cardiac telemetry has been developed, but this method has not been compared with electrocardiography in critically ill patients.ObjectiveTo compare the diagnostic performance of QTc values obtained with cardiac telemetry versus electrocardiography.MethodsThis prospective observational study included patients admitted to intensive care who had an electrocardiogram ordered simultaneously with cardiac telemetry. Demographic data and QTc determined by electrocardiography and telemetry were recorded. Bland-Altman analysis was done, and correlation coefficient and receiver operating characteristic (ROC) coefficient were calculated.ResultsFifty-one data points were obtained from 43 patients (65% men). Bland-Altman analysis revealed poor agreement between telemetry and electrocardiography and evidence of fixed and proportional bias. Area under the ROC curve for QTc determined by telemetry was 0.9 (P < .001) for a definition of prolonged QT as QTc ≥ 450 milliseconds in electrocardiography (sensitivity, 88.89%; specificity, 83.33%; cutoff of 464 milliseconds used). Correlation between the 2 methods was only moderate (r = 0.6, P < .001).ConclusionsQTc determination by telemetry has poor agreement and moderate correlation with electrocardiography. However, telemetry has an acceptable area under the curve in ROC analysis with tolerable sensitivity and specificity depending on the cutoff used to define prolonged QT. Cardiac telemetry should be used with caution in critically ill patients.©2021 American Association of Critical-Care Nurses.

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