Feasibility and compliance with daily home electrocardiogram monitoring of the QT interval in heart transplant recipients

• Published in: Heart & lung 2012-07, Vol.41 (4), p.368-373
• Main Authors: Carter, Erik V., RN, MS, Hickey, Kathleen T., RN, EdD, Pickham, David M., RN, PhD, Doering, Lynn V., RN, DNSc, Chen, Belinda, MPH, Harris, Patricia R.E., RN, MS, Drew, Barbara J., RN, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allograft rejection; Bazett correction formula; Cardiovascular; Cellular phone; Compliance; Critical Care; Electrocardiogram; Electrocardiography, Ambulatory; Feasibility Studies; Female; Graft Rejection - diagnosis; Heart Conduction System - physiopathology; Heart transplantation; Heart Transplantation - physiology; Humans; Male; Middle Aged; Patient Compliance; Pilot Projects; Postoperative Period; Pulmonary/Respiratory; QT interval; Telemedicine; Telephone; Tolerance
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2012.02.012

Abstract Background Recent evidence suggests that acute allograft rejection after heart transplantation causes an increased QT interval on electrocardiogram (ECG). The aims of this pilot study were to (1) determine whether heart transplant recipients could achieve compliance in transmitting a 30-second ECG every day for 1 month using a simple ECG device and their home telephone, (2) evaluate the ease of device use and acceptability by transplant recipients, and (3) evaluate the quality of transmitted ECG tracings for QT-interval measurement. Methods A convenience sample of adult heart transplant recipients were recruited and trained to use the device (HeartOne, Aerotel Medical Systems, Holon, Israel). Lead II was used with electrodes that were easy to slip on and off (expandable metal wrist watch-type electrode for right wrist and C-shaped band electrode for left ankle). Patients used a toll-free number with automated voice prompts to guide their ECG transmission to the core laboratory for analysis. Results Thirty-one subjects (72% were male; mean age of 52 ± 17 years; 37% were nonwhite) achieved an ECG transmission compliance of 73.4% (daily) and 100% (weekly). When asked, how difficult do you think it was to record and transmit your ECG by phone, 90% of subjects replied “somewhat easy” or “extremely easy.” Of the total 644 ECGs that were transmitted by subjects, 569 (89%) were acceptable quality for QT-interval measurement. The mean QTc was 448 ± 44 ms (440 ± 41 ms for male subjects and 471 ± 45 ms for female subjects). Eleven subjects (35%) had an extremity tremor, and 19 subjects (55%) had ≥ 1+ left leg edema. Neither of these conditions interfered with ECG measurements. Conclusion Transplant recipients are compliant with recording and transmitting daily and weekly ECGs.