Shah Rajan L, Kapoor Ridhima, Bonnett Colleen, Ottoboni Linda K, Tacklind Christine, Tsiperfal Angela, Perez Marco V
Department of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Section of Cardiac Electrophysiology, Stanford University Medical Partners, 365 Hawthorne Ave, Ste. 201, Oakland, CA 94609, USA.
Eur Heart J Digit Health. 2021 Mar 25;2(2):259-262. doi: 10.1093/ehjdh/ztab034. eCollection 2021 Jun.
The epidemiological necessity for distancing during the COVID-19 pandemic has resulted in postponement of non-emergent hospitalizations and increase use of telemedicine. The feasibility of virtual antiarrhythmic drug (AAD) loading specifically with digital QTc electrocardiographic monitoring (EM) in conjunction with telemedicine video visits is not well established. We tested the hypothesis that existing digital health technologies and virtual communication platforms could provide EM and support medically guided AAD loading for patients with symptomatic tachyarrhythmia in the ambulatory setting, while reducing physical contact between patient and healthcare system. A prospective pilot, case series was approved by the institutional ethics committee, entailing three subjects with symptomatic arrhythmia during the COVID-19 pandemic who were enrolled for virtual AAD loading at home. Clinicians met with participants twice daily via video visits conducted after QTc analysis (Kardia 6L mobile sensor) and telemetry review (Mobile Cardiac Outpatient Telemetry of silent arrhythmias). Participants received direct instruction to either terminate the study or proceed with the next single dose of AAD. All participants completed contactless loading of five AAD doses, without untoward event. Scheduled video visits allowed dialogue and participant counselling where decision-making was guided by remote review of EM. Participant adherence with transmissions and scheduled visits was 98.3%; a single electrocardiogram was delayed beyond the 2 hours of post-dose schedule. This virtual approach reduced overall expenditures based on retrospective comparison with previous AAD load hospitalizations. We found that a 'virtual hospitalization' for AAD loading with remote EM and twice-daily virtual rounding is feasible using existing digital health technologies.
在新冠疫情期间，出于流行病学上保持社交距离的必要性，非紧急住院治疗被推迟，远程医疗的使用增加。虚拟抗心律失常药物（AAD）负荷试验结合远程医疗视频问诊，特别是采用数字QTc心电图监测（EM）的可行性尚未得到充分证实。我们检验了这样一个假设：现有的数字健康技术和虚拟通信平台能够在门诊环境中为有症状的快速性心律失常患者提供心电图监测，并支持在医学指导下进行AAD负荷试验，同时减少患者与医疗系统之间的身体接触。一项前瞻性试点病例系列研究获得了机构伦理委员会的批准，该研究纳入了三名在新冠疫情期间有症状性心律失常的受试者，他们在家中接受虚拟AAD负荷试验。临床医生通过在QTc分析（Kardia 6L移动传感器）和遥测回顾（用于无症状心律失常的移动心脏门诊遥测）之后进行的视频问诊，每天与参与者会面两次。参与者会收到直接指示，要么终止研究，要么继续服用下一剂单剂量的AAD。所有参与者均完成了五次AAD剂量的非接触式负荷试验，未出现不良事件。定期的视频问诊允许进行对话和为参与者提供咨询，决策由对心电图监测的远程审查指导。参与者对传输和预定问诊的依从率为98.3%；一份心电图延迟至给药后2小时以上。与之前AAD负荷住院治疗的回顾性比较表明，这种虚拟方法降低了总体费用。我们发现，利用现有的数字健康技术，通过远程心电图监测和每日两次的虚拟查房进行AAD负荷试验的“虚拟住院”是可行的。
