Choice of an alternative lead for QT interval measurement in serial ECGs when Lead II is not suitable for analysis

Salvi, Vaibhav; Karnad, Dilip R.; Kerkar, Vaibhav; Panicker, Gopi Krishna; Manohar, Deepak; Natekar, Mili; Kothari, Snehal; Narula, Dhiraj; Lokhandwala, Yash

doi:10.1016/j.ihj.2012.07.023

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…The ECG complex(es) used for interval measurement is not uniform and differs between core laboratories. When using a single lead for analysis, controversy exists as to which lead or leads to utilize for measurement since the QT interval can vary by over 20 ms within a single lead or between leads in a 10 s tracing even in the presence of stable sinus rhythm [45]. Furthermore, an individual’s QT and QTc demonstrates diurnal variability with the longest values occurring during sleep and the shortest values occurring during the day.…”

Section: Measurement Of the Qt Intervalmentioning

confidence: 99%

QT Assessment in Early Drug Development: The Long and the Short of It

Lester

Paglialunga

Johnson

2019

IJMS

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The QT interval occupies a pivotal role in drug development as a surface biomarker of ventricular repolarization. The electrophysiologic substrate for QT prolongation coupled with reports of non-cardiac drugs producing lethal arrhythmias captured worldwide attention from government regulators eventuating in a series of guidance documents that require virtually all new chemical compounds to undergo rigorous preclinical and clinical testing to profile their QT liability. While prolongation or shortening of the QT interval may herald the appearance of serious cardiac arrhythmias, the positive predictive value of an abnormal QT measurement for these arrhythmias is modest, especially in the absence of confounding clinical features or a congenital predisposition that increases the risk of syncope and sudden death. Consequently, there has been a paradigm shift to assess a compound’s cardiac risk of arrhythmias centered on a mechanistic approach to arrhythmogenesis rather than focusing solely on the QT interval. This entails both robust preclinical and clinical assays along with the emergence of concentration QT modeling as a primary analysis tool to determine whether delayed ventricular repolarization is present. The purpose of this review is to provide a comprehensive understanding of the QT interval and highlight its central role in early drug development.

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Section: Measurement Of the Qt Intervalmentioning

confidence: 99%

QT Assessment in Early Drug Development: The Long and the Short of It

Lester

Paglialunga

Johnson

2019

IJMS

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“…This difference in ECG configurations can affect the morphology and some measurements of ECG parameters measured here. A previous study reported ~7 ms difference in QT intervals of patients measured from the two ECG leads (Salvi et al, 2012). However, this relatively small lead‐based difference is unlikely to change the larger anesthesia‐ and DOX‐induced ECG modulation reported in this study.…”

Section: Discussionmentioning

confidence: 94%

Differential cardiotoxic electrocardiographic response to doxorubicin treatment in conscious versus anesthetized mice

et al. 2021

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Introduction Doxorubicin (DOX), an anticancer drug used in chemotherapy, causes significant cardiotoxicity. This study aimed to investigate the effects of DOX on mouse cardiac electrophysiology, in conscious versus anesthetized state. Methods Male and female C57BL/6 mice were injected with saline, 20 or 30 mg/kg DOX. ECGs were recorded 5 days post‐injection in conscious and isoflurane anesthetized states. ECGs were analyzed using a custom MATLAB software to determine P, PR, QRS, QTc, and RR intervals as well as heart rate variability (HRV). Results ECGs from the same mouse demonstrated P wave and QTc shortening as well as PR and RR interval prolongation in anesthetized versus conscious saline‐treated mice. ECG response to DOX was also modulated by anesthesia. DOX treatment induced significant ECG modulation in female mice alone. While DOX20 treatment caused decrease in P and QRS durations, DOX30 treatment‐induced QTc and RR interval prolongation in anesthetized but not in conscious female mice. These data suggest significant sex differences and anesthesia‐induced differences in ECG response to DOX. HRV measured in time and frequency domains, a metric of arrhythmia susceptibility, was increased in DOX20‐treated mice compared to saline. Conclusions This study for the first time identifies that the ECG response to DOX is modulated by anesthesia. Furthermore, this response demonstrated stark sex differences. These findings could have significant implications in clinical diagnosis of DOX cardiotoxicity.

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“…Lead I is frequently adequate for interpretation and the QTc measurement from lead I has been shown to differ by an average of 7.5 ms from that obtained from lead II. 12 Various ECG vectors, including lead II, can be obtained by both the Apple Watch and Kardia Pro devices by repositioning the device on the patient’s body. 13 Accordingly, single-lead mobile cardiac outpatient telemetry units have previously been approved by the United States Federal Drug Administration for QTc measurement.…”

Section: Discussionmentioning

confidence: 99%

Use of a Smartwatch for Assessment of the QT Interval in Outpatients with Coronavirus Disease 2019

Chinitz¹,

Goyal²,

Morales³

et al. 2020

J Innov Cardiac Rhythm Manage.

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Choice of an alternative lead for QT interval measurement in serial ECGs when Lead II is not suitable for analysis

Abstract: When QT interval cannot be measured in Lead II, the best alternative leads are aVR, aVF, V5, V6 and V4 in that sequence. It differs maximally from that in Lead II in Lead aVL.

Cited by 17 publications

References 24 publications

QT Assessment in Early Drug Development: The Long and the Short of It

QT Assessment in Early Drug Development: The Long and the Short of It

Differential cardiotoxic electrocardiographic response to doxorubicin treatment in conscious versus anesthetized mice

Use of a Smartwatch for Assessment of the QT Interval in Outpatients with Coronavirus Disease 2019

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