Introduction: The COVID pandemic has driven an expansion of telemedicine. Telemedicine may be well-suited for pediatric electrophysiology (EP) outpatient consultations. However, an ECG forms part of the standard of care and there is no established strategy for performing a remote 12-lead ECG. Hypothesis: The use of mail-out 12 lead ECG in a pediatric cardiology telemedicine environment is feasible. Methods: Between Nov 2020 and June 2021, select patients with telemedicine EP consultation were offered a mail-out 12 lead ECG (QT Medical, Diamond Bar, CA). The equipment was sent to the patient's home with technical support from both company and the cardiac clinic. ECGs were read and reported on the electronic health record. ECG quality was independently rated by 2 reviewers. Patient experience was recorded via survey (Qualtrics, Seattle, WA). Results: A total of 146 ECG recordings were transmitted in 31 patients [age 13 ± 5 years, 11 female (35%)]. Indications were prior arrhythmia [24 (77%)] or new cardiac symptoms [7 (23%)]. Prior arrhythmia diagnoses included WPW, paced rhythm, Brugada syndrome, ventricular tachycardia, complete heart block, long QT and monitoring of introduction of anti-arrhythmic medication. A median 3 (IQR 3-6) ECGs were recorded per patient. All patients had recordings suitable for clinical decision-making [21 had an 'excellent' recording (68%), 10 'good' (32%), Figure 1]. Total time to perform the ECG (including app set up, application of device and recording transmission) was 46 ± 18 min. 77% found it 'easy' or 'extremely easy' to perform, and 80% were 'confident' or 'moderately confident' in the recording. Median travel time to clinic saved was 62 min (IQR 30-151 min). However, only 33% would prefer to perform the ECG at home rather than in clinic Conclusions: Clinically acceptable pediatric 12-lead ECGs may be performed at home by the patient and family. This technology may be considered for adjunctive use with telemedicine consultation in pediatric EP.
The feasibility of a mail-out 12-lead ECG in a pediatric cardiac electrophysiology telemedicine environment