TY - JOUR
T1 - Prone and Supine 12-Lead ECG Comparisons
T2 - Implications for Cardiac Assessment During Prone Ventilation for COVID-19
AU - Chieng, David
AU - Sugumar, Hariharan
AU - Kaye, David
AU - Azzopardi, Sonia
AU - Vizi, Donna
AU - Rossi, Erina
AU - Voskoboinik, Aleksandr
AU - Prabhu, Sandeep
AU - Ling, Liang Han
AU - Lee, Geoffrey
AU - Kalman, Jonathan M.
AU - Kistler, Peter M.
N1 - Funding Information:
Dr. Chieng is supported by a cofunded National Health and Medical Research Council/ National Heart Foundation post-graduate scholarship. Dr. Kalman has received research and fellowship support from Medtronic and Biosense Webster. Prof. Kistler has received funding from Abbott Medical; and fellowship support from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/11
Y1 - 2021/11
N2 - Objectives: This study sought to describe expected changes in a mirror-image prone electrocardiogram (ECG) compared with normal supine, including a range of cardiac conditions. Background: Unwell COVID-19 patients are at risk of cardiac complications. Prone ventilation is recommended but poses practical challenges to acquisition of a 12-lead ECG. The effects of prone positioning on the ECG remain unknown. Methods: 100 patients each underwent 3 ECGs: standard supine front (SF); prone position with precordial leads attached to front (PF); and prone with precordial leads attached to back in a mirror image to front (PB). Results: Prone positioning was associated with QTc prolongation (PF 437 ± 32 ms vs. SF 432 ± 31 ms; p < 0.01; PB 436 ± 34 ms vs. SF 432 ± 31 ms; p = 0.02). In leads V1 to V3 on PB ECG, a qR morphology was present in 90% and changes in T-wave polarity in 84%. In patients with anterior ischemia, ST-segment changes in V1 to V3 on supine ECG were no longer visible on PB in 100% and replaced by an R-wave in V1. Bundle branch block (BBB) remained detectable in 100% on PB, with left BBB appearing as right BBB on PB in 71% and QRS narrowing with qR in V1 for right BBB. ST-segment/T-wave changes in limb leads and arrhythmia detection were largely unaffected in PB. Conclusions: As expected, the PB ECG is unreliable for the detection of anterior myocardial injury but remains useful for ST-segment/T-wave abnormalities in limb leads, BBB detection, and rhythm monitoring. The prone ECG is a useful screening tool with diagnostic utility in COVID-19 patients who require prone ventilation.
AB - Objectives: This study sought to describe expected changes in a mirror-image prone electrocardiogram (ECG) compared with normal supine, including a range of cardiac conditions. Background: Unwell COVID-19 patients are at risk of cardiac complications. Prone ventilation is recommended but poses practical challenges to acquisition of a 12-lead ECG. The effects of prone positioning on the ECG remain unknown. Methods: 100 patients each underwent 3 ECGs: standard supine front (SF); prone position with precordial leads attached to front (PF); and prone with precordial leads attached to back in a mirror image to front (PB). Results: Prone positioning was associated with QTc prolongation (PF 437 ± 32 ms vs. SF 432 ± 31 ms; p < 0.01; PB 436 ± 34 ms vs. SF 432 ± 31 ms; p = 0.02). In leads V1 to V3 on PB ECG, a qR morphology was present in 90% and changes in T-wave polarity in 84%. In patients with anterior ischemia, ST-segment changes in V1 to V3 on supine ECG were no longer visible on PB in 100% and replaced by an R-wave in V1. Bundle branch block (BBB) remained detectable in 100% on PB, with left BBB appearing as right BBB on PB in 71% and QRS narrowing with qR in V1 for right BBB. ST-segment/T-wave changes in limb leads and arrhythmia detection were largely unaffected in PB. Conclusions: As expected, the PB ECG is unreliable for the detection of anterior myocardial injury but remains useful for ST-segment/T-wave abnormalities in limb leads, BBB detection, and rhythm monitoring. The prone ECG is a useful screening tool with diagnostic utility in COVID-19 patients who require prone ventilation.
KW - COVID-19
KW - electrocardiogram
KW - prone
KW - supine
UR - http://www.scopus.com/inward/record.url?scp=85118831674&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2021.04.011
DO - 10.1016/j.jacep.2021.04.011
M3 - Article
C2 - 34217662
AN - SCOPUS:85118831674
SN - 2405-500X
VL - 7
SP - 1348
EP - 1357
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 11
ER -