7 ECG, Arrhythmia, ST and QT Monitoring
Indications For Use Of QT Interval Monitoring
Of special concern for QT monitoring is the administration of QT prolonging drugs to patients
identified with risk factors for Torsade de Pointe. Females, older patients and patients with
bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia
and hypomagnesemia are in this increased risk category.
Limitations For Use Of QT Interval Monitoring
Some conditions may make it difficult to achieve reliable QT monitoring, for example:
• the T-wave is very flat
• T-waves are not well defined due to atrial flutter or atrial fibrillation
• the end of the T-wave is difficult to define because of the presence of U-waves
• a high heart rate causes the P-wave to encroach on the end of the previous T-wave
• noise or high QRS morphology variation
For these cases you should select a lead with a good T-wave amplitude and no visible flutter activity,
and without a predominant U-wave or P-wave.
Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS
complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS
Because normal beats followed by ventricular beats are not included in the analysis, no QT
measurement will be generated in the presence of a bigeminy rhythm.
If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and
neonates) QT will not be measured.
When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable
QTc calculation it is important to avoid a region where the heart rate is changing.
QT/QTc measurements should always be verified by a qualified clinician.
Selecting The QT Leads
For QT Monitoring you can select one of the following three modes:
• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT
measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used.
• Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary
lead becomes unavailable or is changed, QT measurement will continue with the new primary lead.
• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be
used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.
To select the mode,
Select the QT numeric to enter the Setup QT Analysis window.
Select QT Lead and select All, Primary Lead or one of the available single leads.
When using the All Leads mode, make sure when you compare QT values that they are based on the
same set of leads.
About QT/QTc Interval Monitoring