EASI monitoring in ventricular tachycardia, an alternative to conventional electrocardiography?

Abstract

Background 12-lead electrocardiogram (ECG) is the gold standard for detecting ventricular arrhythmias. In cardiac critical care units (UCC), monitoring systems are used to detect transient events such as arrhythmias or ST-segment acute changes. The discomfort caused in the patient by the need for 10 electrodes to obtain the 12 leads continuously means that complete monitoring is not routine. The EASI monitoring system, based on vector electrocardiography, is an alternative that uses only 5 electrodes (4 thoracic and 1 ground) and theoretically allows obtaining a complete standard ECG. Objectives The main endpoint of this study was to evaluate the diagnostic accuracy of the EASI monitoring system in patients with ventricular tachycardia (VT), compared with conventional ECG. Methods Seven cases of patients admitted to the CCU due to episodes of VT are presented. The patients were monitored with the EASI system upon arrival, and the conventional ECG and the one derived from the EASI system were taken simultaneously for VT events for comparison. The 4 electrodes of the EASI system were placed, as recommended, on the sternal manubrium (S), lower sternum at the level of the 5th intercostal space (E), at the level of the 5th intercostal space, and on the right and left midclavicular lines (I and A). Results Analysing case by case, the axis of the tachycardia was similar in 5 patients, being able to assess the origin of the tachycardia in them. In 2 patients it was different. These cases of patients that differ, one episode has its origin in the right ventricular outflow tract (endocardial) and the other in the area of the left ventricular summit (epicardial). Two patients with different tachycardias and no cardiac characteristics in common. Figure 1. Conclusions EASI monitoring is a feasible alternative for monitoring patients in the CCU, which could give us reliable information (compared with standard ECG) with limitations in some cases in which the cardiac axis differs. For patients admitted for arrhythmic events, a better characterization of the differences would be interesting in order to optimize its use.