Decentralised ECG monitoring for drug-resistant TB patients in ambulatory settings

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Decentralised ECG monitoring for drug-resistant TB patients in ambulatory settingsDear Editor, Managing drug-resistant TB (DR-TB) poses substantial challenges to patients and health systems globally.1 The emergence of new TB drugs such as bedaquiline, pretomanid and delamanid, and the repurposing of fluoroquinolones, clofazimine and linezolid, has marked significant progress in developing shorter, safer and more tolerable regimens for DR-TB. 2 However, it is important to acknowledge that the use of bedaquiline, delamanid, fluoroquinolones and clofazimine come with the potential risk of fatal arrhythmias associated with QT prolongation.[3][4][5][6][7] To address this concern, electrocardiogram (ECG) monitoring is crucial throughout treatment, which is integrated into active drug safety monitoring and management (aDSM).[4][5][6][7][8] Unfortunately, access to ECG is often centralised, requiring patients to travel long distances, thereby introducing practical and logistical challenges.Kazakhstan, a high-burden TB country, 9 has introduced new treatment regimens to enhance the management of DR-TB.9 The delivery of TB services is distributed across TB dispensaries, primary healthcare facilities and TB hospitals.To note, DR-TB treatment is initiated in TB hospitals, after which treatment monitoring (including ECG) continues on an ambulatory basis.10,11 In this context, the KardiaMobile 6L (KM6L; Alivecor, Mountain View, California, USA), which serves as a point-ofcare tool for ECG, may have specific advantages for populations facing challenges in accessing healthcare facilities.The KM6L device is equipped with three electrodes for recording a clinical-grade 6-lead ECG and transmits data wirelessly to a smartphone or tablet.Food & Drug Administration clearance validates its ability to detect atrial fibrillation, bradycardia, tachycardia, sinus rhythm with premature ventricular contractions, sinus rhythm with wide QRS, and sinus rhythm with supraventricular ectopy.[12][13][14] Additionally, it has been approved for monitoring QT prolongation, making it relevant for patients undergoing TB treatment with potentially cardiotoxic drugs.15 To assess the feasibility and acceptability of integrating KM6L into ambulatory settings for QT prolongation monitoring, we conducted a study involving adult DR-TB patients receiving QT-prolonging drugs.The study involved a questionnaire-based survey administered before and after the intervention with KM6L.Patients undergoing DR-TB treatment with QT-prolonging drugs were screened by doctors at the National Scientific Centre of Phthisiopulmonology,

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