Despite the 12-lead electrocardiogram (ECG) being the gold standard in evaluating clinical presentations of arrythmias of various kinds, several notable limitations, namely in accuracy and localization, have recently garnered concern with respect to administering appropriate therapeutic measures. The following text puts these limitations under the spotlight, highlighting the difficulty and challenging nature of standard ECG analysis and therapeutic measures, while simultaneously showing a novel body surface electrocardiographic mapping system that utilizes 3D spatial imaging and pinpoint localization algorithms in order to compensate for the shortcomings of the standard ECG, thereby providing higher precision data collection. We provide a brief overview of the novel device in a selection of arrhythmic demographics, along with its validity and reliability, while illustrating the benefits and positive outcomes of its utility.

Coronavirus disease 2019 (COVID-19) has affected medical practice. More than 7,000,000 patients died worldwide after being infected with COVID-19; however, no specific laboratory markers have yet been established to predict death related to this disease. In contrast, electrocardiographic changes owing to COVID-19 include QT prolongation and ST-T changes; however, there have been no studies on ambulatory electrocardiographic markers of COVID-19. We encountered three patients diagnosed as having COVID-19 who did not have a prior history of significant structural heart diseases. All had abnormalities in ambulatory echocardiogram parameters detected by high-resolution 24-h electrocardiogram monitoring: positive late potentials (LPs) and T-wave alternans (TWA), abnormal heart rate variability (HRV), and heart rate turbulence (HRT). Case 1 involved a 78-year-old woman with a history of chronic kidney disease, Case 2 a 76-year-old man with hypertension and diabetes, and Case 3 a 67-year-old man with renal cancer, lung cancer, and diabetes. None of them had a prior history of significant structural heart disease. Although no significant consistent increases in clinical markers were observed, all three patients died, mainly because of respiratory failure with mild heart failure. LP, TWA, HRV, and HRT were all positive in three cases with no significant structural cardiac disease at the initial phase of admission. There is a possibility that LP, TWA, HRV, and HRT have the potential to be risk stratifiers of COVID-19 pneumonia in the early phase of admission. Further accumulation of data regarding ambulatory electrocardiographic markers in patients with COVID-19 is needed.