Background Atrial fibrillation (AF) affects over 10 million people in the United States and is commonly managed via antiarrhythmic drug (AAD) therapy for symptom and rhythm control. While AADs are known to improve cardiac outcomes in AF patients, they often require a three-day inpatient hospitalization to initiate treatment due to the rare risk (<0.6%) of QT prolongation. These hospitalizations can contribute significantly to healthcare costs. The goal of this case series is to present a novel software platform that supports remote AAD therapy initiation and ECG monitoring of varying durations, offering a safe and cost-effective alternative to inpatient care.

Methods A total of 17 AF patients (7 female, 10 male) underwent software-supported AAD titration (1 dofetilide, 2 amiodarone, 14 sotalol). Baseline ECG parameters were recorded and reviewed by providers who either accepted, modified, or rejected the automated measurements through the SafeBeat Rx software portal. The physicians then approved, modified, or rejected the algorithm-recommended AAD dose, generated based on the manufacturer’s drug label. Heart rate and QTc following each dose were monitored for proarrhythmic effects.

Results Average baseline QTc, heart rate, and creatinine averaged 409.76 ± 20.56 ms, 83.47 ± 19.77 beats/min, and 0.95 ± 0.22 mg/dL, respectively (Table I). Remote cardiac interval monitoring ranged from 3 to 22 days. In total, 11 patients were extended to long-term remote monitoring following the drug titration process. No adverse events were reported, and all patients achieved sinus rhythm.

Conclusion This case series establishes remote and extended QT-interval monitoring during AAD therapy initiation. All patients experienced safe and effective dose administration, suggesting the software platform has the potential to facilitate long-term cardiac therapeutic monitoring of commonly prescribed AADs.