Electrocardiography Pitfalls and Artifacts: The 10 Commandments

Baranchuk, Adrián; Shaw, Catherine; Alanazi, Haitham; Campbell, Debra; Bally, Kathy; Redfearn, Damián P.; Simpson, Christopher S.; Abdollah, Hoshiar

doi:10.4037/ccn2009607

Cited by 49 publications

(51 citation statements)

References 28 publications

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“…The acquisition module has been found as a potential vulnerable site for RF emissions from wireless devices. 10 The effects of the CDMA cellular phone emissions were more pronounced qualitatively, than those produced by either the GSM or analog cellular phones.…”

Section: Discussionmentioning

confidence: 98%

“…This may result in potentially serious medical errors. 10,11 In some academic institutions, medical students and junior residents are the initial call for patient care and thereby the initial decision maker. This instance could result in potential misdiagnosis due to EMI artifact on an ECG and could lead to inappropriate medical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Artifact due to EMI on ECG recordings may lead to interpretation mistakes, unnecessary medical treatment, and potentially dramatic medical errors. 10,11 For the purpose of this study, we hypothesized that cellular phones and other commonly encountered inhospital communication devices may produce EMI that adversely affects the operation of ECG machines. The resulting artifact may lead to the inability of different groups of care providers to properly interpret ECG results.…”

Section: Introductionmentioning

confidence: 99%

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Electromagnetic Interference of Communication Devices on ECG Machines

Baranchuk

Kang

Shaw

et al. 2009

Clinical Cardiology

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Background: Use of communication devices in the hospital environment remains controversial. Electromagnetic interference (EMI) can affect different medical devices. Potential sources for EMI on ECG machines were systematically tested. Hypothesis: Communication devices produce EMI on ECG machines. EMI impairs ECG interpretation.Methods: The communication devices tested were: a global system for mobile communication (GSM) receiver, a code division multiple access (CDMA) receiver, an analog phone, a wireless local area network, and an alpha-numeric pager. EMI was tested on 3 ECG machines: MAC 5000, MAC 1200, and ELI 100. The devices were tested at 2 and 1 meter, 50, 25, and 0 cm from the acquisition module. The ECGs were presented to a heterogeneous group of clinical providers, (medical students, residents, nurses, industry representatives from cardiac devices companies, and attending cardiologists) to evaluate the impact of EMI on ECG interpretation skills. Results: EMI was detected on the MAC 5000 ECG machine when activated GSM, CDMA, and analog phones were placed on top of the acquisition module. No EMI was seen on the other ECG machines or when phones were at a longer distance or deactivated. EMI was incorrectly diagnosed in 18% of the cases. EMI was confused most frequently with atrial fibrillation or flutter (52%), ventricular arrhythmias (22%), and pacemaker dysfunction (26%). Medical students ( p<0.003) and non-cardiology residents ( p = 0.05) demonstrated significantly worse performance on EMI interpretation. Conclusions: Digital and analog phones produce EMI on modern ECG machines when activated in direct contact to the acquisition module. EMI impairs ECG interpretation.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electromagnetic Interference of Communication Devices on ECG Machines

Baranchuk

Kang

Shaw

et al. 2009

Clinical Cardiology

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“…4 Stable blood pressure in an asymptomatic patient at the time of the apparent ventricular tachycardia (pseudo-ventric ular tachycardia) confirms the diagnosis. 1,4 Three helpful characteristic signs of pseudoventricular tachycardia have been described 1,5 : 1. Notch sign: notches can be observed in the wide QRS-like complex artifact that time out with preceding real R-R intervals.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to correctly distinguish between a true arrhythmia and an artifact can result in misdiagnosis and unnecessary therapeutic interventions. 1,2 Artifacts can mimic arrhythmias such as atrial flutter, atrial fibrillation, and ventricular tachycardia. 3 Electrocardiographic artifacts mimicking ventricular tachycardia are not rare, especially in an intensive care unit monitoring setting.…”

Section: Discussionmentioning

confidence: 99%

Pseudo–Ventricular Tachycardia Mimicking Malignant Arrhythmia in a Patient with Rapid Atrial Fibrillation

Barake

Baranchuk

Pintér

2014

American Journal of Critical Care

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Artifacts can simulate arrhythmias such as atrial flutter, atrial fibrillation, and ventricular tachycardia. A case of pseudo-ventricular tachycardia is outlined in a patient with newly diagnosed atrial fibrillation, which made the diagnosis a special challenge. Characteristic signs of pseudo-ventricular tachycardia are described. This case reinforces the importance of recognizing artifacts to avoid unnecessary interventions, especially in the telemetry and critical care units. (American Journal of Critical Care. 2014;23:270-272) A 51-year-old man with a history of mitral valve endocarditis, mitral valve prolapse and regurgitation, hypertension, type 2 diabetes mellitus, and alcohol abuse came to the emergency department with nausea, vomiting, and vague abdominal pain after a binge of alcohol the preceding night. Vital signs included a heart rate of 132 beats/min, blood pressure of 125/96 mm Hg, respiratory rate of 18/min, and body temperature of 36.7ºC. Physical examination was significant for irregular heart sounds with pansystolic murmur best heard at the apex with radiation to the left axilla. His abdomen was tender with absent peritoneal signs. Electrocardiography showed atrial fibrillation with rapid ventricular response (130/min). The patient was admitted to the general internal medicine service for telemetry monitoring and management of his newly diagnosed atrial fibrillation.While being assessed by the medicine team in the emergency department, the patient had an 11-second run of an apparent irregular wide-complex tachycardia at 250/min with variable morphology (Figure, part A). The patient was asymptomatic and his blood pressure remained stable. The electrophysiology service was consulted urgently. Does this patient have ventricular tachycardia? Clinical CourseThe patient started treatment with bisoprolol 5 mg daily for rate control of atrial fibrillation and rivaroxaban 20 mg daily for stroke prophylaxis. After a close look at the tracings, the consulting Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org.

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Electrocardiographic monitoring for cardiovascular dysfunction

Winkler

2015

Critical Care Nursing

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Electrocardiography Pitfalls and Artifacts: The 10 Commandments

Cited by 49 publications

References 28 publications

Electromagnetic Interference of Communication Devices on ECG Machines

Electromagnetic Interference of Communication Devices on ECG Machines

Pseudo–Ventricular Tachycardia Mimicking Malignant Arrhythmia in a Patient with Rapid Atrial Fibrillation

Electrocardiographic monitoring for cardiovascular dysfunction

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