The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Electrocardiographic artefacts mimicking atrial tachycardia resulted in unnecessary diagnostic and therapeutic measures

  • Published : 2013.03.01
⟨ Previous Next ⟩

Abstract

Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pentothal was administered while preparing for electrical cardioversion, the oesophageal ECG recordings and the ECGs during adenosine administration were reviewed. An ECG artefact diagnosis was suspected, and then confirmed, during relapse of the "arrhythmia," with simple palpation of the radial pulse and cardiac auscultation.

Keywords

References

  1. Krasnow AZ, Bloomfield DK. Artifacts in portable electrocardiographic monitoring. Am Heart J 1976;91:349-357. https://doi.org/10.1016/S0002-8703(76)80220-7
  2. Casta A, McCann ME. Electrocardiographic inscription of diaphragmatic contractions during anaesthesia. Paediatr Anaesth 1999;9:175-176. https://doi.org/10.1046/j.1460-9592.1999.9220304.x
  3. Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Clinical consequences of electrocardiographic artifact mimicking ventricular tachycardia. N Engl J Med 1999;341:1270-1274. https://doi.org/10.1056/NEJM199910213411704
  4. Patel S. Electrocardiographic artifact mimicking ventricular tachycardia during high-frequency oscillatory ventilation: a case report. Am J Crit Care 2006;15:310-311.
  5. Boos CJ, Khan MY, Thorne S. An unusual case of misdiagnosed ventricular tachycardia. Emerg Med J 2008;25:173-174. https://doi.org/10.1136/emj.2007.050849
  6. Lin SL, Wang SP, Kong CW, Chang MS. Artifact simulating ventricular and atrial arrhythmia. Jpn Heart J 1991;32:847-851. https://doi.org/10.1536/ihj.32.847
  7. Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia. Am J Med 2001;110:335-338. https://doi.org/10.1016/S0002-9343(01)00627-1
  8. Littmann L, Monroe MH. Electrocardiographic artifact. N Engl J Med 2000;342:590-591. https://doi.org/10.1056/NEJM200002243420815
  9. Drew BJ, Scheinman MM. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: practical aspects for the immediate care setting. Pacing Clin Electrophysiol 1995;18(12 Pt 1):2194-2208. https://doi.org/10.1111/j.1540-8159.1995.tb04647.x
  10. Nabar A, Rodriguez LM, Timmermans C, Kattenbeck K, Wellens HJ. Capture and fusion beats during atrial fibrillation and ventricular tachycardia. Heart 2000;84:E1. https://doi.org/10.1136/heart.84.1.e1

Cited by

  1. Rhythmic chaos: irregularities of computer ECG diagnosis vol.58, pp.9, 2013, https://doi.org/10.11622/smedj.2017088