Interference of the monitored or recorded electrocardiogram is common within operating room and intensive care unit environments. Artifactual signals, which corrupt the normal cardiac signal, may arise from internal or external sources. Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. Newer diagnostic and therapeutic modalities may generate artifactual changes. These artifacts may be nonspecific or may resemble serious arrhythmia. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters, may provide the clues to differentiate artifacts from true changes on the electrocardiogram. Simple measures, such as proper attention to basic principles of electrocardiographic measurement, can eliminate some artifacts. However, in persistent cases, expert help may be required to identify the precise source and minimize interference on the electrocardiogram. Technological advancements in processing the electrocardiographic signal may be useful to detect and eliminate artifacts. Ultimately, an improved understanding of the artifacts generated by equipment, and their identifying characteristics, is important to avoid misinterpretation, misdiagnosis, and iatrogenic complication.

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Equipment-related electrocardiographic artifacts: causes, characteristics, consequences, and correction.

Objective. The objective of this study was to report our observations on the external electromagnetic field influences on deep brain stimulation (DBS) in our patient population and how these influ ...

Electromagnetic Environmental Influences on Implanted Deep Brain Stimulators

That tremor simulates atrial fibrillation and causes oral anticoagulation has not been reported. In a 69-year-old patient with diabetes, arterial hypertension and recurrent strokes, hand tremor developed since 1998. In September 2000 atrial fibrillation was diagnosed upon a routine and 24-hour ambulatory ECG. Because of the additional risk factors for stroke/embolism, phenprocoumon was begun. The diagnosis was changed to paroxysmal AF upon the following ECGs, showing sinus rhythm. Not earlier than 1 year after establishing the diagnosis,"atrial fibrillation" was identified as being due to a tremor artefact. Phenprocoumon was discontinued. Neurological investigations revealed Parkinson's disease as the cause of the tremor. Three weeks after initiation of pramipexol, the tremor artefact was no longer visible on ECG. Misinterpreting an ECG-artefact due to Parkinsons's tremor as atrial fibrillation may be followed by unnecessary diagnostic and therapeutic procedures, including long-term oral anticoagulation. Upon adequate treatment of Parkinson's disease, the tremor artefact immediately disappears from the ECG.

Oral anticoagulation for ECG tremor artefact simulating atrial fibrillation.

https://www.internationaljournalofcardiology.com/article/S0167-5273(02)00355-8/pdf

Differential electrocardiographic artifact from implanted spinal cord stimulator

Transcutaneous electrical nerve stimulation (TENS) is an effective modality for the treatment of pain. TENS use is well tolerated and has relatively few complications. Potentially serious complications of TENS use include disruption of cardiac pacemaker function and electrical artifact during electrocardiographic monitoring. Electrical interference with cardiac monitoring using parasternal electrodes and electrocardiographic (EKG) artifact with an epidural stimulator has been reported. We report the case of EKG artifact produced by surface TENS electrodes applied to the thoracic and lumbar regions. The electrical signal produced by the TENS unit created an electrocardiographic artifact resembling a pacemaker spike on routine EKG. This was interpreted as a malfunctioning cardiac pacemaker. The easily misinterpreted electrical spikes that can result from TENS use as seen in this case highlights the need for physician awareness of this potential complication.

Transcutaneous electrical nerve stimulator-induced electrocardiogram artifact: A brief report

https://www.internationaljournalofcardiology.com/article/0167-5273(92)90093-I/pdf

M. Raza

Papers

Electrocardiographic artifact with a transcutaneous electrical nerve stimulation unit.