EKG artifacts
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Editor-in-Chief: Santosh Patel M.D., FRCA [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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Introduction
Electrocardiograph (EKG) artifacts are unnecessary disturbances on EKG which is a measurement of cardiac potentials on the body surface. As a result of artifacts normal components of the EKG can be distorted.
Causes
Artifacts can be generated by patient's motion or other medical electrical devices attached to or implanted (e.g. deep brain stimulator) in the body. Tremors and shivering are good examples of motion induced artifacts. Simple movements such as brushing and combing the hair can cause EKG disturbances during ambulatory EKG monitoring. External sources of EKG artifacts mainly include power line electrical disturbances and radiofrequency (e.g. mobile phones). In operation theatres and intensive care unit various equipments can affect various components of EKG measurement (e.g. electrodes, leads, amplifier, filters). Examples of equipment which can cause EKG artifacts are - electrocautery, transcutaneus nerve stimulator (TENS), hemofiltration machines etc.
Charectristics
Artifacts on the EKG can distort individual or all components (P, QRS, T waves and PR and ST segments). Most of the time they are easily identifiable and neglected as they do not resemble any specific pattern. On occasions, changes may mimic specific arrhythmia like ventricular tachycardis and atrial flutter or fibrillation. It is important to differentiate these artifactual changes from genuine changes to avoid misdiagnosis. If ST segments are affected by artifacts either ST segment depression or elevation can occur on the EKG. These changes can be misinterpreted as myocardial ischemia or infarction.
Consequences
Apart from the poor quality of EKG, artifacts can cause serious consequences particularly when they mimic like genuine changes. If EKG artifacts are not recognized by physician, anesthesiologist or intensivist unneccasry diagnostic and therapeutic measures could be taken. Such actions may subject patients to invasive investigations or they may receive unnecessary medications like antiarrythmics.
Correction
Attention to basic such as proper electrodes placement and lead connections is required during EKG measurement. Well designed and maintained EKG measurement devices can withstand routine electrical disturbances. Although it is impossible to eliminate artifacts completely, it is essential that physicians keep high vigilance and interpret EKG keeping EKG artifacts in differential diagnosis list.
Examples of Artifacts
The gallery of images below shows a variety of EKG artifacts that are due to tremor, movement, movement disorders and electrical interference. These artifacts should not be confused with an abnormality in the patient's electrocardiogram. Atrial fibrillation can be confused with these artifacts.
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Movement artifacts
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Increasing movement artifacts in a Parkinson patient.
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Baseline drift. The amplifier in the ECG machine has to re-find the 'mean'. This often occurs right after lead connection and after electric cardioversion.
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Cardioversion from atrial fibrillation to sinus rhythm, with clear baseline drift.
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Electrical interference from a nearby electrical appliance. A typical example is a 100 Hz background distortion from fluorescent lights. Not to be confused with atrial fibrillation.
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Another example of an artifact caused by an electrical appliance. The patients rhythm is regular. This strip shows 10 QRS complexes.
References
- Dubois Du Bois-Reymond, E. Untersuchungen über thierische Elektricität. Reimer, Berlin: 1848.
- Hoffa Hoffa M, Ludwig C. 1850. Einige neue versuche uber herzbewegung. Zeitschrift Rationelle Medizin, 9: 107-144
- Waller Waller AD. A demonstration on man of electromotive changes accompanying the heart's beat. J Physiol (London) 1887;8:229-234
- Einthoven W. Le telecardiogramme. Arch Int de Physiol 1906;4:132-164
- Einthoven W. Über die Form des menschlichen Electrocardiogramms. Pfügers Archiv maart 1895, pagina 101-123
- Marey EJ. Des variations electriques des muscles et du couer en particulier etudies au moyen de l'electrometre de M Lippman. Compres Rendus Hebdomadaires des Seances de l'Acadamie des sciences 1876; 82: 975-977
- Marquez PMID 12177632
- Hurst PMID 9799216
- Kligfield PMID 17322457