A BIZZARE ECG

Abstract

Abstract Electrocardiographic artifacts are common and may interfere with interpretation. We describe a clinical case where a limb lead electrode was placed near the pulsation of the radial artery, which created an artery pulse tapping artifact also called Aslanger‘s sign or electromechanical association. This is a very unique physiological type of electrocardiogram (ECG) artifact generated by the movement of the electrode placed near the pulsatile artery, particularly in hyperdynamic state such as hyperthyroidism, severe anemia, liver cirrhosis and arteriovenous fistula, including dialysis fistula of end–stage renal disease. These kind of artifacts may imitate primary repolarization changes characteristic for acute coronary syndrome, arrhythmias or electrolyte abnormalities; thus, they have the potential to trigger unnecessary tests. Careful inspection of the ECG in Fig.1 revealed that the coupling interval of the QRS complex and the artifact is identical, which signifies that the artifact is synchronous with cardiac cycle. In the given ECG, bizarre changes were seen in all limb leads except lead III, suggesting that the artifact arose from right arm limb electrode. The repeat ECG in Fig.2 was taken such that the electrode was not directly on the pulse, showed disappearance of the artifact. When ecountering unexpected electrocardiographic findings, inspection of the ECG and lead placement may identify the cause. Recognizing such intimidating ECG artifacts is very important to avoid unnecessary interventions in a benign condition.