Misdiagnosis of ECG Artifacts May Lead to Drastic and Unnecessary Interventions

Abstract

We came across an article by Knight et al. (1) concerning electrocardiographic artifacts, after our case report had been accepted (2), and we feel that we should also include their warning. They report that the misdiagnosis of electrocardiographic (ECG) artifacts, such as ventricular tachycardia, may lead to unnecessary interventions as drastic as the implantations of a pacemaker or implantable cardioverter-defibrillator. However, they provide us with few concrete expedients that could prevent unnecessary diagnostic or therapeutic interventions as a result of such a misdiagnosis. The reviewers of our paper provided helpful and appropriate suggestions for the prevention of misdiagnosis of ECG artifacts. 1) Consider the possibility that the expected and associated changes in blood pressure may be the result of loss of proper atrioventricular synchrony. 2) If the rhythm is an actual arrhythmia, a reduction in the plethysmographic signal or arterial pulse wave form should be noticeable in pulse oximetry or direct arterial pressure. In addition, an irregular rhythm should be observable simply by palpating the arterial pulse. We firmly believe that this advice must always be kept in mind because anesthesiologists often come across ECG artifacts. We therefore conclude that it is important to examine all the hemodynamic changes associated with each patient before deciding that an observed disturbance is truly an arrythmia. Hirokatsu Toyoyama MD Koh Mizutani MD Humiko Kuki DDS Yoshiro Toyoda, MD