ELECTROCARDIOGRAPHIC ARTIFACTS AS A POTENTIAL SOURCE OF PSEUDO-ARRHYTHMIAS

Abstract
Background: A number of artifacts could mislead diagnosis of ambulatory electrocardiographic monitoring. Hiccup is a well described cause of electrocardiographics artifacts the origin of which are controversial. Methods and results: We prospectively searched for artifacts during ambulatory electrocardiography in patients referred for monitoring to our institution. We divided artifacts according to Krasnow and Bloomfield’s classification (pseudo-arrhythmia, non-arrhythmia) and a new category was added: artifacts in patients with pacemakers. Examples of artifacts encountered mimicking includes: sinus arrest, supraventricular arrhythmias, ventricular arrhythmias, and aberrancy. We performed electrical stimulation of one and/or both phrenic nerves in an open-chest model dog. Only electrical activity of the diaphragm and not mechanical one was associated with electrocardiographic artifacts. Conclusions: A substantial amount of invalid data due to electrocardiographic artifacts could be identified during ambulatory electrocardiographic monitoring. These could lead to inappropriate interpretation and may result in severe diagnostic errors. Clinical electrocardiographic artifacts resulting from hiccup or diaphragmatic flutter are electrical in origin.

Key words
Electrocardiographic artifacts, Holter, ventricular tachycardia, electrocardiogram, hiccup, arrhythmias

Bibliografía del artículo

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