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Electrocardiographic interference: know your patient well

Published online by Cambridge University Press:  05 February 2021

Arjun K. Mahendran Open the ORCID record for Arjun K. Mahendran [Opens in a new window] ,
Philip M. Chang  and
Dipankar Gupta Open the ORCID record for Dipankar Gupta [Opens in a new window]
Arjun K. Mahendran*
Affiliation:
Congenital Heart Center, Department of Pediatrics, University of Florida, Gainesville, FL, USA
Philip M. Chang
Affiliation:
Congenital Heart Center, Department of Pediatrics, University of Florida, Gainesville, FL, USA
Dipankar Gupta
Affiliation:
Congenital Heart Center, Department of Pediatrics, University of Florida, Gainesville, FL, USA
*
Author for correspondence: Arjun K. Mahendran, MD, FAAP, Congenital Heart Center, Department of Pediatrics, University of Florida, Gainesville, FL, USA. Tel: +1 352 273-7770; Fax: +1 352 392-0547. E-mail: amahendran@ufl.edu
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Abstract

Two cases of paediatric patients with gastric pacemakers causing distinct electrocardiographic artefact. Recognition of extracardiac artefact is essential for proper ECG interpretation in patients.

Keywords

ECGartefactgastric stimulator
Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 462 - 463
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

Case

Two paediatric patients with gastroparesis secondary to mitochondrial disease, treated with gastric stimulator implantation (Medtronic® Enterra II Neurostimulator implanted subcutaneously in the lower left abdomen), were screened for cardiomyopathy. Screening electrocardiogram showed sinus rhythm and distinct artefact (Fig 1a and b), with an automated machine interpretation of atrial fibrillation.

Figure 1. (a) Electrocardiogram from a 12-year-old boy with mitochondrial disorder, gastroparesis, and permanent gastric stimulator. Device settings were 8 milliamp, 420 µs pulse width, rate of 40 Hz, and machine cycle of 2 s on and 3 s off. Artefact correlates with the impulse frequency and is noted only when the stimulator is on. (b) Electrocardiogram from a 6-year-old girl with a permanent gastric stimulator. The rate was set at 28 Hz with a cycle of 1 s on and 4 s off.

Discussion

These cases present unique examples of ECG artefact for educational purposes. Tracing artefact can arise from non-cardiac devices, with the quality of artefact dependent on device type, settings, and location in or outside of the body. Reference Guinand, Noble, Frei, Renard, Tramer and Burri1,Reference Gupta, Saidi and Bryant2 One such example is a gastric stimulator, which is used for drug-resistant gastroparesis commonly seen in mitochondrial diseases. Electrical impulses from gastric stimulators are typically low amplitude and high frequency in quality with cyclical on/off periods, thereby mimicking physiologic gastric function. These impulses can be recorded on ECG despite signal filtering. Recognition of this and other types of extracardiac artefact is essential for proper ECG interpretation in complex paediatric patients.

Acknowledgments

None.

Financial support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflict of interest

None.

Ethical statement

The authors assert that all procedures contributing to this work comply with the ethical standards.

References

Guinand, A, Noble, S, Frei, A, Renard, J, Tramer, MR, Burri, H. Extra-cardiac stimulators: what do cardiologists need to know? Europace 2016; 18: 1299–1307.CrossRefGoogle ScholarPubMed
Gupta, D, Saidi, A, Bryant, RM. Artefactual atrial flutter due to interference from a portable media device. Cardiol Young 2015; 25: 1375–1376.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1. (a) Electrocardiogram from a 12-year-old boy with mitochondrial disorder, gastroparesis, and permanent gastric stimulator. Device settings were 8 milliamp, 420 µs pulse width, rate of 40 Hz, and machine cycle of 2 s on and 3 s off. Artefact correlates with the impulse frequency and is noted only when the stimulator is on. (b) Electrocardiogram from a 6-year-old girl with a permanent gastric stimulator. The rate was set at 28 Hz with a cycle of 1 s on and 4 s off.