Elsevier

Journal of Electrocardiology

Volume 50, Issue 4, July–August 2017, Pages 531-533
Journal of Electrocardiology

Artifactual ECG changes induced by electrocautery in a patient with coronary artery disease

https://doi.org/10.1016/j.jelectrocard.2017.03.005Get rights and content

Abstract

Continuous monitoring of 5-lead electrocardiogram is a basic standard of care (included under standard ASA monitor) in the operating room and electrocautery interference is a common phenomenon. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters may provide us clues to differentiate artifacts from true changes on the electrocardiogram. An improved understanding of the artifacts generated by electrocautery and their identifying characteristics is important to avoid misinterpretation, misdiagnosis, and hence mismanagement. This case report highlights the artifacts in electrocardiogram induced by electrocautery.

Introduction

Continuous monitoring of 5-lead electrocardiogram is a basic standard of care (included under standard ASA monitor) in the operating room and electrocautery interference is a common phenomenon. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters may provide us clues to differentiate artifacts from true changes on the electrocardiogram. An improved understanding of the artifacts generated by electrocautery and their identifying characteristics is important to avoid misinterpretation, misdiagnosis, and hence mismanagement. This case report highlights the artifacts in electrocardiogram induced by electrocautery.

Section snippets

Case report

A 47 year old male patient was scheduled for mesh hernioplasty for left sided indirect inguinal hernia. His past medical history was significant for coronary artery disease and hypertension. He underwent coronary stenting in left anterior descending and left circumflex arteries 6 years back. He had also undergone Bentall procedure for ascending aortic aneurysm 2 years back. Preoperative 12 lead ECG revealed q-waves in lead II, III & aVF and T wave inversion in lead I, II, aVL, V4, V5 and V6. A 2D

Discussion

A case of intraoperative electrocautery-induced artifact mimicking ST segment depression in lead II has been reported in a patient with left bundle branch block with CAD by Jain et al. [1]. Ketchey et al. also described similar artifacts in lead V5 [2]. Inappropriate diagnostic and therapeutic interventions are of serious concern in misdiagnosed artifacts. Consequences of 5-lead electrocardiographic artifacts range from simple alarm activation to drastic diagnostic and therapeutic actions, even

Conclusion

We suggest that before the diagnosis and the management of myocardial ischemia or infarction are carried out, the perioperative physicians must consider the artifacts induced by electrocautery in the event of intraoperative intermittent and reproducible significant ST-segment changes. There remains a need for continued technological improvement of medical equipment against the challenges of electrocautery induced interferences.

No funding/conflict of interest/affiliations.

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