Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia

Knight, Bradley P; Pelosi, Frank; Michaud, Gregory F; Strickberger, S.Adam; Morady, Fred

Next »The American Journal of Medicine
Volume 110, Issue 5 , Pages 335-338, 1 April 2001

Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia

Bradley P Knight, MD
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Requests for reprints should be addressed to Bradley P. Knight, MD, University of Michigan Health System, 1500 East Medical Center Drive/B1F245, Ann Arbor, Michigan 48109-0022
Frank Pelosi, MD
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
Gregory F Michaud, MD
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
S.Adam Strickberger, MD
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
Fred Morady, MD
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA

Received 31 July 2000; received in revised form 1 December 2000; accepted 1 December 2000.

Abstract

BACKGROUND: Patients who are misdiagnosed with ventricular tachycardia because of electrocardiographic artifact may be subjected to unnecessary procedures. The purpose of this study was to determine how often electrocardiographic artifact is misdiagnosed as ventricular tachycardia.

METHODS: Physicians (n = 766) were surveyed with a case simulation that included a two-lead electrocardiographic monitor tracing of artifact simulating a wide-complex tachycardia.

RESULTS: The rhythm strip was not recognized as artifact by 52 of the 55 internists (94%), 128 of the 221 cardiologists (58%), and 186 of the 490 electrophysiologists (38%). One hundred fifty-six of the 181 electrophysiologists (88%), 67 of the 126 cardiologists (53%), and 14 of the 15 internists (31%) who misdiagnosed the rhythm as ventricular tachycardia recommended an invasive procedure for further evaluation or therapy.

CONCLUSIONS: This physician survey suggests that electrocardiographic artifact that mimics ventricular tachycardia may frequently result in patients being subjected to unnecessary invasive cardiac procedures. Physicians should include artifact in their differential diagnosis of wide complex tachycardias to minimize unneeded procedures.