Wiktor Wise
Electrocardiograms (ECGs) are a cornerstone of cardiac diagnosis, providing invaluable insights into the heart's electrical activity. However, the accuracy of ECG interpretation can be significantly compromised by artifacts, which are defined as electrocardiographic alterations not related to cardiac electrical activity. These artifacts can result from various internal and external causes, including electrical interference from devices such as power lines, electrical equipment, and mobile phones. This electrical interference can distort the heart's electrical signals on ECG recordings, leading to inaccurate diagnoses of heart conditions. Awareness and understanding of these artifacts are crucial for maintaining the accuracy and reliability of ECG interpretations and improving patient care.
| Characteristics | Values |
|---|---|
| Type | Powerline interference, pacing artifact, motion artifact, electromagnetic interference (EMI) artifact |
| Causes | Electrical equipment, wires, poor electrode attachment, body motion, electrical power lines, mobile phones, fluorescent lights, electrical diathermy, loose or dry electrodes, Parkinson's disease, cerebellar or intention tremor, anxiety, hyperthyroidism, multiple sclerosis, drugs, etc. |
| Effects | Distorted readings of the heart's electrical activity, large bizarre T-waves on the ECG, darkened reinforcement in the ECG baseline, pseudo-QRS complex, etc. |
| Solutions | Proper placement of ECG equipment, minimizing electronic device proximity, careful attention to electrode application, turning off interfering devices, etc. |
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What You'll Learn
Powerline interference
However, powerline interference occurs when other electrical signals are picked up by the ECG, distorting the readings of the heart's electrical activity. This type of artifact is created when the ECG picks up electrical noise from other surrounding devices. This can include electrical power lines, electrical equipment, mobile telephones, and large appliances. The awareness of this artifact is important to maintain the accuracy of ECG interpretations.
To reduce the incidence of powerline interference, proper placement of ECG equipment and minimizing the proximity of electronic devices are essential. It is recommended to ensure that the outlet used for the adapter has nothing else plugged into it, which may require using a longer Ethernet cable. Additionally, it is important to identify and address any interference issues, as they can lead to unnecessary tests and therapeutic interventions, impacting the quality of life for utility customers.
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Motion artifacts
There are multiple ways to simulate continuous motion artifacts, such as those caused by walking. One simple method is to generate Gaussian white noise and then pass it through a lowpass filter, keeping only the low-frequency components of the signal, which resemble the interference introduced by motion artifacts.
In the context of electrocardiography (ECG), motion artifacts can be caused by muscle tremors or tension, usually due to the patient being cold and shivering. They can also occur when patients prop themselves up with their arms. In addition, motion artifacts can be caused by Parkinson's disease, cerebellar or intention tremors, anxiety, hyperthyroidism, multiple sclerosis, and certain drugs such as amphetamines, xanthines, lithium, and benzodiazepines.
To minimise motion artifacts in ECG recordings, it is recommended to address any shivering or muscle twitching by the patient, ensure proper placement of ECG equipment, and minimise the proximity of electronic devices.
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Implanted device interference
The continuous advancement of medical technology has led to a rise in the number of implantable devices that utilize onboard electronics. These include devices used to treat cardiac arrhythmia, such as pacemakers and implantable cardioverter defibrillators (ICDs), which contain sensors to monitor heartbeats, memory to record data, processors to determine therapy, and circuitry to generate electrical impulses or shocks to correct the heart's operation. Other examples include neurostimulator implants, such as spinal cord stimulators for treating chronic pain.
Implanted devices are susceptible to electromagnetic interference (EMI) due to the prevalence of electronic devices in our surroundings. EMI can interrupt or damage implanted devices, and while regulations help minimize EMI, some exposure is unavoidable. Devices with leads, or long wires delivering therapy or taking measurements, are especially vulnerable to EMI as the leads can act as antennas, amplifying electromagnetic radiation (EMR). For instance, ICDs have been shown to record non-existent erratic cardiac behavior due to EMI, resulting in unnecessary activation and painful shocks to patients.
To protect implanted devices and patients, preventative measures such as EMI shielding and filtering are employed. Active or passive filtering can be used, with passive filtering being the simpler method, generally achieved through a capacitor. Capacitors can filter electromagnetic noise by absorbing and smoothing out signals, causing high-frequency noise to interfere with itself and cancel out the disruptive signal.
In a medical setting, EMI can occur from various sources, including electrosurgery, magnetic resonance imaging (MRI), ventricular assist devices, ionizing radiation, and cardioversion. Close communication between medical specialists is crucial to developing patient-specific strategies that consider factors like device type and surgery type to mitigate the risk of EMI. Additionally, guidelines provide recommendations for managing risks associated with MRI scans in patients with implanted cardiac devices.
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Electromagnetic interference
An electrocardiogram (ECG) is a cornerstone of cardiac diagnosis, providing invaluable insights into the heart's electrical activity. However, the accuracy of ECG results can be significantly compromised by artifacts, which represent any extraneous electrical activity that interferes with the underlying cardiac signal.
One such artifact is electromagnetic interference (EMI). EMI is unwanted noise or interference in an electrical path or circuit caused by an electromagnetic field (EMF) from an outside source. It can cause electronics to operate poorly, malfunction, or stop working altogether. In the context of ECG, EMI artifacts usually result from electrical power lines, electrical equipment, and mobile telephones. This is known as powerline interference, which distorts the heart's electrical signals on the ECG recording.
There are three types of EMI: radiated EMI, conducted EMI, and coupled EMI. Radiated EMI occurs when a high-power transmitter or electrical device produces a radio frequency that is picked up and negatively affects another device. An example of radiated EMI is when wireless telephones cause Wi-Fi to drop. Conducted EMI happens when there is a physical electrical path from the source to the receptor, often along power transmission lines. An example of conducted EMI is when a treadmill or clothes dryer is turned on, causing a computer on the same electrical circuit to reboot. Coupled EMI occurs when the source and receptor are close together but not electrically connected. It can be transmitted through induction or capacitance. An example of inducted EMI is a hum heard on an audio line when a power cable and an audio cable are near each other.
To minimize the impact of EMI in ECG recordings, it is important to ensure proper placement of ECG equipment and minimize the proximity of electronic devices. This includes turning off or moving cell phones and other electronic devices away from the ECG sensor module.
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Pacing artifacts
Electrocardiograms (ECGs) are a cornerstone of cardiac diagnosis, providing invaluable insights into the heart's electrical activity. However, the accuracy of ECG interpretation can be significantly compromised by artefacts—electrocardiographic alterations not related to cardiac electrical activity.
Pacing artefacts are commonly encountered in clinical practice. They are caused by external interference from devices such as chronic retained abdominal generators, which can lead to ECG manifestations of atria lead malfunction. These artefacts can be identified through careful attention to the patient's history and physical examination.
One specific type of pacing artefact is associated with transcutaneous pacing (TCP). Echo distortion creates a pseudo-QRS complex after the pacing spike, sometimes referred to as "false capture." The pacing spike is a graphical representation that an electrical current is about to pass between the pacing pads. This is followed by a short "blanking period" where the monitor essentially "closes its eyes" to avoid the signal going off the ECG paper. However, if the monitor catches the pacing current as it returns to baseline, it creates a pseudo-QRS complex, resulting in large, bizarre T-waves on the ECG.
To minimise pacing artefacts and other interferences, it is essential to carefully apply electrodes and choose an appropriate environment for the ECG. This includes ensuring proper grounding of the device and minimising the proximity of electronic devices, especially power lines, electrical equipment, mobile phones, and fluorescent lights, as these can cause powerline interference and electromagnetic interference (EMI). Obvious artefacts may also result from poor electrode attachment, dry electrodes, or body motion, while subtle artefacts can be more challenging to identify and may mimic cardiac arrhythmias.
Technicians who record ECGs require continuous education to improve their understanding of artefacts and minimise their occurrence, as they can lead to unnecessary tests and therapeutic interventions.
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Frequently asked questions
An electrocardiogram (ECG) is a test that records the electrical activity of the heart through electrodes placed on the skin.
An artifact in an ECG refers to any electrocardiographic alteration that is not related to cardiac electrical activity. In simpler terms, it is any interference or noise in the ECG signal that can distort the readings.
Artifacts in an ECG can be caused by both internal and external factors. External causes include interference from electronic devices such as mobile phones, electrical beds, and fluorescent lights. Internal causes can include muscle tremors, poor electrode placement, and chest compression during CPR.
Artifacts in an ECG can be minimised by ensuring proper placement of the ECG equipment and maintaining a safe distance from electronic devices. Additionally, performing periodic evaluations of technicians and providing continuous education can help reduce artifacts and improve the accuracy of ECG interpretations.
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