Ambulatory electrocardiographic monitoring between artifacts and misinterpretation, management errors of commission
Nabil El-Sherif1,2, Gioia Turitto3
1SUNY Downstate Medical Center, Brooklyn, NY.
Background:
The aim of the study is to contrast the role of conventional ambulatory electrocardiographic monitoring (AEM) artifacts with a less emphasized problem with potentially more serious implications, that is, the failure to recognize, and therefore misinterpret, a genuine arrhythmia episode in the AEM recording.
Methods:
The study material included 500 Holter recordings and 500 recordings from the cardiac telemetry unit.
Results:
Electrocardiographic (ECG) artifacts were more common in telemetry recordings (5.6%) compared to Holter recordings (4%) for a total of 4.8%. There were 35 examples of misinterpretation of AEM recordings (3.5%). These were significantly more common in telemetry recordings (2.6%) compared to Holter recordings (0.9%). The most common ECG artifacts were examples of pseudo ventricular tachyarrhythmia (VT). The majority of misinterpretation (26 of 35 examples) were fast supraventricular tachyarrhythmias with aberrant QRS (including six examples of atrial flutter with periods of 1:1 atrioventricular conduction) that were misdiagnosed as ventricular VT. Other examples were misinterpretation of arrhythmic episodes consistent with sick sinus syndrome, pacemaker malfunction, and long QT syndrome. Only 5 of 48 examples of AEM artifacts resulted in management errors of commission or errors of omission compared to all 35 examples of misinterpretation.
Conclusions:
Compared to conventional artifacts in AEM, misinterpretation of nonartifactual arrhythmic episodes consistently resulted in management errors. Misinterpretation was significantly more common with telemetry recordings compared to Holter ECG. This highlights the need for more appropriate training of the entire clinical team in charge of the management of the cardiac telemetry unit.
Insights
Misinterpreting genuine arrhythmias on ambulatory electrocardiographic monitoring (AEM) causes more management errors than artifacts. Telemetry recordings showed higher misinterpretation rates than Holter ECG, necessitating improved clinical team training.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Ambulatory electrocardiographic monitoring (AEM) can be affected by artifacts.
- A significant issue is the misinterpretation of genuine arrhythmia episodes within AEM recordings.
Purpose of the Study:
- To contrast the impact of conventional AEM artifacts with the misinterpretation of true arrhythmias.
- To evaluate the clinical significance of misinterpreting non-artifactual arrhythmic events.
Main Methods:
- Analysis of 500 Holter recordings and 500 cardiac telemetry unit recordings.
- Comparison of artifact frequency and misinterpretation rates between Holter and telemetry data.
Main Results:
- Electrocardiographic (ECG) artifacts occurred in 4.8% of recordings (Holter 4%, telemetry 5.6%).
- Misinterpretation of genuine arrhythmias occurred in 3.5% of recordings, significantly more in telemetry (2.6%) than Holter (0.9%).
- Misinterpretations often involved mistaking supraventricular tachyarrhythmias for ventricular VT, leading to management errors in all 35 cases, unlike the 5 errors from artifacts.
Conclusions:
- Misinterpretation of non-artifactual arrhythmias leads to management errors, unlike conventional artifacts.
- Telemetry recordings exhibit higher rates of misinterpretation compared to Holter ECG.
- Enhanced training for clinical teams managing cardiac telemetry units is crucial.
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