ST elevation myocardial infarction, or not - This is the question.
Andrei D Margulescu1, Dewi E Thomas1
1Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Swansea SA6 6NL, UK.
Journal of Electrocardiology
|August 29, 2021
Summary
A digital electrocardiogram (ECG) artifact mimicking myocardial infarction led to an unnecessary coronary angiogram. This specific artifact, caused by QRS complex deletion after pacing, has not been previously reported.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Complete atrio-ventricular block, biventricular pacing, and chronic atrial fibrillation are complex cardiac conditions.
- Electrocardiogram (ECG) interpretation is crucial for diagnosing acute cardiac events.
- Artifacts in ECG recordings can lead to misdiagnosis and inappropriate interventions.
Purpose of the Study:
- To report a novel ECG artifact.
- To highlight the potential for diagnostic errors in patients with cardiac pacing.
- To raise awareness among clinicians regarding this specific artifact pattern.
Main Methods:
- Case report of a patient with complete atrio-ventricular block, biventricular pacing, and chronic atrial fibrillation.
- Analysis of a digital ECG recording exhibiting an unusual artifact.
- Review of the clinical presentation and subsequent diagnostic procedures.
Main Results:
- An artefactual ECG was generated by a digital ECG machine.
- The artifact resulted from the deletion of the initial 80 ms of the QRS complex post-pacing spike.
- This artifact was misinterpreted as inferior ST-elevation myocardial infarction, prompting an urgent coronary angiogram.
Conclusions:
- This specific ECG artifact pattern, associated with biventricular pacing, appears to be previously unreported.
- Misinterpretation of such artifacts can lead to unnecessary invasive procedures.
- Vigilance in ECG interpretation is essential, especially in patients with cardiac pacing devices.
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