Electrocardiographic Artifact Caused by Deep Brain Stimulation Mimicking Atrial Flutter in Patient With Contralateral...

Deep brain stimulation (DBS), used in the management of neurologic movement disorders, can generate electrocardiographic artifacts that mimic atrial arrhythmias.

A 63-year-old man with a history of atrial fibrillation ablation, left bundle branch block, and atrioventricular block status post-cardiac resynchronization therapy pacemaker developed Parkinson disease and underwent right-sided deep brain stimulator implantation. A routine electrocardiogram demonstrated apparent atrial flutter. However, interrogation of his pacemaker confirmed normal sinus rhythm, indicating that the surface electrocardiographic findings represented electrical artifacts from DBS. No interruption in pacemaker function or electromagnetic interference was present on intracardiac monitoring.

DBS electrical output can generate artifacts that closely mimic atrial flutter on surface electrocardiogram. In patients who have both deep brain stimulation and a cardiac implantable electronic device (CIED), confirmation with intracardiac electrograms and device interrogation may be used to avoid misdiagnosis and unnecessary intervention.

Recognition of DBS-induced ECG artifact is important to ensure appropriate diagnosis and avoid unnecessary interventions. DBS and CIEDs systems can safely coexist without electrical interference when appropriate safety precautions are observed.