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Pseudoatrial flutter: artifact simulating atrial flutter caused by a transcutaneous electrical nerve stimulator
S H Weitz1, P A Tunick, L McElhinney
1Department of Medicine, New York University Medical Center, New York 10016, USA.
Pacing and Clinical Electrophysiology : PACE
|February 10, 1998
Summary
Transcutaneous electrical nerve stimulation (TENS) units can cause artifact that mimics atrial flutter on Holter monitoring. This TENS artifact is not a true arrhythmia and can be reproduced in healthy individuals.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Atrial flutter is a supraventricular tachyarrhythmia requiring accurate diagnosis.
- Holter monitoring is a standard tool for ambulatory cardiac rhythm assessment.
- Transcutaneous electrical nerve stimulation (TENS) units are used for pain management.
Observation:
- A patient with a history of atrial flutter presented with Holter monitoring findings suggestive of recurrent atrial flutter during TENS unit use.
- The observed cardiac rhythm abnormality on Holter monitoring was investigated for its origin.
- The TENS unit was identified as a potential source of interference.
Findings:
- The apparent atrial flutter on Holter monitoring was conclusively identified as artifact.
- The artifact was directly attributable to the electromagnetic interference generated by the TENS unit.
- The artifactual findings were successfully replicated in a healthy volunteer by applying the TENS unit, confirming the TENS unit as the cause.
Implications:
- Clinicians should be aware of potential TENS unit artifact mimicking arrhythmias on electrocardiogram (ECG) and Holter monitoring.
- Distinguishing TENS-induced artifact from true arrhythmias is crucial for appropriate patient management and avoiding unnecessary interventions.
- Further research may be warranted to develop methods for mitigating electromagnetic interference from TENS units during cardiac monitoring.