TY  - JOUR
T1  - Klinik Elektrokardiyografide Zorluklar:  Artefakt mı Değil mi?
TT  - Challenges in Clinical Electrocardiography:  Artifact or not?
AU  - Yıldız, Mustafa 
AU  - Erdogan, Okan 
AU  - Guler, Ahmet 
AU  - Oner, Cevat Naci 
AU  - Scheinman, Melvin M. 
PY  - 2013
DA  - January
JF  - Koşuyolu Kalp Dergisi
PB  - Kartal Koşuyolu Yüksek İhtisas EAH
WT  - DergiPark
SN  - 1300-8706
SP  - 0
VL  - 17
IS  - 1
LA  - tr
KW  - Elektrokardiyografi; artefakt; preeksitasyon; psödodelta dalgası; bloklu atriyal erken atımlar
N2  - A 53-year-old man was admitted to our hospital because of chest pain and palpitation. The patient’s clinical  history was unremarkable such as hypertension, diabetes mellitus or drug use. Physical examination was normal.  Biochemical variables were within normal limits. Also, thyroid function tests and electrolytes were normal.  Transthoracic echocardiography, Holter rhythm monitoring and electrophysiologic study revealed normal  findings. Because of positive exercise test we performed coronary angiography which revealed normal coronary  arteries. Surface electrocardiography (ECG) taken on admission is shown in Figure 1 (also see all leads and  arrows in V5).  Questions What is the most likely explanation for slurred QRS complexes and what rhythm abnormalities would you  consider in the differential diagnosis?  Comment Differential diagnosis comprises preexcitation, pseudodelta wave, blocked atrial premature beats and artifact.  Electrocardiographic artifacts are typically unintentional and are not associated with hemodynamic findings(1).  It may cause unnecessary diagnosis and treatment(1). They are usually caused by poor surface electrode contact  or patient movement. In our case, the top tracing shows a burst of apparent wide complex tachycardia seen in  leads I, II, aVr and aVL but not in lead III. Because of this, the most likely diagnoses is artifact. Thought it was  the left arm but subsequently seen in aVL but not in lead II, so artifact may be variable depending on specific  body movements. The bottom strip shows a constant sinus rhythm with erratic P wave activity, however the  ventricular rate is constant. Note that some of the putative P waves fall very close to one another which would be  unphysiological since the atrium needs a refractory period. Also note the erratic rhythm in lead II below.  Take home messages: Electrocardiographic artifacts may cause unnecessary diagnosis and treatment
CR  - Pinter A, Sklar L, Dorian P. Factitious ventricular tachyarrhythmia outbreak. Arch Intern Med 2011;171:191-3. Figure 1. Surface electrocardiography on admission
UR  - http://dergipark.org.tr/tr/pub/kkd/issue//124954
L1  - http://dergipark.org.tr/tr/download/article-file/106718
ER  -