Electrocardiogram Artifacts Caused by Deep Brain Stimulation

Constantoyannis, Constantine; Heilbron, Brett; Honey, Christopher R.

doi:10.1017/s0317167100003425

Cited by 30 publications

(31 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It was recently shown that bipolar DBS produces far less electrical artifact than monopolar DBS in EKG. 7 The purpose of our investigation is to confirm these earlier findings and to compare artifact produced from bipolar and monopolar DBS in routine EKG, EEG, and PSG studies. …”

mentioning

confidence: 57%

An MRI view of a ruptured dermoid cyst

Ernemann¹,

Rieger²,

Tatagiba³

et al. 2006

Neurology

View full text Add to dashboard Cite

Abstract-As the population of patients treated with deep brain stimulation (DBS) grows and the patients age, more will require routine or emergent electrophysiologic tests. DBS artifact may render these uninterpretable, whereas stopping DBS may release symptoms that confound evaluation. The authors find that monopolar, but not bipolar, stimulation produces significant artifact during EKG, EEG, and polysomnography. NEUROLOGY 2006;66:268-270 6 Because of the growing prevalence of DBS and the aging of patients with DBS, more will require electrodiagnostic procedures (such as EKG, EEG, and polysomnography) for evaluation of acute or chronic disease. DBS generates electrical artifact, a confounder that may obscure important diagnostic information. It was recently shown that bipolar DBS produces far less electrical artifact than monopolar DBS in EKG. 7 The purpose of our investigation is to confirm these earlier findings and to compare artifact produced from bipolar and monopolar DBS in routine EKG, EEG, and PSG studies. Methods.Subjects. Subject A. A 67-year-old man with bilateral subthalamic nucleus (STN) DBS for tremor-dominant PD underwent voluntary EKG and EEG. The DBS electrodes (Medtronic model 3389) were connected to subclavicular pulse generators (Medtronic, Soletra). He was initially treated with monopolar configurations, but programming sessions over the next 2 years yielded optimal clinical effects with bipolar settings: 4.3 V, 160 Hz, contacts 3ϩ, 0Ϫ, pulse width 90 microseconds (right) and 120 microseconds (left).Following informed consent, standard EKG and EEG were obtained initially at baseline bipolar DBS settings (figures 1A and 2A), with DBS off (see figures 1B and 2B), followed by a monopolar configuration (0Ϫ, caseϩ, 3.0 V) (see figures 1C and 2C).Subject B. A 66-year-old man was treated effectively with a right thalamotomy and a left ventralis intermedius thalamic DBS for tremor. He developed postoperative hypervigilance that evolved into excessive daytime sleepiness and fractionated sleep.He was prepared for overnight polysomnography by setting DBS to a bipolar configuration (3ϩ, 0Ϫ, 120 microseconds, 160 Hz, 5.3 V).Results. Figure 1A shows the V2 lead trace clipped from the standard 12-lead EKG recorded during bipolar stimulation (see figure 1B during temporary discontinuation of DBS and figure 1C during monopolar stimulation). The bipolar configuration produced clinically insignificant artifact (see figure 1A) that was similar to the "DBS off" condition (see figure 1B). In contrast, monopolar settings produced a large-amplitude artifact on EKG that obscured the P and T waves and QRS complex on all leads, rendering the study uninterpretable (see figure 1C). Figure 2 shows samples of optimal, occipital wakeful EEG rhythm. The montage included channels with both long and short interelectrode distances. The EEG demonstrated interpretable signal during bipolar stimulation (see figure 2A) with minimal differences between bipolar mode and DBS off (see figure 2, A and B). Resting tremor was visibl...

show abstract

mentioning

confidence: 57%

An MRI view of a ruptured dermoid cyst

Ernemann¹,

Rieger²,

Tatagiba³

et al. 2006

Neurology

View full text Add to dashboard Cite

show abstract

“…In procedures involving usage of somatosensory evoked potential monitoring, ECG electrodes should be positioned away from the site of stimulating electrodes 7. Similarly, in patients with implanted electrostimulators, preoperative consultation with the programmer should be carried out 16. Appropriate grounding of machines to prevent charge accumulation should be tested.…”

Section: Discussionmentioning

confidence: 99%

ECG artefacts mimicking atrial flutter in posterior fossa surgery

Rudigwa

Elakkumanan

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

ECG artefacts are defined as abnormalities in the monitored ECG, which result from measurement of cardiac potentials on the body surface and are not related to the electrical activity of the heart. In the operation theatre, the use of various types of electrical equipment may interfere with ECG interpretation. We describe our experience with artefacts resembling atrial fibrillation when a nerve integrity monitoring device was used on a patient undergoing posterior fossa surgery for epidermoid tumour. These artefacts resemble serious arrhythmias and may result in unwanted interventions. To enable better identification of such artefacts, a 12-lead ECG should be considered as it will display rhythm in all the leads; while artefacts will present in only a few leads, true arrhythmia will be present in all the 12 leads. Our case report aims to increase awareness regarding ECG artefacts and to explain how to distinguish them from actual arrhythmias.

show abstract

“…However, bipolar (as opposed to monopolar) DBS has been shown to produce far fewer electrical artefacts in ECG and EEG studies 4 5. In bipolar DBS, intracranial electrodes act as anode and cathode—forming a short electrical dipole which affects a smaller volume of tissue and therefore generating far fewer artefacts.…”

Section: Discussionmentioning

confidence: 99%