Electrocardiographic Artifacts During Shoulder Arthroscopy Using a Pressure-Controlled Irrigation Pump

Equipment-related Electrocardiographic Artifacts

“…17,19 Shape of the artifacts can be variable in different leads. 4,13,28,59 Differential artifact, variable frequency, and amplitudes in different electrocardiographic leads have been described recently with spinal cord and deep brain stimulators 24,27 (fig. 5).…”

“…Transcutaneous electrical nerve stimulator 17,19,22,25,28,30,59 Hemodialysis machine 10,11,21,29,57 Evoked potentials monitoring unit 2,6,7,60 Electrostimulators Thalamic, 23,27,61 spinal cord, 24 peripheral nerve 9 Other electrostimulators 26,62 Cardiopulmonary bypass 1,56 Ventilator-HFOV 12,13 Intravenous fluid warmer/warming set 53,55 ESWL 58 Flexible bronchoscope 50 Digital urine output/core temperature monitor 18 Pressure-controlled irrigation pump 4 Cell phone 16 Sinus endoscope 51 Intraoperative MRI 5 Orthopedic shaver 8 Monitor and its components…”

“…2), whereas electrical noise from a pressurecontrolled irrigation pump, during shoulder arthroscopy, generated pseudo-atrial flutter or fibrillation changes on the monitor. 4 Chase and Brady 52 reported wide QRS complex tachycardia due to placement of new electrical lines near a monitor whose internal insulation was broken. Capacitive coupling between metal plates of a faultily grounded fluid warmer and the insulated plastic fluid package led to pacemaker spikes appearing, coincident with use of the warmer.…”

“…Correlation with other monitored parameters may provide clues allowing the exclusion of genuine changes. Other waveforms providing rate and rhythm may not be consistent with the artifactual rhythm, e.g., plethysmographic, 2,4,7,8,12,51 direct arterial blood pressure, 12 and central venous pressure. 21 Pulse rate from plethysmograph and direct arterial blood pressure trace will indicate true heart rate in case of pseudo-atrial fibrillation or -ventricular tachycardia.…”

“…Electrocardiographic artifacts originate from a wide range of sources, predominantly simultaneous use of other devices. Such equipment-related artifacts have been reported specific to patient groups [1][2][3][4][5][6][7][8][9] or to care areas such as the ICU, 10 -12 neonatal ICU, [13][14][15] emergency room, 16 obstetric unit, 17 post-cardiac surgical ICU, 18,19 coronary care unit, 20 pediatric ICU, 21 acute medical ward, 22,23 and general ward. 18 Artifacts have occurred in various age groups, including premature babies, 14 neonates, 13,15 other pediatric groups, 6,21 young adults, 9,10,22,24,25 and geriatric patients.…”