Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia.
BACKGROUND
Patients who are misdiagnosed with ventricular tachycardia because of electrocardiographic artifact may be subjected to unnecessary procedures. The purpose of this study was to determine how often electrocardiographic artifact is misdiagnosed as ventricular tachycardia.


METHODS
Physicians (n = 766) were surveyed with a case simulation that included a two-lead electrocardiographic monitor tracing of artifact simulating a wide-complex tachycardia.


RESULTS
The rhythm strip was not recognized as artifact by 52 of the 55 internists (94%), 128 of the 221 cardiologists (58%), and 186 of the 490 electrophysiologists (38%). One hundred fifty-six of the 181 electrophysiologists (88%), 67 of the 126 cardiologists (53%), and 14 of the 15 internists (31%) who misdiagnosed the rhythm as ventricular tachycardia recommended an invasive procedure for further evaluation or therapy.


CONCLUSIONS
This physician survey suggests that electrocardiographic artifact that mimics ventricular tachycardia may frequently result in patients being subjected to unnecessary invasive cardiac procedures. Physicians should include artifact in their differential diagnosis of wide complex tachycardias to minimize unneeded procedures.
Knight
B P
BP
Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0022, USA.
Pelosi
F
F
Michaud
G F
GF
Strickberger
S A
SA
Morady
F
F
D016477:Artifacts; D002309:Cardiology; D002568:Certification; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004562:Electrocardiography; D004594:Electrophysiology; D006801:Humans; D007388:Internal Medicine; D010820:Physicians / Q000592:standards* / Q000706:statistics & numerical data; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D014481:United States; D019564:Unnecessary Procedures