El-Sherif Nabil, Turitto Gioia
SUNY Downstate Medical Center, Brooklyn, NY.
NY Harbor VA Healthcare System, Brooklyn, NY.
Ann Noninvasive Electrocardiol. 2015 May;20(3):282-9. doi: 10.1111/anec.12222. Epub 2014 Nov 4.
The aim of the study is to contrast the role of conventional ambulatory electrocardiographic monitoring (AEM) artifacts with a less emphasized problem with potentially more serious implications, that is, the failure to recognize, and therefore misinterpret, a genuine arrhythmia episode in the AEM recording.
The study material included 500 Holter recordings and 500 recordings from the cardiac telemetry unit.
Electrocardiographic (ECG) artifacts were more common in telemetry recordings (5.6%) compared to Holter recordings (4%) for a total of 4.8%. There were 35 examples of misinterpretation of AEM recordings (3.5%). These were significantly more common in telemetry recordings (2.6%) compared to Holter recordings (0.9%). The most common ECG artifacts were examples of pseudo ventricular tachyarrhythmia (VT). The majority of misinterpretation (26 of 35 examples) were fast supraventricular tachyarrhythmias with aberrant QRS (including six examples of atrial flutter with periods of 1:1 atrioventricular conduction) that were misdiagnosed as ventricular VT. Other examples were misinterpretation of arrhythmic episodes consistent with sick sinus syndrome, pacemaker malfunction, and long QT syndrome. Only 5 of 48 examples of AEM artifacts resulted in management errors of commission or errors of omission compared to all 35 examples of misinterpretation.
Compared to conventional artifacts in AEM, misinterpretation of nonartifactual arrhythmic episodes consistently resulted in management errors. Misinterpretation was significantly more common with telemetry recordings compared to Holter ECG. This highlights the need for more appropriate training of the entire clinical team in charge of the management of the cardiac telemetry unit.
本研究的目的是对比传统动态心电图监测（AEM）伪差的作用，以及一个较少受到关注但可能具有更严重影响的问题，即未能识别并因此错误解读AEM记录中的真正心律失常发作。
研究材料包括500份动态心电图记录和500份心脏遥测单元记录。
与动态心电图记录（4%）相比，遥测记录中的心电图（ECG）伪差更为常见（5.6%），总体发生率为4.8%。AEM记录存在35例假阳性（3.5%）。与动态心电图记录（0.9%）相比，遥测记录中的假阳性明显更为常见（2.6%）。最常见的心电图伪差是假性室性快速心律失常（VT）的例子。大多数假阳性（35例中的26例）是伴有异常QRS波的快速室上性快速心律失常（包括6例1:1房室传导的心房扑动），被误诊为室性VT。其他例子包括对与病态窦房结综合征、起搏器故障和长QT综合征一致的心律失常发作的错误解读。在48例AEM伪差中，只有5例导致了处理上的错误或遗漏，而所有35例假阳性均导致了处理错误。
与AEM中的传统伪差相比，对非伪差性心律失常发作的错误解读始终会导致处理错误。与动态心电图相比，遥测记录中的错误解读明显更为常见。这凸显了对负责心脏遥测单元管理的整个临床团队进行更适当培训的必要性。
