Electrocardiogram Artifact in Catheterizaton Laboratory Setting Mimicking Ventricular Fibrillation

Abstract

Electrocardiogram (ECG) is a reliable tool in the initial diagnostic workup of patients presenting to the Emergency Department (ED). However, it is not totally free of interference from artifacts due to various causes such as positional changes during capture, muscle contractions, limb tremors, etc., Such artifacts can have disastrous complications if they mimic arrhythmias and are treated as such. This case report describes two such patients in the catheterization laboratory (Cath lab) setting who developed ECG changes mimicking ventricular fibrillation. The first patient was shivering upon arrival to the Cath lab and developed ECG changes that were initially thought to be ventricular fibrillation. The patient received 2 DC shocks as a consequence. The ECG changes reflected artifacts caused by shivering and muscle activity. The second patient had similar changes induced by triggering the contrast injector during his coronary angiogram. These cases highlight the importance of staying vigilant for causes of artifacts in asymptomatic, hemodynamically stable patients, especially in Cath lab areas, where rapid management response is expected for optimal patient care.