Ambulatory Electrocardiographic Monitoring between Artifacts and Misinterpretation, Management Errors of Commission and Errors of Omission
Ambulatory Electrocardiographic Monitoring between Artifacts and Misinterpretation, Management Errors of Commission and Errors of Omission
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DOI：
10.1111/anec.12222
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发表时间：
2015-05-01
影响因子：
1.9
通讯作者：
Turitto, Gioia
中科院分区：
文献类型：
--
作者：
El-Sherif, Nabil;Turitto, Gioia
背景本研究的目的是将传统的动态心电图监测（AEM）伪影的作用与一个不太强调的问题进行对比，这个问题具有潜在的更严重的影响，即未能识别，因此误解，方法研究材料包括500例霍尔特记录和500例来自心脏遥测装置的记录。与霍尔特记录（4%）相比，遥测记录（5.6%）中的伪影更常见，总计为4.8%。有35例AEM记录的误解（3.5%）。与霍尔特记录（0.9%）相比，这些在遥测记录（2.6%）中明显更常见。最常见的ECG伪影是假性室性快速性心律失常（VT）。大多数误解（35例中的26例）为快速室上性快速心律失常伴异常QRS（包括6例房室传导周期为1：1的房扑），被误诊为室性VT。其他的例子是对与病窦综合征、起搏器故障和长QT综合征一致的心律失常发作的误解。只有5的48例AEM文物导致管理错误的委员会或错误的遗漏相比，所有35例misinterpretation.ConclusionsCompared传统的文物在AEM，误解nonartifactual的mammic事件一贯导致管理错误。与霍尔特ECG相比，遥测记录的误解明显更常见。这突出表明，需要对负责管理心脏遥测装置的整个临床团队进行更适当的培训。
BackgroundThe 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.MethodsThe study material included 500 Holter recordings and 500 recordings from the cardiac telemetry unit.ResultsElectrocardiographic (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.ConclusionsCompared 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.