Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia

BACKGROUND: Patients who are misdiagnosed with ventricular tachycardia beca use of electrocardiographic artifact maybe subjected to unnecessary procedu res. The purpose of this study was to determine how often electrocardiograp hic artifact is misdiagnosed as ventricular tachycardia. METHODS: Physicians (n = 766) were surveyed with a case simulation that inc luded a two-lead electrocardiographic monitor tracing of artifact simulatin g a wide-complex tachycardia. RESULTS: The rhythm strip was not recognized as artifact by 52 of the 55 in ternists (94%), 128 of the 221 cardiologists (58%), and 186 of the 490 elec trophysiologists (38%). One hundred fifty-six of the 181 electrophysiologis ts (88%), 67 of the 126 cardiologists (53%), and 14 of the 15 internists (3 1%)who misdiagnosed the rhythm as ventricular tachycardia recommended an in vasive procedure for further evaluation or therapy. CONCLUSIONS: This physician survey suggests that electrocardiographic artif act that mimics ventricular tachycardia may frequently result in patients b eing subjected to unnecessary invasive cardiac procedures. Physicians shoul d include artifact in their differential diagnosis of wide complex tachycar dias to minimize unneeded procedures. (C) 2001 by Excerpta Medica, Inc.