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Equipment-related Electrocardiographic Artifacts
Causes, Characteristics, Consequences, and Correction

Interference of the monitored or recorded electrocardiogram is common within operating room and intensive care unit environments. Artifactual signals, which corrupt the normal cardiac signal, may arise from internal or external sources. Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. Newer diagnostic and therapeutic modalities may generate artifactual changes. These artifacts may be nonspecific or may resemble serious arrhythmia. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters, may provide the clues to differentiate artifacts from true changes on the electrocardiogram. Simple measures, such as proper attention to basic principles of electrocardiographic measurement, can eliminate some artifacts. However, in persistent cases, expert help may be required to identify the precise source and minimize interference on the electrocardiogram. Technological advancements in processing the electrocardiographic signal may be useful to detect and eliminate artifacts. Ultimately, an improved understanding of the artifacts generated by equipment, and their identifying characteristics, is important to avoid misinterpretation, misdiagnosis, and iatrogenic complication.
CONTINUOUS electrocardiographic monitoring is now a basic standard of care in the operating room and the intensive care unit (ICU). Both of these environments have experienced an increase in the number of electrical devices used for patient care, with a consequent increase in the risk of interference. Accurate interpretation of the electrocardiogram requires that it be of high quality and free from distortion and artifact. Although technological advancement has increased the reliability of most apparatuses, interference of the displayed electrocardiogram still occurs. Electrocardiographic artifacts originate from a wide range of sources, predominantly simultaneous use of other devices. Such equipment-related artifacts have been reported specific to patient groups or to care areas such as the ICU, neonatal ICU, emergency room, obstetric unit, post–cardiac surgical ICU, coronary care unit, pediatric ICU, acute medical ward, and general ward. Artifacts have occurred in various age groups, including premature babies, neonates, other pediatric groups, young adults, and geriatric patients.