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Twelve-lead electrocardiogram artefacts in patients with arteriovenous fistulas for haemodialysis

Twelve-lead electrocardiogram artefacts in patients with arteriovenous fistulas for haemodialysis We report on electrocardiographic pseudo-artefacts due to the presence of arteriovenous fistulas (AVFs) for haemodialysis. The first 12-lead electrocardiogram (ECG) (Panel A) belongs to a 70-years old patient admitted to our hospital for surgical revision of his AVF on the right arm. The second 12-lead ECG (Panel B) belongs to an 87-years old fellow admitted for vertebroplasty due to a post-traumatic L1 fracture, on chronic haemodialysis through a left arm AVF. Both patients were admitted to the hospital electively and did not complain of any cardiovascular symptom. A 12-lead ECGs are performed at rest as part of the routine preoperative assessment. In both cases, peripheral electrodes were placed above the patient’s AVF and showed arterial tapping pseudo-artefacts. In particular, the following features should be noticed in both ECGs: baseline ST-segment elevation may arise before and/or after the QRS complexes and are not organized in any specific distribution. However, these artefacts do not affect all the peripheral electrodes simultaneously. When electrodes are placed over a right AVF all peripheral leads but lead III (since it is constructed by comparing left arm and left leg electrodes) show these artefacts. To the contrary, when electrodes are placed over a left AVF all peripheral leads but lead II (since it is constructed with right arm and left leg electrodes) show these artefacts. Finally, they disappear when electrodes are placed far from the AVF anastomosis site. These cases illustrate unusual ECG artefacts with distinct appearance which can be easily diagnosed by changing electrodes positioning. Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance. Open in new tabDownload slide Open in new tabDownload slide Conflict of interest: None declared. Funding: None declared. Author notes Elia Rigamonti, Giorgio Moschovitis contributed equally and are shared first authors. © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal - Case Reports Oxford University Press

Twelve-lead electrocardiogram artefacts in patients with arteriovenous fistulas for haemodialysis

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Publisher
Oxford University Press
Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
eISSN
2514-2119
DOI
10.1093/ehjcr/ytab466
Publisher site
See Article on Publisher Site

Abstract

We report on electrocardiographic pseudo-artefacts due to the presence of arteriovenous fistulas (AVFs) for haemodialysis. The first 12-lead electrocardiogram (ECG) (Panel A) belongs to a 70-years old patient admitted to our hospital for surgical revision of his AVF on the right arm. The second 12-lead ECG (Panel B) belongs to an 87-years old fellow admitted for vertebroplasty due to a post-traumatic L1 fracture, on chronic haemodialysis through a left arm AVF. Both patients were admitted to the hospital electively and did not complain of any cardiovascular symptom. A 12-lead ECGs are performed at rest as part of the routine preoperative assessment. In both cases, peripheral electrodes were placed above the patient’s AVF and showed arterial tapping pseudo-artefacts. In particular, the following features should be noticed in both ECGs: baseline ST-segment elevation may arise before and/or after the QRS complexes and are not organized in any specific distribution. However, these artefacts do not affect all the peripheral electrodes simultaneously. When electrodes are placed over a right AVF all peripheral leads but lead III (since it is constructed by comparing left arm and left leg electrodes) show these artefacts. To the contrary, when electrodes are placed over a left AVF all peripheral leads but lead II (since it is constructed with right arm and left leg electrodes) show these artefacts. Finally, they disappear when electrodes are placed far from the AVF anastomosis site. These cases illustrate unusual ECG artefacts with distinct appearance which can be easily diagnosed by changing electrodes positioning. Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance. Open in new tabDownload slide Open in new tabDownload slide Conflict of interest: None declared. Funding: None declared. Author notes Elia Rigamonti, Giorgio Moschovitis contributed equally and are shared first authors. © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Journal

European Heart Journal - Case Reports – Oxford University Press

Published: Nov 17, 2021

Keywords: arteriovenous fistula; hemodialysis; artifacts; 12 lead ecg

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