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Table of Contents
LETTER TO EDITOR  
Year : 2011  |  Volume : 14  |  Issue : 2  |  Page : 164-165
Artifactual ST segment depression induced by electrocautery


Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication25-May-2011
 

How to cite this article:
Jain A, Solanki SL, Sahni N, Sharma A. Artifactual ST segment depression induced by electrocautery. Ann Card Anaesth 2011;14:164-5

How to cite this URL:
Jain A, Solanki SL, Sahni N, Sharma A. Artifactual ST segment depression induced by electrocautery. Ann Card Anaesth [serial online] 2011 [cited 2019 Oct 19];14:164-5. Available from: http://www.annals.in/text.asp?2011/14/2/164/81580


The Editor,

We describe a case of electrocautery-induced artifactual ST segment depression in a 46-year-old male patient with coronary artery disease (CAD) undergoing open reduction and internal fixation of fractured shaft of the left femur. He was presently asymptomatic and the medications included oral telmesartan 40 mg, amlodipine 10 mg and isosorbide mononitrate 10 mg once a day. His preoperative 12-lead electrocardiogram (ECG) showed inverted T wave in lead II, III, aVF, V4-V6. Echocardiography showed ejection fraction of 55% with no regional wall motion abnormality. In the operating room, noninvasive arterial pressure monitoring, 5-lead ECG with ST-segment analysis and pulse oximetry were applied. His baseline blood pressure was 140/90 mmHg, with a heart rate of 80 beats/min. The continuous 5-lead ECG tracings revealed inverted T waves in lead II [Figure 1] and lead V. Intravenous access was secured using a 16-gauge cannula. The left radial artery was cannulated under local anesthesia and used for continuous blood pressure measurement. Spinal anesthesia was administered with 15 mg of 0.5% hyperbaric bupivacaine and fentanyl 25 μg. The patient was administered 350 ml of Ringer's lactate and a single bolus of phenylephrine 50 μg was given 15 min after the spinal drug to maintain the mean arterial pressure within 20% of the baseline. The blood pressure at that time was 110/72 mmHg, with a heart rate of 88 beats/min. No change in 5-lead ECG was observed at this time. However, during skin incision, severe ST-segment depression was noted in lead II [Figure 1]. The blood pressure was 130/76 mmHg, with a heart rate of 73 beat/min. The ST changes were intermittent and, on closer examination of the ECG tracing, it was recognized that the ST-segment depression was temporally linked with the surgeon's use of unipolar electrocautery. The ECG change occurred only during activation of the electrocautery and remained reproducible throughout the remainder of the case. The artifactual nature of the findings is further supported by the fact that the ST depression was absent in the tenth and the eleventh cycle [Figure 2]. The postoperative 12-lead ECG remained unchanged and the postoperative enzyme markers were negative for myocardial infarction (MI).
Figure 1: Electrocardiogram tracing taken during the period of no electrocautery

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Figure 2: During periods of electrocautery, isolated ST depression was present. Complete disappearance of the ST depression can be seen in the tenth and the eleventh cycles

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A similar case of intraoperative electrocautery-induced artifact mimicking ST segment depression in lead II has been recently reported in a patient with left bundle branch block with CAD. [1] Ketchey et al, described similar artifacts in lead V5. [2] The authors performed transesophageal echoexamination to rule out any evidence of wall motion abnormalities. Our patient was ASA status II with moderate risk for perioperative cardiac events, including MI and severe arrhythmias. The ECG monitor was and continues to be in routine use without similar occurrences in other cases. The hypothesis that the electromagnetic vector created by the unipolar electrocautery combined with the heart's intrinsic vectors could produce such an artifact on the ECG tracing seems logical, but warrants further research. To conclude, electrocautery-induced artifact should be ruled out if intermittent and reproducible ST-segment depression intraoperatively, before the diagnosis and the management of myocardial strain or ischemia is made.

 
   References Top

1.Jain A, Makkar JK, Mangal K. Electrocautery-induced artifactual ST-segment depression in a patient with coronary artery disease. J Electrocardiol 2010;43:336-7.  Back to cited text no. 1
    
2.Ketchey C, Goldschlager N, Tang J, Young WL. Electrocautery interference with intraoperative electrocardiogram mimicking ST-segment depression. J Electrocardiol 2009;42:425.  Back to cited text no. 2
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Correspondence Address:
Amit Jain
Department of Anaesthesia & Intensive Care Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.81580

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    Figures

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