Pitfalls in ECG Monitoring That are Easy to Fall into in Daily Clinical Practice

Abstract

  The electrocardiogram (ECG) is an essential monitor that enables cardiac abnormalities to be imaged easily and non-invasively in clinical settings. However, interpreting ECG results can be more difficult than interpreting other biomonitoring information because of the need to link non-numeric waveforms to cardiac conduction. Also of note, preoperative 12-lead ECG examinations and intraoperative ECG monitoring have different purposes and testing environments. During intraoperative ECG monitoring, which is based on comparisons with the preoperative waveform but focuses on dynamic changes, the continuously flowing waveform appearing on the monitor must be evaluated by eye in real time. Furthermore, the strong filtering that is taken for granted and commonly applied to obtain a stable and easy-to-read waveform can result in waveform distortions and lead to erroneous interpretations. This article provides an overview of ECG monitoring basics, such as the detection of myocardial excitation and automaticity and the basic mechanisms of tachyarrhythmias, focusing on a less-conscious attention to intraoperative ECG monitoring and focusing particularly on ECG filtering.