Neurostimulator-induced ECG artefacts: A systematic analysis

Melanie Mruk; Ralf Stroop; Jan Boergel; Norbert M Lang; Makoto Nakamura; Ralph Lehrke; Samer Zawy Alsofy

doi:10.1016/j.clineuro.2021.106557

Neurostimulator-induced ECG artefacts: A systematic analysis

Clin Neurol Neurosurg. 2021 Apr:203:106557. doi: 10.1016/j.clineuro.2021.106557. Epub 2021 Feb 10.

Authors

Melanie Mruk¹, Ralf Stroop², Jan Boergel³, Norbert M Lang⁴, Makoto Nakamura⁵, Ralph Lehrke⁴, Samer Zawy Alsofy⁶

Affiliations

¹ Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, St. Barbara-Hospital, Hamm, Germany.
² Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Hamm, Germany. Electronic address: ralf@stroop.de.
³ Department of Internal Medicine, St. Barbara-Hospital, Hamm, Germany.
⁴ Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Hamm, Germany.
⁵ Department of Neurosurgery, Academic Hospital Cologne-Merheim, Cologne, Germany.
⁶ Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Neurosurgery, St. Barbara-Hospital, Hamm, Germany.

PMID: 33610952
DOI: 10.1016/j.clineuro.2021.106557

Abstract

Objectives: Deep brain stimulation (DBS) is known to interfere with electrocardiographic (ECG) examinations. In emergency situations, such electrical interferences can not only thwart ECG diagnostics, but even induce an ECG pattern that causes the emergency medical service to initiate inadequate or even harmful therapy. Aim of this prospective study was to evaluate factors influencing ECG interpretation in DBS and to evaluate the susceptibility of ECG criteria 'frequency', 'rhythm', 'regularity', 'QRS-configuration', and 'ST-segment' on neurostimulation.

Patients and methods: In 33 DBS patients (17 male, 16 female, mean age 64 years), limb-, 12 channel-, Nehb, and adhesive paddle-lead ECG were performed in activated (n = 33) and deactivated (n = 31) stimulation mode during outpatient follow-up examinations. The examinations were carried out using three different ECG devices (two portable emergency ECG-monitor/defibrillation/pacer-devices, one stationary hospital device), resulting in 4096 ECG leads. Statistics have been based on regression analyses and on a maximum likelihood estimation regression model.

Results: Monopolar settings were found to be a relevant factor interfering significantly more often with ECG recording than bipolar parameters (p < 0.0001). Due to recurring movement artefacts, deactivation of bipolar stimulation might even significantly worsen ECG quality (p < 0.0001). Interpretability of 'rhythm' (β = -0.088, p = 0.03) and 'frequency' (β = -0.110, p = 0.02) revealed significant negative correlation to the applied neurostimulation voltage. Nehb lead yielded in highest ECG interpretability.

Conclusion: Bipolar neurostimulation mode barely affected the ECGs; furthermore, the suppression of motion artefacts by neurostimulation can improve ECG quality. If monopolar neurostimulation is required, at least, stimulation voltage should be as low as possible to obtain good stimulation results.

Keywords: Bipolar neurostimulation; Deep brain stimulation; Dystonia; ECG; Movement disorders; Parkinson’s disease; Tremor.

MeSH terms

Aged
Artifacts*
Cohort Studies
Deep Brain Stimulation / instrumentation*
Dystonia / therapy
Electrocardiography*
Female
Humans
Implantable Neurostimulators*
Male
Middle Aged
Parkinson Disease / therapy*
Tremor / therapy