行政院國家科學委員會專題研究計畫 成果報告
巴金森氏病顫抖造成的心電圖干擾看起來像心房或心室性
心律不整的比率及其影響
研究成果報告(精簡版)
計 畫 類 別 ： 個別型 計 畫 編 號 ： NSC 97-2314-B-006-024- 執 行 期 間 ： 97 年 08 月 01 日至 98 年 07 月 31 日 執 行 單 位 ： 國立成功大學醫學系神經科 計 畫 主 持 人 ： 黃文柱 處 理 方 式 ： 本計畫可公開查詢中 華 民 國 98 年 10 月 12 日
行政院國家科學委員會補助專題研究計畫
■ 成 果 報 告
□期中進度報告
巴金森氏病顫抖造成的心電圖干擾看起來像心房或心室性心律 不整的比率及其影響
The prevalence and impact of Parkinson’s tremor related electrocardiographic artifact mimicking atrial/ventricular
tachycardia
計畫類別：■ 個別型計畫 □ 整合型計畫
計畫編號：NSC 97－2314－B－006－024－
執行期間： 97 年 8 月 1 日至 98 年 7 月 31 日
計畫主持人：黃文柱/國立成功大學醫學院神經科
共同主持人：無
計畫參與人員： 宋碧姍、陳思吟
成果報告類型(依經費核定清單規定繳交)：■精簡報告 □完整報告
本成果報告包括以下應繳交之附件：
□赴國外出差或研習心得報告一份
□赴大陸地區出差或研習心得報告一份
□出席國際學術會議心得報告及發表之論文各一份
□國際合作研究計畫國外研究報告書一份
處理方式：除產學合作研究計畫、提升產業技術及人才培育研究計畫、列管
計畫及下列情形者外，得立即公開查詢
□涉及專利或其他智慧財產權，□一年■二年後可公開查詢
執行單位：國立成功大學
中 華 民 國 98 年 10 月 12 日
中文摘要:
巴金森氏病是一種常見且重要的神經系統退化性疾病，隨著整個社會人口結構的高齡化， 它也益顯重要。顫抖是巴金森氏病一個常見且重要的症狀。心電圖檢查在臨床實務上是一項很 常被使用的檢查項目。巴金森氏病的顫抖引起心電圖的干擾進而導致心電圖解讀的錯誤，影響 病人的處置，在 30 年前就已被注意到，並且也有一些零星的個案報告。最近我們也報告一個案 例。 巴金森氏病顫抖產生的心電圖干擾被誤判為心房/心室性心律不整的問題有多嚴重，對病人 影響有多大，並不清楚。這個研究的目的是在探討巴金森氏病顫抖引起心電圖干擾的頻率有多 高，這些受干擾的心電圖被錯誤解讀的比率有多高，它所導致的臨床後果(病人接受不必要的檢 查及處置)有多嚴重。 關鍵字：巴金森氏病，顫抖，心電圖，假性心律不整英文摘要:
Parkinson’s disease (PD) is a common and important neurodegenerative disorder. The prevalence of PD increases with age, and thus it is an important public issue for the society with increased old-aged people. Rest tremor of the limbs at a frequency of 4–5 Hz is a common and cardinal
symptom of PD. Electrocardiogram (ECG) is a common and popular examination in everyday clinical practice. Tremor-induced electrocardiographic artifact mimicking atrial or ventricular tachycardia have been occasionally reported before. The ECG artifacts related to the tremulous limbs may cause diagnostic problems in some special situations. Even a board-certified cardiologist may make a mistake and interprets the motion-related artifacts as cardiac arrhythmia. The misinterpretation may cause unnecessary and potentially harmful diagnostic work-up and treatment. We had noted this problem before and reported a case “Tremor-induced electrocardiographic artifact mimicking atrial flutter” recently. The magnitude and clinical consequences of misinterpreting tremor-induced artifact as cardiac arrhythmia are not clear.
The purpose of this study is to determine the prevalence of tremor-induced ECG artifact and how often ECG artifact is misinterpreted as cardiac arrhythmia.
Introduction
Rest tremor of the limbs at a frequency of 4–5 Hz is a common and cardinal symptom of Parkinson’s disease (PD). Electrocardiogram (ECG) is a common examination in daily clinical practice. Tremor-induced electrocardiographic artifact mimicking atrial or ventricular tachycardia has been occasionally reported before. The misinterpretation of ECG artifact may cause unnecessary and potentially harmful diagnostic work-up and treatment. However, the magnitude and clinical
Materials and Methods
We enrolled 26 patients (10 men, 16 women) of PD who had visible rest tremor in this case-series study. A neurology resident accompanied the patient to the ECG examination room where a technician did the recoding. If erratic baseline or patterns mimicking atrial or ventricular arrhythmia were found, the neurology resident would check the blood pressure, auscultate the heart sound with a stethoscope, palpate the patient’s pulse and ask the patient for any symptoms or discomfort. The neurology resident then tried to reduce or abate the patient’s tremor by holding the tremulous limbs and the technician did the recording again. Only the first copy of the ECG was analyzed and interpreted by the cardiologists. The above procedures done by the neurology resident were to make sure that the ECG recording was due to tremor-induced artifact.
Results
In this preliminary report, we analyzed 26 PD patients with rest tremor. Twelve patients had normal ECG without artifacts, the other fourteen patients showed either erratic baseline (5 cases) or artifact mimicking either atrial fibrillation/flutter (8 cases, Figure 1) or ventricular tachycardia (1 case, Figure 2A–C). The prevalence of tremor related ECG artifact mimicking cardiac arrhythmia was 35%. The impact of ECG misinterpretation will be determined by a large-scale prospective study.
Figure 1. Electrocardiogram showing tremor-induced artifact mimicking atrial flutter
Figure 2-A. Electrocardiogram showing tremor-induced artifact mimicking ventricular tachycardia (250/min, 4.16/sec)
Figure 2-B. Disappearance of tremor-induced artifact after direct pressure on the tremulous limb
Figure 2-C. The tremogram study of right upper limb at rest shows rhythmic alternating bursts of antagonistic muscles at the frequency of 4 Hz
Conclusion
Our findings showed a high prevalence rate of tremor related ECG artifact. This report emphasized the clinical importance that motion-related artifact should be kept in mind in interpreting the data of electrophysiological studies (e.g. ECG).
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