Two Cases of Intraoperative ECG Artifact Mimicking Ventricular Tachycardia and How to Know When It Is Real.

Electrocardiographic (ECG) artifacts may resemble ventricular tachycardia (VT), leading to inappropriate therapies. Despite extensive training, electrophysiologists have still been shown to misinterpret artifacts. The literature is scant regarding the intraoperative identification by anesthesia providers of ECG artifacts resembling VT. We present two cases of the intraoperative occurrence of ECG artifacts resembling VT. The first case involved a patient undergoing extremity surgery after receiving a peripheral nerve block. The patient was treated with a lipid emulsion for a presumptive local anesthetic systemic toxicity diagnosis. The second case was a patient with an implantable cardiac defibrillator (ICD) with suspended anti-tachycardia functionality due to the location of the surgery in the region of the ICD generator. The second case's ECG was identified as an artifact, and no treatment was initiated. Misinterpretation of intraoperative ECG artifacts continues to lead clinicians to institute unnecessary therapies. Our first case occurred in the context of a peripheral nerve block leading to the misdiagnosis of local anesthetic toxicity. The second case occurred during the physical manipulation of the patient during liposuction.