What potential pitfalls can adversely affect the interpretation of 12-lead ECGs?

Many potential pitfalls can adversely affect the interpretation of 12-lead ambulatory and telemetry electrocardiograms (ECGs). Artifacts, for example, are a common finding in patients who require ECG monitoring. Artifacts are defined as ECG abnormalities that may be due to sources other than the electrical activity of the heart. Failure to correctly distinguish between an arrhythmia and artifact can result in misdiagnosis and unnecessary therapeutic interventions.11 

The most common causes of artifacts originate from internal (physiological) and external (non-physiological) sources (Table 1). Artifacts created from these sources can simulate arrhythmias such as atrial flutter and ventricular tachycardia.22 

Electrode misplacement is another common artifact. Such misplacement may lead to changes in ECG morphology that could potentially be interpreted as ischemic in origin.33 Electrode misplacements can also mimic...

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