IMAGING IN CARDIOLOGY
An unusual
R.
Riezebos,
M.
Khan, J.
cause of electrical
artfc
on te
Schroeder-Tanka
Figqure 1. ECGshows a
normnal sinus rhythm. A low-voltage, highfrequency signal is visible in all leads.
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R. Riezebos
M. Khan
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands J. Schroeder-Tanka
Department of Cardiology, St Lucas Andreas Hospital, Amsterdam, the Netherlands Correspondence
to: R. Riezebos
Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Oosterparkstraat 279, 1091 HA Amsterdam,
stimulator used for the
E-mail:
[email protected]
(Ae
Netherlands Heart Journal, Volume 14, Number 1,
le
the Netherlands
A54-year-old woman was referred to our clinic complaining of severe angina, for which percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) was indicated. Her medical history revealed Parkinson's disease. Besides a normal sinus rhythm, the electrocardiogram (ECG) prior to the procedure revealed a high-frequency, low-voltage signal. Due to the electrical artefact, proper interpretation of the ECG was not possible (figure 1). This phenomenon was found to be caused by highfrequency electrical imnpulses generated by a deep brain
January 2006
treatment
of her Parkinson's
31
IMAGING IN CARDIOLOGY
Figure 2. Fluoroscopy of l'eftr thorax shows a deep brain stimulator device implanted left subpectorally and a guidewire in the LAD. disease (figures 2 and 3). The patient was asked to turn off the electrical stimulation and subsequently the artefact ceased.
Repeated ECG sampling showed sinus rhythm with a normal QRS axis and flattened T waves in leads III and aVL (ECG not shown). Hence, PCI and stent implantation via radial artery access was performed successfillly, whereby the patient could be discharged on the day of admittance. The use of deep brain stimulation of the subthalamic nucleus has been associated with a marked improvement in individuals suffering from advanced Parkinson's disease. The device is used in individuals in whom treatment with medication alone is not sufficient.' It is thus apparent that the days when only cardiologists use thrombolysis and implanted electrical devices are over! U
32
Figure 3. Fluoroscopic view shows the intracranialpart of the deep brain stimulator.
Reference 1
Kleiner-Fisman G, Fisman DN, Sime E, et al. Long term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 2003;99: 489-95.
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one page at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, e-mail:
[email protected]. 'Moving images' are also welcomed and (after acceptance) will be published as aWeb Site Feature and shown on our website: www.cardiologie.nl This section is edited byM.J.M. Cramer andjj. Bax.
Netherlands Heart Journal, Volume 14, Number 1, January 2006
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