This tracing shows over-sensing of T wave during exercise when heart rate exceeded 100bpm. Alternating 320 and 260ms intervals produces the train track appearance of the sensed activity. Raise the sensitivity threshold to make signals less likely to be detected with exercise.
Other Differential Diagnosis of Train Track Pattern:
The “train track” appearance on cardiac CEID (Cardiac Electronic Implantable Device) tracings, such as those from pacemakers or defibrillators, can be attributed to several causes. Here are the key causes:
Electromagnetic Interference (EMI):
- External electrical sources can cause interference, leading to a regular, repetitive pattern on the device tracings that resembles train tracks.
Lead Fracture:
- A break or fracture in the lead wire can cause intermittent or repetitive signals, creating a characteristic “train track” pattern on the tracing.
Lead Insulation Breach:
- Damage to the insulation of the leads can result in electrical noise and artifact patterns resembling train tracks.
Improper Lead Placement:
- Leads that are not properly placed or are dislodged can pick up extraneous signals, leading to artifacts in the recordings.
Muscle Artifact:
- Skeletal muscle activity can produce signals that the device may interpret as cardiac activity, resulting in repetitive artifacts.
Device Malfunction:
- Internal malfunctions of the device itself can cause abnormal repetitive signals to appear on the tracings.
Electronic Noise from Other Implanted Devices:
- Other implanted electronic devices, such as neuros-timulators, can create interference that manifests as train track patterns on cardiac device tracings.
Radiofrequency Interference:
- Exposure to radiofrequency sources, like MRI machines, can cause artifacts that resemble train tracks on the device’s ECG tracings.
Identifying the exact cause typically involves correlating the timing and circumstances of the artifact appearance with potential external sources, examining the device and lead integrity, and sometimes employing diagnostic tools to isolate the source of interference or malfunction.
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