The influence of electrocardiogram (ECG) filters on the heights of R and T waves in children

Anesthesiologists often compare intraoperative and preoperative electrocardiogram (ECG) waveforms in patients undergoing general anesthesia. In addition, many intraoperative ECG monitors have filters for removing electrocautery noise. In pediatric anesthesiology practice, we often note the appearance of elevated T waves—specifically, an increase in their height—with the use of such filters, even though no actual clinical change has occurred, which possibly leads to misdiagnosis. We investigated changes in R and T wave heights and in the T/R ratio according to the use of the strong (S) versus the diagnostic (D) filtering mode during pediatric anesthesiology. Primary outcomes were the dependence of the heights of the R and T waves on the filter mode and the correlation between rates of change in the R- and T-wave heights and heart rate (HR). In the S mode, the height of the R wave was lower (p = 0.013, η² = 0.28) and the T/R ratio was higher than the corresponding values in the D mode (χ² = 20.46, p < 0.001). The T/R ratios were also higher in the S mode than in the D mode, and when the D mode was changed to the S mode during tachycardia, there was a strong correlation between the rate of reduction in the R wave and HR (r = 0. 573, p = 0.041). Significant differences in the heights of the R wave and in the T/R ratio occur when using different intraoperative ECG filtering modes. Specifically, in S mode, a greater relative increase in T wave height may occur due to a significant decrease in R wave height. To avoid spurious diagnoses, anesthesiologists should be familiar with these potentially purely filter-driven changes whenever ECG is intraoperatively monitored.