An unusual case of misdiagnosed ventricular tachycardia

Boos, CJ; Khan, Mariya; Thorne, S A

doi:10.1136/emj.2007.050849

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…With 4:1 conduction through the AV node (i.e., every fourth atrial impulse conducted), this would lead to a ventricular rate of 65-85 bpm. 5 The ECG findings in our patient mimicked atrial fibrillation both in frequency and amplitude. Despite the presence of atrial flutter on ECG, his hemodynamics was stable, his pulse was rhythmical, and his blood pressure was normal.…”

Section: Discussionsupporting

confidence: 53%

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Could you say that was an atrial flutter or not?

et al. 2019

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Muscle-tremor artefact is a potential cause of misdiagnosis of atrial arrhythmias on electrocardiography (ECG) monitoring. Such errors may lead to inappropriate and potentially dangerous therapies in some patients. We present a case of a patient with uncontrolled seizures whose bedside electrocardiogram monitor analysis appeared to demonstrate atrial flutter with 4:1 conduction through the AV node. The ECG monitor and ECG rhythm strip additionally showed a regular ventricular rate of 94 bpm with an underlying regular 'saw-tooth' baseline. We applied cardioversion to convert to sinus rhythm. Amiodarone was loaded and added to the patients therapy who had atrial flutter after cardioversion. Echocardiogram was performed by a pediatric cardiologist and they noted that the atrial rate and ventricular rate were equal. After this, we began to suspect this situation might be a pseudoflutter due to his muscle contractions. We applied rocuronium to the patient to understand whether this was a pseudo-flutter or not. We saw that the ECG returned to normal sinus rhythm. Physicians especially working in intensive care units should be aware of artifact to avoid unnecessary therapeutic procedures. As Hippocrates said centuries ago "First, do no harm."

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Section: Discussionsupporting

confidence: 53%

“…Electrocardiographic (ECG) artefacts may closely imitate both supraventricular and ventricular tachycardias. [1][2][3][4][5] Muscle-tremor artefact is a potential cause of misdiagnosis of atrial arrhythmias on ECG monitoring. 6 Such errors may lead to inappropriate and potentially dangerous therapies in some patients.…”

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confidence: 99%

Could you say that was an atrial flutter or not?

et al. 2019

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“…There are only two case reports in the literature regarding Parkinson's tremor mimicking ventricular tachycardia (3,4). However, in these cases the differentiation of the tremor-induced pseudo-VT from true VT was not confirmed using any accurate algorithm.…”

Section: Discussionmentioning

confidence: 98%

What Is Your Diagnosis: Ventricular or Pseudo-Tachycardia?

Gül¹,

Kayrak²,

Gök³

2011

JAEM

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“…The most likely reported causes of ECG artefacts that mimic both supraventricular and ventricular tachycardia are body movements, muscular fasciculations or contractions, tremor in patients with Parkinson's disease, poor skin-electrode contact, recorder malfunctioning, and electromagnetic interference [1-3,5,6]. ECG artefacts simulating both ventricular tachycardia and atrial flutter have been produced-and reproduced-by the arm movements that occur during tooth brushing [6].…”

Section: Discussionmentioning

confidence: 99%

“…Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias [1-5]. An erroneous diagnosis of an ECG artefact as an arrhythmia can lead to unnecessary diagnostic measures and interventions [3].…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic artefacts mimicking atrial tachycardia resulted in unnecessary diagnostic and therapeutic measures

Y‐Hassan

Sylvén

2013

Korean J Intern Med

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Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pentothal was administered while preparing for electrical cardioversion, the oesophageal ECG recordings and the ECGs during adenosine administration were reviewed. An ECG artefact diagnosis was suspected, and then confirmed, during relapse of the "arrhythmia," with simple palpation of the radial pulse and cardiac auscultation.

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An unusual case of misdiagnosed ventricular tachycardia

Cited by 4 publications

References 7 publications

Could you say that was an atrial flutter or not?

Could you say that was an atrial flutter or not?

What Is Your Diagnosis: Ventricular or Pseudo-Tachycardia?

Electrocardiographic artefacts mimicking atrial tachycardia resulted in unnecessary diagnostic and therapeutic measures

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