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

Abstract

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.

Electrocardiographic spiked-helmet sign in critical non-cardiac illness

“…After further review, it became clear that the apparent repolarisation changes were the result of rapid undulating artefacts at a rate of approximately 230/min. Such very fast artefact is generally believed to be the result of body shaking,4 chest physical therapy5 or unknown. Pacemaker spikes allowed for identification of PR segments which followed a regular sinusoidal pattern.…”