Could you say that was an atrial flutter or not?

Muscle-tremor artefact is a potential cause of misdiagnosis of atrialarrhythmias on electrocardiography (ECG) monitoring. Such errors maylead to inappropriate and potentially dangerous therapies in some patients.We present a case of a patient with uncontrolled seizures whose bedsideelectrocardiogram monitor analysis appeared to demonstrate atrial flutterwith 4:1 conduction through the AV node. The ECG monitor and ECGrhythm strip additionally showed a regular ventricular rate of 94 bpm with anunderlying regular ‘saw-tooth’ baseline. We applied cardioversion to convertto sinus rhythm. Amiodarone was loaded and added to the patients therapywho had atrial flutter after cardioversion. Echocardiogram was performed bya pediatric cardiologist and they noted that the atrial rate and ventricular ratewere equal. After this, we began to suspect this situation might be a pseudoflutter due to his muscle contractions. We applied rocuronium to the patientto understand whether this was a pseudo-flutter or not. We saw that the ECGreturned to normal sinus rhythm.Physicians especially working in intensive care units should be aware ofartifact to avoid unnecessary therapeutic procedures. As Hippocrates saidcenturies ago “First, do no harm.”

___

1. Krasnow AZ, Bloomfield DK. Artifacts in portable electrocardiographic monitoring. Am Heart J 1976; 91: 349-357.

2. Casta A, McCann ME. Electrocardiographic inscription of diaphragmatic contractions during anaesthesia. Paediatr Anaesth 1999; 9: 175-176.

3. Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Clinical consequences of electrocardiographic artifact mimicking ventricular tachycardia. N Engl J Med 1999; 341: 1270-1274.

4. Patel S. Electrocardiographic artifact mimicking ventricular tachycardia during high-frequency oscillatory ventilation: A case report. Am J Crit Care 2006; 15: 310-311.

5. Boos CJ, Khan MY, Thorne S. An unusual case of misdiagnosed ventricular tachycardia. Emerg Med J 2008; 25: 173-174.

6. Samaniego NC, Morris F, Brady WJ. Electrocardiographic artefact mimicking arrhythmic change on the ECG. Emerg Med J 2003; 20: 356-357.

7. Finsterer J, Stollberger C, Gatterer E. Oral anticoagulation for ECG tremor artefact simulating atrial fibrillation. Acta Cardiol 2003; 58: 425-429.
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
Sayıdaki Diğer Makaleler

Could you say that was an atrial flutter or not?

Serkan ÖZSOYLU, Başak Nur AKYILDIZ, Adem DURSUN, Özge PAMUKÇU

An adolescent case of extensive Behçet’s disease successfully treated with Infliximab

Emel ISIYEL, Sevcan BAKKALOĞLU, Deniz OĞUZ, İdil YENİCESU, Öznur BOYUNAĞA, Yeşim ÖZDEMİR, Çağrı DAMAR, Yaşar KANDUR, Meltem AKÇABOY, Ayşe Tana ASLAN, Tuğba ŞİŞMANLAR, Enver HASANOĞLU, Necla BUYAN

Cranial MR characteristics of Cerebral Palsy cases and correlation of findings with clinical results

Asuman ALİ, Ramazan YALÇIN, Ayşem Ünlüer GÜMÜŞTAŞ

Medicolegal evaluation of a maternal filicide attempt: a case report

Dilşad Foto ÖZDEMİR, Aysun Balseven ODABAŞI, Özlem TEKŞAM, Ferda KARADAĞ, Ramazan AKCAN, Eda YILMAZ

Netherton syndrome previously misdiagnosed as hyper IgE syndrome caused by a probable mutation in SPINK5 C

Kemal ÖZYURT, Mustafa ATASOY, Ragıp ERTAŞ, Yılmaz ULAŞ, Muhammed Reşat AKKUŞ, Aslıhan KİRAZ, Hans Christian HENNİES

Reversible cardiomyopathy-tachycardiomyopathy in children

Alev ARSLAN, İlkay ERDOĞAN, Birgül VARAN, Mustafa YILMAZ, Mehmet Bülent ÖZİN, Niyazi Kürşad TOKEL

Alpha gal specific IgE positivity due to tick bites and red meat allergy: the first case report in Turkey

Şennur KELEŞ, Mehmet GÜNDÜZ

What triggered massive hemoptysis in Goodpasture syndrome with isolated pulmonary involvement in a 14-year-old boy?

Tuğba Şişmanlar EYÜBOĞLU, Ayşe Tana ASLAN, Deniz Gezgin YILDIRIM, Necla BUYAN, Serhat EMEKSİZ, Gökhan KALKAN

Eleven-year surveillance of acute flaccid paralysis in southwestern Iran

Ali Akbar MOMEN, Abdolhussein SHAKURNİA, Mehdi MOMEN

Two years of newborn screening for cystic fibrosis in Turkey: Çukurova experience

Ayşe Şenay ŞAŞİHÜSEYİNOĞLU, Derya Ufuk ALTINTAŞ, Atıl BİŞGİN, Dilek DOĞRUEL, Mustafa YILMAZ, Mahir SERBES