Global Pseudo-Atrial Flutter on Electrocardiogram and the Importance of Clinical Correlation

Parkinson's disease is a condition in which tremors, rigidity, bradykinesia, difficulties with sleep, autonomic symptoms, and mood disturbances can be present. We present an intriguing case in which such tremors appear as a global pseudo-atrial flutter on electrocardiogram (ECG). A 73-year-old Caucasian female presented to the cardiology clinic for management of atrial flutter diagnosed by ECG in a primary care setting. In the cardiology clinic, the physical examination of the patient revealed bilateral upper extremity resting tremors. The ECG machine initially read the findings as "atrial flutter." However, immobilization of the patient's arms bilaterally resulted in a normal sinus rhythm. Repeated ECGs when the arms were relaxed and when the arms were immobilized resulted in findings consistent with pseudo-atrial flutter and normal sinus rhythm, respectively. Considering tremors as a source of artifact on electrocardiogram in patients with tremors and using corrective measures are critically important to prevent misdiagnosis, unnecessary testing, and potentially harmful treatments. This case underscores the importance of educating healthcare team members about tremor-induced artifacts in patients with tremors to avoid misdiagnosis based on ECG readings.