Tremor Artifact Presenting as Pseudo-Ventricular Tachycardia

Electrocardiographic artifacts can present as pseudo-arrhythmia, such as ventricular tachycardia (VT), leading to unnecessary interventions.

A 47-year-old woman with hypertension, asthma, obstructive sleep apnea, lupus/Sjögren disease, and schizoaffective disorder was admitted for failure to thrive. Telemetry suggested polymorphic and monomorphic VT, prompting a rapid response. She was asymptomatic and hemodynamically stable, with a pulse 93/min. A baseline tremor was noted. Post-rapid-response electrocardiogram revealed an normal sinus rhythm with a QTc interval of 460 milliseconds. Preserved QRS complexes were seen to be embedded within the observed VT on telemetry review. Identification of the artifact pattern prevented further unwarranted interventions.

Tremor-induced artifacts can present as compelling VT mimics. Stable hemodynamics, concealed QRS complexes, and bedside examination are crucial in distinguishing pseudo-arrhythmia from true arrhythmia.

Electrocardiographic artifacts should be considered in clinically stable patients with telemetry VT alarms. Careful holistic approach to such alarms can avoid unnecessary invasive procedures and antiarrhythmic use.