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January 22, 1973

Electrocardiographic Artifacts Simulating Atrial Flutter

Author Affiliations

University of Siena Siena, Italy

JAMA. 1973;223(4):439. doi:10.1001/jama.1973.03220040053018

To the Editor.—  Rubenfire recently observed an unusual electrocardiographic artifact simulating atrial flutter. The artifact was only evident in leads II, III, and aVF. The artifact was proven to be due to a broken wire on the left leg electrode. According to Rubenfire, had this artifact occurred in a monitoring situation, auricular flutter would have inappropriately been diagnosed.We have recently observed an unusual ECG in which involuntary muscle contractions caused simulation of atrial flutter. The ECG showed typical F waves in leads to V1 to V2 (Fig 1). Involuntary muscle contractions of the muscle pectoralis major were observed in the anterior chest wall. These myoclonics were probably caused by the cold temperature of the room, because they disappeared immediately after a warm cover was put on the patient (Fig 2). The frequency and size of these muscle contraction waves were quite unusual and might be almost considered