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A 75-year-old woman was referred to our pacemaker/implantable cardioverter-defibrillator (ICD) clinic with an abnormal electrocardiogram (ECG). The ECG (Figure, A) showed abnormal spikes compared with a regular ECG (without spikes) (Figure, B) of the same patient performed 3 months earlier, prompting a referral for device interrogation. Clinical manifestations such as dizziness, lightheadedness, syncope, or signs and symptoms of congestive heart failure were absent. The patient’s vital signs were normal.
Reif S, Tiller M, Hoffmann E. Uncommon Etiology of Abnormal Spikes on Electrocardiogram. JAMA Intern Med. 2014;174(3):458-459. doi:10.1001/jamainternmed.2013.13666