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Challenges in Clinical Electrocardiography
February 14, 2011

Factitious Ventricular Tachyarrhythmia Outbreak—Discussion

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Intern Med. 2011;171(3):192. doi:10.1001/archinternmed.2010.538

July 27-29, 2009: The same patient visited a third hospital with the same history. He was admitted to the CCU, where recurrent “VT with syncope” episodes were diagnosed based on telemetry recordings and the patient's report of loss of consciousness. Electrophysiologic assessment was requested. The consulting electrophysiologist diagnosed an artifact based on the following observations (Figure 1): the sharp deflection of the normal QRS complexes that are clearly seen in the second half of the tracing after the artifact stopped marching through the whole rhythm strip (Figure 1, asterisks); the polymorphic ventricular tachycardia/fibrillation–looking signals and the sharp QRS signals sometimes superimposed on each other with an extremely short (<100 milliseconds) coupling interval that physiologically cannot occur (Figure 1, arrows); and the fact that the loss of consciousness—the only piece of information supporting the diagnosis of malignant ventricular arrhythmia—was never witnessed despite multiple episodes in a telemetry-CCU setting. The lack of a cause explaining the tachyarrhythmia and the patient's drug-seeking attitude further supported the suspicion of factitious ventricular tachyarrhythmia.

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