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July 23, 1982

Pseudobradycardia During Holter Monitoring: The Electronic Munchausen Syndrome?

JAMA. 1982;248(4):469-470. doi:10.1001/jama.1982.03330040057033

AMBULATORY ECG (Holter) monitoring is a widely used and effective technique for detecting arrhythmias and determining the efficacy of antiarrhythmic treatment. Major therapeutic decisions are often based on the results of these recordings. However, electrode, lead, recorder, and playback components may malfunction and produce artifacts that simulate serious arrhythmias. Pseudotachyarrhythmias and bradyarrhythmias caused by component malfunction are well described in the literature.1-4 However, to our knowledge, artifacts produced by tampering with the recorder have not been described pre[ill]usly. We discuss herein a case of pseudobradycardia and asystole apparently produced by this newly uncovered mechanism.

Report of a Case  A 24-year-old woman arrived at an outlying hospital with atypical chest pain and recurrent syncope that resulted in numerous visits to the emergency service. She was found to have frequent ventricular premature beats (VPBs). Attempts to control the arrhythmia failed, and she was then referred to the cardiology service at the