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Challenges in Clinical Electrocardiography
May 27, 2013

Finding Needles in a Haystack—Diagnosis

Author Affiliations
 

SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD

JAMA Intern Med. 2013;173(10):850-851. doi:10.1001/jamainternmed.2013.128b

The ECG rhythm strip shows normal sinus rhythm interspersed with salvos of regular wide QRS complexes with the appearance of ventricular tachycardia (VT). However, closer assessment reveals evidence against VT: (1) the shortest R-R cycle length of the wide QRS complexes is 160 milliseconds (>300/min, more likely consistent with ventricular flutter); (2) absence of pauses following the wide complex salvos before resumption of sinus rhythm; and (3) notching of the wide QRS complexes occurring at regular intervals that align with the sinus QRS complexes (Figure 2, arrows). These findings are consistent with normal sinus rhythm disrupted by motion artifact.  

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