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Challenges in Clinical Electrocardiography
April 22, 2019

Pseudo–Ventricular Tachycardia, Pseudo–Atrial Fibrillation, and Pseudo–Atrial Flutter in a Patient With Parkinson Disease: Two’s Company, Three’s a Crowd

Author Affiliations
  • 1Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
JAMA Intern Med. 2019;179(6):824-826. doi:10.1001/jamainternmed.2019.0746

A man in his late 60s with a history of Parkinson disease presented to the emergency department (ED) after worsening tremors, which were most pronounced in the left arm and leg. He otherwise felt well with no cardiac symptoms and had normal vital signs. While in the ED he underwent telemetry, and the initial telemetry strip, including both leads II and VI, revealed what was initially thought to be atrial flutter (Figure 1A). Subsequent telemetry strips showed what ED physicians believed to be nonsustained ventricular tachycardia (Figure 1B). A 12-lead electrocardiogram (ECG) was ordered (Figure 2), and the diagnosis shifted to atrial fibrillation. He was started on treatment with intravenous amiodarone and transferred from the hospital to a tertiary care center for investigation and treatment of potential arrhythmia in the cardiology unit.

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