Could you say that was an atrial flutter or not?

Özet

Muscle-tremor artefact is a potential cause of misdiagnosis of atrialarrhythmias on electrocardiography (ECG) monitoring. Such errors maylead to inappropriate and potentially dangerous therapies in some patients.We present a case of a patient with uncontrolled seizures whose bedsideelectrocardiogram monitor analysis appeared to demonstrate atrial flutterwith 4:1 conduction through the AV node. The ECG monitor and ECGrhythm strip additionally showed a regular ventricular rate of 94 bpm with anunderlying regular ‘saw-tooth’ baseline. We applied cardioversion to convertto sinus rhythm. Amiodarone was loaded and added to the patients therapywho had atrial flutter after cardioversion. Echocardiogram was performed bya pediatric cardiologist and they noted that the atrial rate and ventricular ratewere equal. After this, we began to suspect this situation might be a pseudoflutter due to his muscle contractions. We applied rocuronium to the patientto understand whether this was a pseudo-flutter or not. We saw that the ECGreturned to normal sinus rhythm.Physicians especially working in intensive care units should be aware ofartifact to avoid unnecessary therapeutic procedures. As Hippocrates saidcenturies ago “First, do no harm.”