Tremor artefact resembling ventricular tachycardia

ECG shows artefacts due to tremor resembling a ventricular tachycardia (VT). The upper panel shows the artefacts resembling a wide QRS tachycardia and the lower panel shows the ECG with same leads when the tremor was not severe. The spikes of the QRS complexes (blue arrows) can be seen at regular intervals even when the tremor artefacts are strong. Similar artefacts can sometimes be seen on the cardiac monitor during chest physiotherapy due the movement artefacts picked up by the chest electrodes. Occasionally unilateral tremor may produce artefacts only in leads involving that particular limb, while it may be absent in other ECG leads. Artefacts resembling wide QRS tachycardia can lead on to ‘inappropriate shocks’ in an ICU setting! This can be avoided by physically checking the pulse every time an ‘arrhythmia’ is detected and therapy planned.

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