Global pseudo-atrial flutter ECG appearance secondary to unilateral parkinsonian tremor
Author(s)
Nam, MCY
Best, L
Greaves, K
Dayananda, N
Griffith University Author(s)
Year published
2016
Metadata
Show full item recordAbstract
An 82-year-old man with previous bioprosthetic aortic valve replacement for aortic stenosis had a routine ECG (figure 1). This was thought to represent an atrial tachycardia with cycle length 280 ms and 3:1 atrioventricular response. A diagnosis of atrial flutter was made based on tachycardia cycle length, p-wave morphology and previous cardiac surgery. He had a mild left-sided tremor in keeping with known Parkinson's disease. The patient was anticoagulated and admitted electively for an electrophysiology (EP) study. In the EP laboratory, the patient had a 12-lead ECG (figure 2A) showing sinus rhythm with a ventricular rate ...
View more >An 82-year-old man with previous bioprosthetic aortic valve replacement for aortic stenosis had a routine ECG (figure 1). This was thought to represent an atrial tachycardia with cycle length 280 ms and 3:1 atrioventricular response. A diagnosis of atrial flutter was made based on tachycardia cycle length, p-wave morphology and previous cardiac surgery. He had a mild left-sided tremor in keeping with known Parkinson's disease. The patient was anticoagulated and admitted electively for an electrophysiology (EP) study. In the EP laboratory, the patient had a 12-lead ECG (figure 2A) showing sinus rhythm with a ventricular rate of 60 bpm. Figure 2B shows the EP electrogram recorded in the coronary sinus confirming sinus rhythm. However, it was noted that the ‘flutter waves’ in the original ECG were most marked in the left limb leads. In the EP laboratory, ECG labels are placed on the torso, as opposed to the limbs. After moving ECG labels to the forearms, the surface ECG is shown (figure 3) with re-emergence of ‘flutter’ waves. A diagnosis of pseudo-atrial flutter was made.
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View more >An 82-year-old man with previous bioprosthetic aortic valve replacement for aortic stenosis had a routine ECG (figure 1). This was thought to represent an atrial tachycardia with cycle length 280 ms and 3:1 atrioventricular response. A diagnosis of atrial flutter was made based on tachycardia cycle length, p-wave morphology and previous cardiac surgery. He had a mild left-sided tremor in keeping with known Parkinson's disease. The patient was anticoagulated and admitted electively for an electrophysiology (EP) study. In the EP laboratory, the patient had a 12-lead ECG (figure 2A) showing sinus rhythm with a ventricular rate of 60 bpm. Figure 2B shows the EP electrogram recorded in the coronary sinus confirming sinus rhythm. However, it was noted that the ‘flutter waves’ in the original ECG were most marked in the left limb leads. In the EP laboratory, ECG labels are placed on the torso, as opposed to the limbs. After moving ECG labels to the forearms, the surface ECG is shown (figure 3) with re-emergence of ‘flutter’ waves. A diagnosis of pseudo-atrial flutter was made.
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Journal Title
BMJ Case Reports
Volume
2016
Subject
Clinical sciences