ECG Artifact Masquerading as Ventricular Tachycardia During Dofetilide Initiation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Symptomatic atrial flutter (n=1). Intervention: Dofetilide initiation with structured telemetry artifact review. Primary outcome: Differentiation of telemetry motion artifact from polymorphic ventricular tachycardia allowing completion of dofetilide loading.

Q: What does this research mean for the field?

Systematic review of telemetry strips before and after apparent ventricular tachycardia episodes can distinguish motion artifact from true arrhythmia by revealing underlying native QRS complexes, preventing unnecessary cessation of dofetilide initiation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Robert M. Weinstein; Melina Brito; Brandon Custer; Chang Gil Kim; Joseph E. Marine; Ronald Berger; David Spragg; Aravindan Kolandaivelu

doi:10.1016/j.jaccas.2026.107404

March 1, 2026JACC Case ReportsOpen Access

ECG Artifact Masquerading as Ventricular Tachycardia During Dofetilide Initiation

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Key result

Systematic telemetry review differentiates bed-vibration artifact from polymorphic VT, enabling safe completion of dofetilide loading.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Motion artifacts can mimic ventricular tachycardia on telemetry during dofetilide initiation, complicating rhythm interpretation.

Key Points

To describe a case of telemetry motion artifact resembling ventricular tachycardia during inpatient dofetilide initiation and outline a systematic method to distinguish noise from true arrhythmia.
Evaluation of a 67-year-old man with symptomatic atrial flutter admitted for inpatient initiation and 72-hour loading of dofetilide.
Investigation of an overnight telemetry alarm suggestive of polymorphic ventricular tachycardia by systematically analyzing multi-lead rhythm strips before, during, and after the event.
Telemetry recorded approximately 20 seconds of an abnormal rhythm, but native QRS complexes were found persisting through the episode in leads I, II, V1, and aVL.
The tracing was confirmed to be motion artifact linked to hospital bed vibration rather than ventricular tachycardia, allowing dofetilide loading to be safely resumed and completed without complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient aged 67 years with recurrent symptomatic atrial flutter admitted for 72-hour inpatient dofetilide initiation.

I

Intervention

Inpatient dofetilide loading for 72 hours (temporarily held overnight due to suspected ventricular tachycardia on telemetry, then resumed after systematic review of telemetry strips before and after the alarm identified motion artifact from a vibrating hospital bed), followed by 200J synchronized cardioversion.

O

Outcome

Differentiation of motion artifact from true polymorphic ventricular tachycardia on telemetry, allowing safe resumption and completion of 72-hour inpatient dofetilide loading and restoration of sinus rhythm.

A structured evaluation of telemetry strips before and after an alarm—specifically looking for persistent native QRS complexes across multiple leads and correlating with clinical status—can accurately distinguish mechanical artifact from torsades de pointes during inpatient dofetilide loading, preventing unnecessary discontinuation of antiarrhythmic therapy.

Limitations

Single-patient case report

Implication

Telemetry review may permit safe dofetilide continuation after apparent polymorphic VT; hypothesis-generating for routine adoption in inpatient monitoring.

Abstract

BACKGROUND: Motion artifacts can cause interference over the heart's native electrical activity, leading to confusion regarding the underlying rhythm. CASE SUMMARY: A 67-year-old-man presenting for dofetilide initiation had telemetry concerning for ventricular tachycardia, resulting in a pause in dofetilide loading. Upon further review of the telemetry strips surrounding the event, it was determined that the abnormal rhythm was secondary to motion artifact, and medication was resumed without complications. DISCUSSION: Motion artifact or electrical disturbances on electrocardiogram or telemetry are common occurrences that can be challenging to differentiate from true arrhythmias. Methods such as identifying the rhythm in all available leads before and after the event of interest, determining tachycardia rate and nonphysiologic R-R intervals, and taking a detailed history can help identify the underlying rhythm. TAKE-HOME MESSAGE: Identification of telemetry monitoring before and after events of interest can provide valuable insight in differentiating artifact versus arrhythmia in unclear electrocardiograms.

Discussion

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Cite This Study

Weinstein et al. (2026) conducted a case report in Symptomatic atrial flutter (n=1). Dofetilide initiation with structured telemetry artifact review was evaluated on Differentiation of telemetry motion artifact from polymorphic ventricular tachycardia allowing completion of dofetilide loading. Systematic review of telemetry strips before and after an apparent 20-second polymorphic VT episode identified native QRS complexes through bed-vibration artifact, enabling safe 72-hour dofetilide loading.

synapsesocial.com/papers/69cb63c9e6a8c024954b88b9 https://doi.org/10.1016/j.jaccas.2026.107404

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ECG Artifact Masquerading as Ventricular Tachycardia During Dofetilide Initiation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

ECG Artifact Masquerading as Ventricular Tachycardia During Dofetilide Initiation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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