Tremor Artifact Presenting as Pseudo-Ventricular Tachycardia

BACKGROUND: Electrocardiographic artifacts can present as pseudo-arrhythmia, such as ventricular tachycardia (VT), leading to unnecessary interventions. CASE SUMMARY: A 47-year-old woman with hypertension, asthma, obstructive sleep apnea, lupus/Sjögren disease, and schizoaffective disorder was admitted for failure to thrive. Telemetry suggested polymorphic and monomorphic VT, prompting a rapid response. She was asymptomatic and hemodynamically stable, with a pulse 93/min. A baseline tremor was noted. Post-rapid-response electrocardiogram revealed an normal sinus rhythm with a QTc interval of 460 milliseconds. Preserved QRS complexes were seen to be embedded within the observed VT on telemetry review. Identification of the artifact pattern prevented further unwarranted interventions. DISCUSSION: Tremor-induced artifacts can present as compelling VT mimics. Stable hemodynamics, concealed QRS complexes, and bedside examination are crucial in distinguishing pseudo-arrhythmia from true arrhythmia. TAKE-HOME MESSAGES: Electrocardiographic artifacts should be considered in clinically stable patients with telemetry VT alarms. Careful holistic approach to such alarms can avoid unnecessary invasive procedures and antiarrhythmic use.