ECG Artifacts Simulating Atrial Flutter

To the Editor.— Atrial flutter (223: 439, 1973), or ventricular fibrillation as reported by Labram (Nouvelle Presse Med1:2402, 1972) and by Delzant (Nouvelle Presse Med2:112, 1973) may be simulated by muscular tremulation with typical parkinsonism. A simple method of avoiding such artifacts is to place the two brachial electrodes (or even one if the tremulation is exactly unilateral) on the deltoid areas and not on the arms or forearms. The Figure emphasizes this fact, often observed, that corresponds to the inactivity of the proximal muscles in this condition; the upper line represents the ECG with antibrachial electrodes, the second line with elect rodes on the deltoids.