Introduction: Palpitations are one of the most common reasons patients come to internists and cardiologists. Failure to distinguish artifacts from potentially life-threatening arrhythmias might lead to further unnecesarry invasive procedure.
Case report: A 40-yo-female came to cardiology clinic because of intermittent palpitation, without precipitating or exaggerating factors. She had no accompanying symptoms nor family history of sudden cardiac death. Her resting EKG was normal and 24-hour Holter showed “run VT” (Figure 1). She demanded more invasive study that failed to demonstrate run VT with programmed extrastimulus on electrophysiology (EP) study. No symptom was experienced afterwards.
Discussion: Her Holter showed normal QRS complex within pseudo-VT and unstable baseline before and after the episodes, so most likely these were artifacts mimicking VT. EKG tracing with body movement is needed as specific muscle movement might intervene. One-third of electrophysiologists failed to identify artifacts mimicking VT and most ordered unecessary invasive procedures. Patient’s tiresless effort asking for further evaluation made us perform EP study showing her “uninduced-arrhytmia”.
Conclusions: QRS complex within pseudo-VT and unstable baseline were an useful diagnostic finding to distinguish real VT from artifacts in this patient.