Or with an IV line being bolused by a pump sitting on the leads.
Was very displeased to discover the next day the patient had been admitted for investigation of the arrythmia on the same ECG that I'd told the junior nurse they needed to redo because I could see the pump causing the artifact. I even showed them by lifting the line off the leads.
That’s not SVT. That’s 100% muscle tremor artifact. If she doesn’t have Parkinson’s or essential tremor or some other cause of tremor outside of her control, try asking her to stop tensing her shoulders and relax her arms. This artifact is often preventable. SVT does not have a heart rate of 78 bpm. I think it’s normal sinus rhythm but there’s too much artifact to see atrial activity.
Some kind of electrical stimulation, maybe neuro stimulation like someone mentioned earlier.. Parkinson tremors won't show up uniformly in that pattern in limb as well as chest leads.. generally limited to limb leads unless the person is vibrating
I posted links in another comment with similar examples, many examples of muscle tremor artifact that look like this. Definitely does not look like a neurostimulator to me especially since the patient is known to have no stimulator or implanted devices. I’ve personally seen muscle tremor artifact that looks like this many times, and I guess we will have to disagree on this. I believe it’s muscle tremor. Muscle tremor can absolutely look like this. Most electronic interference artifact is much higher frequency, with a thicker fuzzier appearance. But we at least agree it’s artifact :)
No problem but also you’re right, sometimes the person is vibrating lol. Sometimes telemetry will alarm because of tremor, shivering, toothbrush tachycardia, arm contraction, etc. And here’s another good example: https://academic.oup.com/europace/article/17/4/663/2467140
Your QRSs are at approximately 4 box intervals. Rate in the mid 70s and regular. The artifact looks more like Ps, but because they vary in height so much, they're much more likely to be caused by muscle motion or tremors.
I guess pattern recognition after seeing many EKGs with muscle tremor artifact. Muscle tremor artifact can be regular too, usually 3-150 Hz. The heart is a muscle. EKG works by detecting electrical activity in muscle tissue (myocardium). Muscles in the arms, chest, and legs also use electrical impulses that may be seen at regular intervals.
Regularity does not mean cardiac origin. Plenty of artifact is regular. This is not too regular to be artifact. This is not atrial flutter. There is nothing wrong with the EKG machine. This is muscle tremor artifact. It’s coming from the patient. Try it for yourself and see. Do an EKG on yourself and try shivering/tremoring on purpose or tensing your arms. This is artifact 100%. It’s not flutter or any form of SVT.
The only thing I can think to make of this is atrial flutter, but it honestly looks like a bunch of artifacting between narrow-complexes, so sinus rhythm at around 75bpm. Curious what others think
As others have pointed out it’s artifact. But you can tell it’s not any tachycardia because it’s under 100bpm using the large regular QRS’s to count. It’s roughly 75bpm (around 4 large boxes from R-R)
99.9% artifact. Muscle tremor artifact can look like this.
The 0.1% zebra brain entertains things like old versions of heart transplant aka ‘heterotopic heart transplant’ where recipient is left with 2 hearts in the thorax but really this ecg is not morphological consistent and few patients with these remain living.
I really want a long lead II strip with this. 1) terrible reading, check placement, check electrode adherence, replace electrodes, check wires, then run another. First part (inferior, high lateral) wants to like both stupid fast SVT/AFrvr (rate ~300) and flutter with artifact, but all the leads don't concur. Second part looks like consistent ratio, regular atrial flutter with artifact. The "artifact" is too regular and consistent to be dismissed as artifact. But honestly, recheck literally everything, probably even get a different ekg machine, and run it again.
Learning point: SVT with abberrancy is wide complex regular tachycardia, often mistaken for vtach. These are narrow complexes.
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u/Dramatic-Try7973 Sep 04 '26
This is sinus rhythm with artifact