ECG Artifact Masquerading as Ventricular Tachycardia During Dofetilide Initiation

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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.

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