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False Electrocardiographic Diagnosis of Atrial Flutter

Richard L. Golden, MD
JAMA. 1973;226(2):200. doi:10.1001/jama.1973.03230020046027.
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To the Editor.—  The simulation of atrial flutter by electrocardiographic artefacts may be of varied origin, including a broken wire in an extremity electrode,1 myoclonic contractions of the pectoralis major muscle secondary to cold,2 and the muscle tremor of Parkinson disease.3-5 While the electrical artefact produced by the tremor of Parkinson disease is usually easily recognized, a well-defined "flutter pattern" may occasionally be produced. This simulated flutter may appear only in the standard leads with bilateral tremor, or may be confined to certain of the standard leads when unilateral.3 However, the spurious pattern may also be seen in the chest leads in some cases, increasing the difficulty of diagnosis.4 Various methods have been proposed to eliminate these false flutter patterns such as warming the patient in the case of cold-induced tremor,2 and holding the affected extremity in parkinsonism.3 Saint-Pierre5 has suggested placing


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