A 79 year-old man with coronary artery disease who underwent percutaneous coronary intervention to the circumflex and second marginal arteries in 2006, and with tremor-predominant Parkinson’s disease, presented to the emergency room with progressive confusion and imbalance prompting imaging which identified a 2.5cm peripherally enhancing left parietal brain mass. He underwent a gross total resection (pathology high grade glioma) and was subsequently neurologically intact. On postoperative day 1, telemetry displayed what appeared to be polymorphic ventricular tachycardia lasting 15-20 seconds. However, the patient was asymptomatic, with normal serum electrolytes, troponins, ECG, and QTc. Further evaluation of the telemetry revealed well-formed distinct QRS complexes in lead V5 (panel A) with corresponding arterial oximetry waves (panel B) thereby demonstrating that the patient did not have ventricular tachycardia, and that the abnormal telemetry signals were instead an artifact of his Parkinson’s tremor. This case underscores the importance of considering tremor artifact when evaluating abnormal telemetry and ECG signals in patients with tremor, and highlights some features that can distinguish tremor artifact from a true arrhythmia.
Copyright © 2020. Published by Elsevier Inc.