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Challenges in Clinical Electrocardiography |

Flutter Waves in a Dialysis Patient—Discussion

Arch Intern Med. 2011;171(18):1623-1624. doi:10.1001/archinternmed.2011.463.
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Correspondence: Dr Tanawuttiwat, Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, 1611 NW 12th St, Room Central 409, Miami, FL 33136 (ttanawuttiwat@med.miami.edu).

Financial Disclosure: None reported.

Bronzetti G, Canzi A, Picchio FM, Boriani G.Fluttering waves in electrocardiograms recorded in neonatal intensive care unit. Int J Cardiol. 2003;92(2-3):299-301
PubMed   |  Link to Article[[XSLOpenURL/10.1016/S0167-5273(03)00103-7]]
Weitz SH, Tunick PA, McElhinney L, Mitchell T, Kronzon I.Pseudoatrial flutter: artifact simulating atrial flutter caused by a transcutaneous electrical nerve stimulator (TENS). Pacing Clin Electrophysiol. 1997;20(12, pt 1):3010-3011
PubMed   |  Link to Article[[XSLOpenURL/10.1111/pace.1997.20.issue-12]]
Chakravarthy M, Mattur K, Raghavan R,  et al. Artifactual “atrial flutter” caused by a continuous passive motion device after total knee replacement. Anaesth Intensive Care. 2009;37(6):1038-1039
Biswas A, Thompson M.Atrial flutter? an electrocardiographic artifact caused by the COBE PRISMA system. Pediatr Nephrol. 1998;12(6):524
Paulsen AW, Pritchard DG.ECG artifact produced by crystalloid administration through blood/fluid warming sets. Anesthesiology. 1988;69(5):803-804
PubMed   |  Link to Article[[XSLOpenURL/10.1097/00000542-198811000-00043]]
Kostis WJ, Cohen L, Dominiecki SM.Continuous veno-venous hemodialysis pseudoflutter. J Electrocardiol. 2007;40(4):316-318
PubMed   |  Link to Article[[XSLOpenURL/10.1016/j.jelectrocard.2006.09.002]]
Patel SI, Souter MJ.Equipment-related electrocardiographic artifacts: causes, characteristics, consequences, and correction. Anesthesiology. 2008;108(1):138-148
PubMed   |  Link to Article[[XSLOpenURL/10.1097/01.anes.0000296537.62905.25]]
Austin SM, Flach SD, Gaines CM.Atrial flutter simulated by a portable compact disk player. Mayo Clin Proc. 2007;82(3):383-384
Graansma C, Liu TT, Tobe SW.A simple solution to pseudoarrhythmia during continuous renal replacement therapy. CANNT J. 2004;14(4):24-25
Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F.Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia. Am J Med. 2001;110(5):335-338
PubMed   |  Link to Article[[XSLOpenURL/10.1016/S0002-9343(01)00627-1]]
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Figure 2. Evaluation of the 12-lead electrocardiogram (ECG). A, Inspection of the 12-lead ECG during continuous venovenous hemodialysis (CVVHD) revealed prominent P waves prior to QRS complexes in leads II, aVF, and V1 (black arrows) with different morphology compared with the other flutter waves in leads V2 and V3 (white arrows). B, When the CVVHD machine was paused, the 12-lead ECG showed normal sinus rhythm with a premature atrial complex in the same ventricular rate (73/min).




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