Teaching neuroImages: Rest tremor mimicking ventricular tachycardia.

Ventricular tachycardia is a life-threatening condition. ECG artifact caused by the 4to 6-Hz rest tremor of Parkinson disease (PD) can mimic a wide complex ventricular tachycardia (figure). Misinterpretation of ECG artifact can have grave consequences, including cardiac catheterization, administration of antiarrhythmics, and placement of automated implantable cardioverter-defibrillators.1 Tremor artifact is most prominent in limb leads and represents the action potentials of striated muscle. Artifact in leads I, III, and aVL in this patient suggests left arm rest tremor. Holding the limb or placing electrodes on the chest can minimize this artifact.2 Neurologists should be aware of this ECG artifact to prevent unnecessary cardiac interventions.