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Fusion or confusion on Holter recording
L M van Gelder1, F A Bracke, M I el Gamal
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|May 1, 1991
Summary
Pacemaker electrocardiogram recordings can be misleading due to equipment issues. Misaligned Holter recorder heads can mimic pacemaker malfunction, affecting interpretation of dual chamber and VVI pacemaker function.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Pacemakers are crucial for managing cardiac rhythm disorders.
- Holter monitoring is a standard non-invasive diagnostic tool for evaluating pacemaker function and cardiac arrhythmias.
- Accurate interpretation of electrocardiograms (ECGs) from pacemaker patients is essential for appropriate clinical management.
Observation:
- An electrocardiogram from a dual chamber rate responsive pacemaker showed ventricular depolarization seemingly initiated by the atrial stimulus.
- A Holter recording from a VVI pacemaker revealed a delay in pacemaker impulse registration after ventricular depolarization onset.
Findings:
- The observed phenomena in both cases were attributed to misalignment in one of the Holter system's recorder heads.
- This technical artifact can lead to misinterpretation of pacemaker function, particularly in complex pacing modes.
Implications:
- Misinterpretation of Holter recordings can lead to unnecessary device adjustments or patient anxiety.
- Ensuring proper calibration and function of Holter monitoring equipment is critical for reliable pacemaker assessment.
- Awareness of potential recording artifacts is necessary for clinicians interpreting pacemaker ECGs.