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Is the diagnostic function of pacemakers a reliable source of information about ventricular arrhythmias?
Magdalena Kumor1, Rafał Baranowski, Edward Koźluk
1Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland. magdakumor@wp.pl
Insights
Pacemaker diagnostic functions are unreliable for diagnosing ventricular arrhythmias, often under- or overestimating ectopic beats. 24-hour ECG monitoring is crucial for verification.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Pacemaker diagnostic functions are increasingly used for arrhythmia detection.
- However, their reliability in diagnosing ventricular arrhythmias requires thorough evaluation.
Purpose of the Study:
- To assess the accuracy and reliability of pacemaker diagnostic functions in identifying ventricular arrhythmias.
- To compare pacemaker data with simultaneous 24-hour electrocardiogram (ECG) recordings.
Main Methods:
- Compared ventricular ectopic beat counts from 51 simultaneous 24-hour ECGs and pacemaker event counters.
- Qualitatively assessed complex ventricular arrhythmias (accelerated rhythms, tachycardia, triplets, couplets) in 38 patients.
- Defined agreement as detection of at least one complex ventricular arrhythmia by both methods.
Main Results:
- Significant discrepancies found in ventricular ectopic beat counts; pacemakers underestimated in 39% and overestimated in 55% of patients.
- Clinically significant differences observed in 47% of patients even with liberal agreement criteria.
- Pacemaker sensitivity for ventricular tachycardia was 38%, specificity 70%; it missed 5 of 8 tachycardias and falsely identified 9.
Conclusions:
- Pacemaker evaluation alone is insufficient for diagnosing ventricular arrhythmias.
- Findings suggest that any significant ventricular arrhythmia or sensing issues detected by pacemakers necessitate confirmation with 24-hour ECG monitoring.
Background:
The aim of this study was to evaluate the reliability of pacemaker diagnostic function in diagnosing ventricular arrhythmias.
Methods:
We compared the occurrence of ventricular ectopic beats in 51 simultaneous 24-hour electrocardiogram (ECG) recordings and pacemaker event counters printouts. The diagnostic function of a pacemaker allowed also for a qualitative assessment in 38 patients. In these cases, the occurrence of complex forms of ventricular arrhythmias was cross-checked for accelerated ventricular rhythms together with ventricular tachycardia, and triplets and couplets. The detection of at least one type of complex ventricular form of arrhythmia, diagnosed by both methods, was considered as an agreement between the methods.
Results:
The results of ventricular ectopic beat counts differed significantly between the methods. In three (6%) patients, the results were consistent; in 20 (39%) the pacemaker underestimated results; in 28 (55%) they were overestimated. When more liberal criteria of agreement were applied, clinically significant differences were observed in 24 (47%) patients; in seven (29%) patients the count made by the pacemaker was lowered; and in 17 (71%) it was overestimated. Ventricular tachycardias were recorded in 24-hour ECG in eight patients. In three, they were identified by the pacemaker diagnostic function. In five, the pacemaker did not recognize tachycardia (because of its frequency being below 120/min). In nine, tachycardia was recognized falsely. The sensitivity in ventricular tachycardia diagnosis by pacemaker diagnostic function was 38%, specificity - 70%, the value of a positive result - 25%, negative - 81%.
Conclusions:
The evaluation of ventricular arrhythmias by pacemaker cannot serve as the only reliable diagnostic method of arrhythmias. The presence of a large number of sequences that may correspond to ventricular arrhythmia or failure to sense, should result in verification via 24-hour ECG monitoring.
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