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Published on: June 4, 2019
Observations of pacemaker pulses in high-bandwidth electrocardiograms and Dower-estimated vectorcardiograms
Jonathon Koenig1, Alan V Sahakian, Anthony Ricke
1Robert R. McCormick School of Engineering, Northwestern University, Evanston, IL, USA.
Background:
Electronic pacemaker pulses are poorly reproduced in computerized electrocardiogram (ECG) tracings, impairing both automated and human interpretation. In this study, a high-bandwidth system is used to examine ECG and vectorcardiogram characteristics of pacemaker pulses.
Methods:
In 69 subjects with artificial pacemakers, electrocardiograms were recorded at 75,000 samples per second with a high-bandwidth ECG system (GE Healthcare, Milwaukee, WI). Vectorcardiograms, as estimated with the Dower transform, were examined.
Results:
Pulse loops in the vectorcardiogram consisted of distinct discharge and recharge waves, with an angle difference of 174° ± 10° (mean ± SD) in 3 dimensions. Atrial pulses were on average oriented anteriorly, superiorly, and to the left; right ventricular pulses were oriented posteriorly, superiorly, and to the right; and left ventricular pulses were oriented posteriorly, inferiorly, and to the right. Other details of pacemaker pulses could be readily observed.
Conclusions:
The high-bandwidth ECG has the potential to improve interpretation of paced rhythms in computerized ECGs.
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