Implanted cardiac pacemaker pulses as recorded from the body surface

This study investigates the characteristics of contemporary pacemaker pulses as recorded from the body surface. Twelve-lead paced ECGs from 140 patients (68 ± 12 years, 71% males) were collected at 32,000 samples per second. Pacer pulses were manually annotated based on the high-sampling rate data stream. The results show that durations of the various pulses are stable, while amplitudes exhibit large variations. Also, more than 50% of pulses have either durations <0.5 ms or amplitudes <2 mV, which are the AAMI/IEC thresholds for detection and marking of pacemaker pulses on an ECG report. Therefore the current standards for pacemaker pulse detection are not fit for purpose and require to be updated. Further, this study suggests that a high-sampling rate database should be used as a standard test for pacemaker annotation and detection from body surface ECGs.