Accuracy of the pacemaker event recorder versus Holter-ECG to detect both symptomatic and asymptomatic ventricular
Stela Maria Vitorino Sampaio1, Neyle Moara Craveiro1, Francisco Darrieux2
1Messejana Hospital, Fortaleza, Ceará, Brazil.
Insights
Pacemaker monitors underestimate ventricular arrhythmias compared to Holter. Algorithm standardization is needed for accurate clinical use in patients with pacemakers.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- New pacemakers can monitor cardiac rhythm, but their accuracy in diagnosing ventricular arrhythmias (VA) is not well-established.
- Few studies have evaluated the diagnostic capabilities of pacemaker event monitors for VA.
- This research addresses the need to understand the reliability of implanted devices for arrhythmia detection.
Purpose of the Study:
- To assess the correlation and agreement between pacemaker event monitors and ambulatory Holter monitoring in detecting VA.
- To compare the accuracy of different VA detection parameters between pacemakers and Holter.
- To provide insights into the clinical utility of pacemaker data for VA management.
Main Methods:
- 129 patients with pacemakers underwent simultaneous 72-hour monitoring with both pacemaker event monitors and ambulatory Holter.
- Pacemaker algorithms were programmed to detect specific criteria for VA (PVCs, couplets, NSVT, HVR).
- Spearman correlations and Intraclass Correlation Coefficients (ICCs) were used to analyze data concordance.
Main Results:
- Overall agreement between pacemaker monitors and Holter for VA detection was low.
- High agreement was observed for three-beat non-sustained ventricular tachycardia (NSVT) (ICC = 0.984).
- Moderate correlation was found for >10 premature ventricular complexes (PVCs) per hour (Kappa = 0.483).
- Programming pacemakers for high ventricular rate (HVR) detection of three-beat sequences <140 bpm showed perfect correlation (r=1) and high agreement (ICC=0.800) with NSVT.
Conclusions:
- Pacemaker event monitors tend to underestimate the occurrence of ventricular arrhythmias compared to Holter monitoring.
- Standardization of pacemaker algorithms is crucial for reliable clinical follow-up of patients.
- Further research is needed to optimize pacemaker detection parameters for accurate VA assessment.
Background:
Although new pacemakers can register cardiac rhythm, few studies were performed evaluating their accuracy in diagnosing ventricular arrhythmias (VA). This study aimed to assess the correlation and agreement between the pacemaker's monitor and the ambulatory Holter in detecting VA.
Methods And Results:
We studied 129 patients with pacemakers, mean age 68.6 ± 19.1 years, 54.8% female. Once Holter monitoring was connected, the pacemakers' event counters were reset and clocks of both systems were synchronized to register electrocardiograms (ECG) simultaneously. Pacemakers were programmed to detect the lowest ventricular rate and lowest number of sequential beats allowed in their event monitors. After 72 hours, Holter and pacemakers records were analyzed. VA was defined in Holter and event monitor, respectively, as: isolated premature ventricular complexes: "PVC"; pairs: "couplets"; nonsustained ventricular tachycardia (NSVT): "triplets"-3 beats; "runs"-4-8 or > 8 beats, and high ventricular rates ("HVR")-3-4 beats. Spearman correlations evaluated whether pacemaker and Holter identified the same parameters. Intraclass correlation coefficients (ICCs) and respective 95% confidence intervals were calculated to assess the concordance between methods. The agreement between both systems was low, except for "triplet" and three beats NSVT (ICC = 0.984). The correlation for more than 10 PVC/h was moderate (Kappa = 0.483). When the pacemaker was programmed to detect HVR sequences of three beats lower than 140 bpm (< 140/3), the correlation with NSVT was perfect (r = 1) and agreement was also quite high (ICC = 0.800).
Conclusions:
Pacemakers' event monitors underestimate the occurrence of ventricular arrhythmias detected by Holter. Standardization of pacemakers' algorithms is required before using this function for patients' clinical follow-up.
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