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A low-pass filter of 300 Hz improved the detection of pacemaker spike on remote and bedside electrocardiogram

Jian Sun1, Qiu-Feng Lu, Yan Zhao

  • 1Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.

Chinese Medical Journal
|February 27, 2019
PubMed
Abstract

Insights

A 300 Hz low-pass filter (LPF) significantly improves pacemaker spike detection on electrocardiograms (ECGs), outperforming the standard 150 Hz cutoff. This enhanced detection accuracy applies to both remote and bedside ECGs, aiding in accurate pacemaker function diagnosis.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Diagnostics

Background:

  • The standard 150 Hz upper-frequency cutoff in electrocardiogram (ECG) filters can lead to the loss of pacemaker spikes, potentially causing misdiagnosis.
  • Investigating alternative low-pass filter (LPF) settings is crucial for improving the accurate detection of pacemaker activity.
  • This study evaluates the impact of various LPF settings on pacemaker spike detection in both remote and bedside ECG recordings.

Purpose of the Study:

  • To determine the optimal upper-frequency cutoff for low-pass filters (LPFs) to enhance pacemaker spike detection on ECGs.
  • To compare the efficacy of different LPF settings (40, 100, 150, 200, 300, and 400 Hz) in identifying atrial and ventricular pacing spikes.
  • To assess whether remote ECG transmission affects the diagnostic performance of different LPF settings.

Main Methods:

  • Collected standard 12-lead ECGs from 88 patients with permanent pacemakers during routine follow-up.
  • Recorded ECGs using six different upper-frequency cutoff settings: 40, 100, 150, 200, 300, and 400 Hz.
  • Analyzed both bedside and remotely transmitted ECGs for atrial and ventricular pacing spikes by two independent medical practitioners, using pacemaker programming as the gold standard.

Main Results:

  • The 300 Hz LPF demonstrated superior performance in detecting atrial-paced spikes on bedside ECGs, with a significantly higher area under the curve (AUC) compared to the 150 Hz filter (0.73 vs. 0.56, P=0.002).
  • For atrial pacing detection using the 300 Hz LPF, sensitivity was 59.4%, specificity 85.7%, positive predictive value 92.7%, and negative predictive value 40.9%.
  • The 300 Hz LPF also showed higher accuracy in detecting ventricular-paced spikes on bedside ECGs (AUC=0.93) compared to the 150 Hz filter (AUC=0.86; P<0.001). Results for remote ECGs were comparable.

Conclusions:

  • A 300 Hz upper-frequency cutoff for LPF is recommended for improved ECG detection of pacemaker spikes.
  • Implementing the 300 Hz LPF allows remote ECGs to achieve diagnostic performance equivalent to bedside ECGs.
  • This finding supports the use of higher LPF settings for more accurate pacemaker function assessment in clinical practice.

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