Improving Diagnostic Yield for Analyzing Periodic Electrograms in the Remote Detection of Pacemaker Lead Issues

Remote monitoring of pacemakers decreases patient complications and reduces public health expenses. The transmission of passive real-time electrograms (EGM) has been shown to increase the diagnostic yield, but this may add to the work burden. Passive EGMs provide snapshots without adjustments, while active EGMs modify pacemaker settings temporarily to encourage sensing and pacing, potentially revealing issues such as undersensing, oversensing, or loss of capture. The added value of active EGMs compared to the passive EGM remains to be shown. The objective of this multicenter observational study is to evaluate, in a large population of patients implanted with a pacemaker capable of transmitting both passive and active periodic EGMs, the added benefit of active periodic EGMs on diagnostic yield of pacemaker-related anomalies. In a retrospective analysis of 7068 EGMs from 2733 patients, active modes detected significantly more anomalies (6.7%) than passive alone (3.3%, p < 0.001), particularly for atrial leads. However, the extended duration of active EGMs (36 s versus 12 s) was the primary contributor to improved detection rates rather than the active pacing modes themselves. Our findings suggest that focusing on longer passive EGMs may enhance diagnostic yield, reducing the need for active pacing adjustments.