Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our Patients

Nowak, Bernd

doi:10.1046/j.1460-9592.2002.t01-1-00838.x

Cited by 23 publications

(4 citation statements)

References 32 publications

(45 reference statements)

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“…Analysis of HREGM made a contribution to the final interpretation in nearly 90% of ATR, and nearly 50% of VT or NSVT detections. These results confirm the diagnostic importance of HREGM analysis to detect or clarify the nature of pacing anomalies, and to verify the appropriateness of device reprogramming to correct anomalous behavior of the pacing system 9 . Furthermore, this diagnostic tool can be used for the detection of symptomatic or asymptomatic rhythm disturbances, and to monitor the efficacy of antiarrhythmic therapy.…”

Section: Discussionsupporting

confidence: 67%

Contributions of High Resolution Electrograms Memorized by DDDR Pacemakers in the Interpretation of Arrhythmic Events

Defaye

Leclercq²,

Guilleman

et al. 2003

Pacing Clinical Electrophis

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The accuracy of information retrievable from the memories of DDDR pacing systems has been limited by the absence of actual electrograms confirming the proper sensing of spontaneous cardiac activity versus that of extraneous signals. This study examined the diagnostic power of a new arrhythmia interpretation scheme, which includes the recording and storage of high resolution endocavitary atrial and ventricular electrograms (HREGM). HREGM stored in the memories of new generation pacemakers (PM) in response to nonsustained ventricular tachycardia (NSVT), sustained VT, and atrial arrhythmias were analyzed in a follow-up registry of 520 patients at 1 month, and 3 to 6 months after implantation of a PM for standard indications. For each sequence of stored HREGM, the accuracy of the PM response was examined, classified as accurate (true positive), versus inaccurate (false positive), versus undetermined, and the relative contribution of the HREGM in verifying the PM diagnosis was measured. During a follow-up of 4.9 +/- 2 months, 256 (49%) of the 520 patients had an event recorded, which was confirmed to be arrhythmic on the basis of HREGM. Overall, approximately 34% of atrialtachy response (ATR) episodes were confirmed to be appropriate. Similar percentages of episodes were prompted by oversensing of signals unrelated to cardiac arrhythmias, while nearly 12% of the episodes could not be clarified because of such brief duration as to preclude recording of their onset. Approximately one-third of NSVT, and one-half of VT detections were false positive. Ventricular oversensing, most often due to myopotential interference in presence of unipolar sensing, and atrial undersensing were both identified as sources of false-positive detections of ventricular events. The proportion of true-positive detections was significantly higher in the bipolar (83%) than unipolar configuration. Among 520 PM recipients, miscellaneous episodes of atrial arrhythmias were confirmed by HREGM in 37% of patients within 3 to 6 months of follow-up. Atrial fibrillation was confirmed in only 6% of patients, of whom over 50% already had histories of atrial fibrillation. The prevalence of unsuspected atrial arrhythmia in this unselected population was lower than previously reported.

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Section: Discussionsupporting

confidence: 67%

Contributions of High Resolution Electrograms Memorized by DDDR Pacemakers in the Interpretation of Arrhythmic Events

Defaye

Leclercq²,

Guilleman

et al. 2003

Pacing Clinical Electrophis

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“…The efficacy of conventional diagnostics tools, including electrocardiograms (ECG) during follow‐up and 24‐hour ambulatory ECG monitoring, is limited. Today's cardiac implantable electronic devices (CIED) diagnostics include system diagnostics revealing battery status, energy consumption, and lead impedance, but also algorithms for detecting and treating cardiac arrhythmias . However, when interpreting counter data, one should evaluate for possible inappropriate device behavior or programming.…”

Section: Cardiac Implantable Electronic Devices and Atrial High Rate mentioning

confidence: 99%

Atrial High Rate Episodes in Patients with Dual‐Chamber Cardiac Implantable Electronic Devices: Unmasking Silent Atrial Fibrillation

Bénézet-Mazuecos

Rubio

Farré

2014

Pacing Clinical Electrophis

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Assessment of the prevalence of silent paroxysmal atrial fibrillation (AF) represents a challenge, since the arrhythmia may be brief, completely asymptomatic, and difficult to detect. Lack of symptoms from AF should not be equated to lack of risk of thromboembolic complications. Today's cardiac implantable electronic devices (CIED) diagnostics include system diagnostics accurately revealing asymptomatic cardiac arrhythmias as atrial high rate episodes (AHRE). The presence of AHRE has been related to increased risk of stroke and systemic embolism. The application of anticoagulation therapy in patients with device-detected AHRE is yet unclear and challenging in the absence of randomized studies. Until further studies are available, anticoagulation therapy should be individualized and promoted attending to the CHADS2 score. Future guidelines should deal with this peculiar AF scenario to make professionals who routinely perform CIED follow-ups aware of these relevant episodes and their clinical implications.

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“…The real value is in the analysis of the recorded endocardial electrograms. 4 Experience of endocardial electrograms is extensive from implantable cardioverter-defibrillators (ICDs) that document therapy events. Stored electrograms have provided the clinician with an invaluable tool in aiding clinical follow up of arrhythmias and potential trouble shooting of device related programming issues or hardware problems such as lead fracture or displacement ( fig 1).…”

Section: Electrogram Storagementioning

confidence: 99%

Follow up and optimisation of cardiac pacing

Roberts¹

2005

Heart

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Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our Patients

Cited by 23 publications

References 32 publications

Contributions of High Resolution Electrograms Memorized by DDDR Pacemakers in the Interpretation of Arrhythmic Events

Contributions of High Resolution Electrograms Memorized by DDDR Pacemakers in the Interpretation of Arrhythmic Events

Atrial High Rate Episodes in Patients with Dual‐Chamber Cardiac Implantable Electronic Devices: Unmasking Silent Atrial Fibrillation

Follow up and optimisation of cardiac pacing

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