Validation of Dual‐Chamber Pacemaker Diagnostic Data Using Dual‐Channel Stored Electrograms

Abstract

This large-scale study of stored EGMs revealed their value in validating diagnostic counter data. Therapeutic decisions should not be based on diagnostic counters alone; they should be validated by sophisticated tools like stored EGMs.

Development of Atrioventricular Block and Diagnostic Value of Stored Electrograms in Patients With Sick Sinus Syndrome and Implanted Pacemaker

“…24- 26 Nowak et al suggested that 45% of EGM that were recorded as atrial high rate episodes were false-positive events due to far-field sensing, noise, sinus tachycardia, double counting, or under-sensing. 24 In the present study, a total of 304 EGM (80.6%) did not show actual second-or third-degree AVB, and showed atrial tachycardia or atrial fibrillation, premature ventricular contractions in the blanking period or AV junctional rhythm, and premature atrial contractions with block. The episodes of atrial tachyarrhythmia and premature atrial contraction with block, however, were not completely incorrect detections and were therefore classified as AVB, because AV conduction block actually occurred in these events.…”

Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls

“…Literature shows that the most frequent causes of incorrect detection of atrial tachyarrhythmias are the occurrence of short runs of atrial premature beats and secondly, intermittent FFRW sensing by the atrial channel. 14,18,[28][29][30] FFRW sensing occurs when a deflection is detected in the programmed AV interval or after postventricular atrial blanking (PVAB) (figure 3). FFRW sensing can occur prior to a ventricular paced event during a fusion beat where the intrinsic ventricular wave front is sensed by the atrial channel before the ventricular channel paces.…”

“…[11][12][13] The expanded PM memory offered more insight into the natural course of PAT, and also displayed the relevance of the mode switch to DDI or VVI pacing in PAT as a marker of correct detection. 11,14,15 All together, these technical developments promised to become an attractive alternative treatment for PAT, thus justifying primary PM implantation when drug treatment of PAT fails.…”

“…Furthermore, the PM-delivered information about the type, incidence and timing of PAT can strongly mislead the cardiologist and the cardiac device technician. 14,16,22 This review discusses a number of technical reasons why PM prevention or suppression of PAT can fail. The cardiologist's awareness of these potential errors can guide a tailored programming of specific pacing treatment to prevent or suppress PAT in already implanted PMs.…”

Atrial pacing for rhythm control of atrial fibrillation

“…10 Though technical pitfalls are certainly present, as the authors state themselves, the total duration of AF burden measured with a pacemaker seems highly reliable. 11,12 Certainly, improvement in technical features will further enhance the accurate use of these diagnostic tools. But is it worthwhile to put every effort into improving this technology in order to use it for rhythm control for AF, also in patients without a pacing indication?…”