Stepwise approach to the unknown pacemaker ECG.
A method is presented for obtaining data about a pacemaker from a routine ECG without any prior information about the type of pacemaker or the pacemaker parameters. The method begins with assessment of the mode of the pacemaker (AAI, VVI, VDD, DVI, or DDD) and the presence of physiologic sensing. After the mode is determined, pacemaker parameters are estimated: LRLI for all pacemakers, as well as AV interval, LRLI, and post-ventricular atrial refractory period for dual-chambered pacemakers. Finally, pacemaker function is analyzed to determine if an emergency exists, such as ventricular noncapture or ventricular nonsensing. This method should benefit practitioners who are faced with unknown patients, unknown pacemakers, or both, and may serve as a tool for teaching how to analyze the pacemaker ECG.
Garson
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Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
D002304:Cardiac Pacing, Artificial / Q000379:methods; D004562:Electrocardiography; D004630:Emergencies; D004867:Equipment Design; D006801:Humans; D010138:Pacemaker, Artificial; D009626:Terminology as Topic