title: Validation of dual-chamber pacemaker diagnostic data using dual-channel stored electrograms.
abstract: BACKGROUND
  Pacemaker diagnostic counters are used to guide device programming and patient management. However, these data are susceptible to inappropriate classification of events. The aim of this multicenter study was to evaluate pacemaker diagnostic data using stored intracardiac electrograms (EGMs).
  
  
  METHODS
  The study included 351 patients (191 males, aged 71 +/- 10 years) with standard indications for dual-chamber pacemaker implantation. EGM triggers were atrial tachycardia (AT), ventricular tachycardia (VT), sudden bradycardia response (SBR), and pacemaker-mediated tachycardia (PMT). For this study, the devices could store up to 5 EGMs of 8s each (with marker annotation and onset recording). After 3 months, the EGMs were analyzed and classified as "confirmed" if the EGM validated the trigger and as "false positive" if the EGM showed an event different from the trigger.
  
  
  RESULTS
  Of the 1,003 EGMs available, the triggers were AT in 640 EGMs, VT in 76, SBR in 105, and PMT in 178 EGMs. Four EGMs were triggered by magnet application. The trigger was confirmed in 614 EGMs (62%): 62% of AT episodes, 18% of VT episodes, 100% of SBR episodes, and 54% of PMT episodes. In 385 cases (45%), the EGMs revealed false-positive events due to far-field sensing (39%), noise and myopotential sensing (26%), sinus tachycardias (21%), double counting (9%), exit block (4%), and undersensing (1%).
  
  
  CONCLUSIONS
  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.
authors: Cardiovascular Center Bethanien, CCB, Frankfurt/Main, Germany. b.nowak@ccb.de
authors: Bernd
authors: B
authors: Nowak
authors: James
authors: J
authors: McMeekin
authors: Marie
authors: M
authors: Knops
authors: Bernd
authors: B
authors: Wille
authors: Eberhard
authors: E
authors: Schröder
authors: Concepcion
authors: C
authors: Moro
authors: Matthias
authors: M
authors: Oelher
authors: Eduardo
authors: E
authors: Castellanos
authors: Benoit
authors: B
authors: Coutu
authors: Ben
authors: B
authors: Petersen
authors: Wolfgang
authors: W
authors: Pfeil
authors: Joachim
authors: J
authors: Kreuzer
mesh_terms: D000368:Aged; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D001919:Bradycardia / Q000175:diagnosis; D004562:Electrocardiography; D005189:False Positive Reactions; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis; D017180:Tachycardia, Ventricular / Q000175:diagnosis