Observations of pacemaker pulses in high-bandwidth electrocardiograms and Dower-estimated vectorcardiograms.
BACKGROUND
Electronic pacemaker pulses are poorly reproduced in computerized electrocardiogram (ECG) tracings, impairing both automated and human interpretation. In this study, a high-bandwidth system is used to examine ECG and vectorcardiogram characteristics of pacemaker pulses.


METHODS
In 69 subjects with artificial pacemakers, electrocardiograms were recorded at 75,000 samples per second with a high-bandwidth ECG system (GE Healthcare, Milwaukee, WI). Vectorcardiograms, as estimated with the Dower transform, were examined.


RESULTS
Pulse loops in the vectorcardiogram consisted of distinct discharge and recharge waves, with an angle difference of 174° ± 10° (mean ± SD) in 3 dimensions. Atrial pulses were on average oriented anteriorly, superiorly, and to the left; right ventricular pulses were oriented posteriorly, superiorly, and to the right; and left ventricular pulses were oriented posteriorly, inferiorly, and to the right. Other details of pacemaker pulses could be readily observed.


CONCLUSIONS
The high-bandwidth ECG has the potential to improve interpretation of paced rhythms in computerized ECGs.
Robert R. McCormick School of Engineering, Northwestern University, Evanston, IL, USA.
Jonathon
J
Koenig
Alan V
AV
Sahakian
Anthony
A
Ricke
Steven
S
Swiryn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014672:Vectorcardiography / Q000379:methods*; D055815:Young Adult