Diagnostic accuracy of pace spikes in the electrocardiogram to diagnose paced rhythm.
OBJECTIVE
To determine how often cardiac resynchronization therapy (CRT) pacing systems generate visible pace spikes in the electrocardiogram (ECG).


METHODS
In 46 patients treated with CRT pacing systems, we recorded ECGs during intrinsic rhythm, atrial pacing and ventricular pacing. ECGs were analysed for atrial and ventricular pace spikes by two experienced ECG readers blinded to the pacing therapy and to the study purpose.


RESULTS
Atrial pacing generated visible pace spikes in less than 70% of the ECGs, whereas ventricular pacing generated visible pace spikes in about 90% of ECGs. The sensitivity of manual ECG interpretation for pace spikes was low for atrial pacing (Reader 1: 0.62 [95% confidence interval (CI) 0.50-0.74]; Reader 2: 0.65 [95% CI 0.53-0.77]) and moderate for ventricular pacing (Reader 1: 0.88 [95% CI 0.81-0.93]; Reader 2: 0.93 [95% CI 0.87-0.97]).


CONCLUSIONS
In patients with CRT pacing systems, the absence of visible pace spikes in the ECG does not rule out paced rhythm.
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: hedvig.andersson@regionh.dk.
Hedvig Bille
HB
Andersson
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Marco Bo
MB
Hansen
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Mads
M
Thorsberger
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
Tor
T
Biering-Sørensen
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.
Jonas Bille
JB
Nielsen
Department of Health Science and Technology, Aalborg University, Denmark.
Claus
C
Graff
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Steen
S
Pehrson
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.
Jesper Hastrup
JH
Svendsen
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000145:classification* / Q000175:diagnosis*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
Bipolar pacing; Cardiac resynchronization therapy; Diagnostic accuracy; Electrocardiogram; Pace spike; Pacemaker