Diagnostic accuracy of pace spikes in the electrocardiogram to diagnose paced rhythm

J Electrocardiol. 2015 Sep-Oct;48(5):834-9. doi: 10.1016/j.jelectrocard.2015.07.005. Epub 2015 Jul 7.

Abstract

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.

Keywords: Bipolar pacing; Cardiac resynchronization therapy; Diagnostic accuracy; Electrocardiogram; Pace spike; Pacemaker.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / classification*
  • Arrhythmias, Cardiac / diagnosis*
  • Cardiac Pacing, Artificial / methods*
  • Diagnosis, Differential
  • Electrocardiography / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Therapy, Computer-Assisted / methods*
  • Treatment Outcome