The pacemaker inverse problem--computer diagnosis of paced electrocardiograms.

Like the electrocardiographic inverse problem, the object of which is the algorithmical analysis and diagnosis of the electrocardiogram (ECG), the pacemaker inverse problem is the analysis of the ECG in order to establish details of heart-pacemaker interaction (HPI) with special reference to the diagnosis of pacemaker failure. The solution to this problem is of practical importance, since it is often difficult to evaluate such records clinically. The ECG patterns of natural cardiac depolarizations and paced events may not be distinguishable and many combinations of potential pacemaker response must be taken into account. A computer system providing automatic analysis of the HPI, based on ECG data, has been developed and implemented on an IBM PC AT computer. The system uses a complex algorithm which enables the evaluation of all possible combinations of HPI events, and establishes for each of these combinations its correspondence to the specified pacemaker algorithm. The system is written in Pascal and its source text has approximately 11,000 lines. The first version of the system has been tested with algorithms of the dual chamber cardiac pulse generator AUTIMA-II (Telectronics). The interactive input of the system allows the pacemaker algorithm and the ECG, in the form of timing of "definite" and "possible" sensing events and pacemaker pulses, to be specified. The analysis establishes whether the device operates correctly within permitted error. Should one or more correct explanations of the specified case be found, the system prints simplified patterns of the ECG accompanied by a simulated marker channel tracing the possible HPIs.