Pacemaker assessment in the ambulant patient.

A new technique for assessing implanted cardiac pacemaker function in the ambulant patient has been introduced and assessed. A modified portable electrocardiograph recorder is used to store 24 hours of electrocardiograms along with marker pulses indicating the timing of pacemaker impulses. The recorder detects this narrow impulse and records a wider marker pulse on a second channel. The false positive detection rate was estimated from recordings, each of 24 hours, taken from 10 patients. All of these patients were ambulant and none had a cardiac pacemaker. There was on average less than one false positive per 24 hours. When similar recordings were taken from a group of 15 patients with pacemakers, the average false positive rate in 13 of these patients was also less than on per 24 hours. In the two other recordings artefacts resulted in false positive rates of 28 and 960 per 24 hours. Failure to detect pacemaker pulses was confirmed in only one patient. In addition to determining the accuracy of pacemaker pulse detection, the clinical usefulness of this technique was assessed. Two patients had fixed-rate pacemakers and 13 had demand pacemakers. Of the latter, two patients had a total of three episodes of failure to sense, one patient frequently failed to capture, and six patients had episodes of inappropriate inhibition of the pacemaker, the number of episodes ranging from one to 21 in 24 hours. Paced complexes were easily identified even when they occurred as fusion complexes. The frequency of paced complexes was quantified in each patient and varied from 21 to over 100 000 impulses in the 24 hour period.