Brandes A, Gonska B D, Distler W K, Diederich K W, Bethge K P
Klinik für Kardiologie, Medizinische Universität zu Lübeck.
Z Kardiol. 1994 May;83(5):351-8.
The importance of the pacemaker follow-up clinic has markedly increased in the face of the currently available multiprogrammable pacemakers. In contrast to the common standard techniques in assessing pacemaker dysfunctions, Holter monitoring allows the detection of transient pace-maker dysfunctions during a long period of time. Especially computer-aided analysis provides a considerable progress, because different pacemaker dysfunctions can be detected during prolonged time periods, and--in contrast to visual analysis--a reliable survey of the real extent of transient pacemaker dysfunctions in the individual patient is assessed. The reliability of computer-aided analysis by a specially designed module was prospectively investigated in 100 consecutive patients with permanent ventricular inhibited demand pacemakers. It could be demonstrated that the positive predictive accuracy of this analysis was limited to 60.2% in detecting failures to sense and 63.2% in detecting inappropriate inhibitions, respectively. All detected failures to capture were false positive events. The positive predictive accuracy, therefore, was not calculated for this category of event. The overall positive predictive accuracy was 59.9%. In contrast, the sensitivity of computer-aided analysis was remarkably high. Possible causes of false positive and false negative findings are described. The reliability of pacemaker pulse detection was also investigated. Out of 100 analyzed Holter recordings five showed a temporary total loss of pacemaker pulses. Loss of single pacemaker pulses was found in 30 patients. False positive pacemaker pulses were seen in three patients. These results show that visual control and validation by an experienced physician are mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)
面对当前可用的多程控起搏器，起搏器随访门诊的重要性显著增加。与评估起搏器功能障碍的常见标准技术不同，动态心电图监测可在较长时间内检测到短暂的起搏器功能障碍。特别是计算机辅助分析取得了相当大的进展，因为在较长时间段内可以检测到不同的起搏器功能障碍，而且与视觉分析不同，可以评估个体患者短暂起搏器功能障碍的实际程度的可靠概况。通过一个专门设计的模块对计算机辅助分析的可靠性进行了前瞻性研究，研究对象为100例连续的永久性心室按需起搏器患者。结果表明，该分析在检测感知失败方面的阳性预测准确率分别为60.2%，在检测不适当抑制方面为63.2%。所有检测到的夺获失败均为假阳性事件。因此，未计算此类事件的阳性预测准确率。总体阳性预测准确率为59.9%。相比之下，计算机辅助分析的敏感性非常高。描述了假阳性和假阴性结果的可能原因。还研究了起搏器脉冲检测的可靠性。在100份分析的动态心电图记录中，有5份显示起搏器脉冲暂时完全消失。30例患者出现单个起搏器脉冲丢失。3例患者出现假阳性起搏器脉冲。这些结果表明，经验丰富的医生进行视觉控制和验证是必不可少的。（摘要截短至250字）
