Pacemaker diagnostic diagrams.

Abstract

Dual-chamber pacemakers interact with cardiac rhythms in complex ways. The resultant surface electrocardiograms (ECGs) are often very difficult to interpret. A simple and automatic diagnostic diagram is described that graphically illustrates pacemaker-heart interactions. Pacemaker operation is explained by a continuous series of lines and symbols that interconnect any sequence of paced and sensed events in both chambers. Fixed, programmable, and adaptive pacemaker timing intervals are all shown in a simple format. The pacemaker diagnostic diagram is plotted directly below the ECG to help users interpret the paced cardiac rhythm. The pacemaker diagnostic diagram is generated by software in a pacemaker programmer from: (1) telemetered real-time event markers; (2) fixed and programmable timing parameters (lower rate, AV interval, etc.); (3) pacemaker conditional logic. If this computer analysis of the telemetered event markers is not consistent with normal pacemaker operation, a specific error-message is printed. The pacemaker diagnostic diagram should be useful for instruction, pacemaker follow-up, and troubleshooting.