Event Monitors in Patients with Pacemakers
Yes, event monitors can be ordered for patients with pacemakers, but specific considerations must be made regarding monitor selection and potential interference with pacemaker function. The American Heart Association and European Society of Cardiology guidelines support the use of cardiac monitoring in pacemaker patients when clinically indicated 1, 2.
Types of Monitoring Options for Pacemaker Patients
Appropriate Monitoring Devices
- Standard event monitors - Generally compatible with most modern pacemakers
- Smartphone-compatible devices - The AliveCor Kardia device has been shown to have "excellent safety profile" with cardiac implantable electronic devices with no electromagnetic interference 3
- Remote pacemaker monitoring - Often preferred as first-line monitoring option as it directly accesses pacemaker data 4
Devices Requiring Caution
- Transcutaneous electrical nerve stimulation (TENS) - Can potentially interfere with pacemaker function and requires extended cardiac monitoring during use 5
- Portable heart rate monitors (sport watches) - May count double in patients with unipolar pacing mode (23% under exercise conditions), but work properly with bipolar pacing systems 6
Clinical Indications for Event Monitoring
High-Priority Indications
- Suspected pacemaker malfunction - To detect lead dislodgement, sensing failures, or capture issues 2
- Unexplained symptoms - Syncope, presyncope, or palpitations despite normal pacemaker interrogation
- Arrhythmia detection - Particularly for atrial fibrillation surveillance in patients at high stroke risk 1
Post-Procedural Monitoring
- After lead implantation - 12-24 hours of monitoring is recommended for non-pacemaker dependent patients to confirm appropriate function 1
- After generator replacement - Monitoring is essential to detect potential lead dislodgement 2
Monitoring Protocol Considerations
Duration of Monitoring
- Short-term (24-48 hours) - For immediate post-procedural monitoring or evaluation of frequent symptoms
- Extended monitoring (7-30 days) - For intermittent symptoms or suspected arrhythmias
- Implantable monitors - Consider for very rare events or when other monitoring fails to capture events 1
Interpretation Challenges
- Pacemaker spikes may be misinterpreted by some monitoring systems
- Bipolar pacing systems generally cause less interference with external monitoring devices 6
- Quality of recordings may be affected by pacing status (90% of paced recordings and 94.7% of non-paced recordings were correctly interpreted with Kardia device) 3
Potential Pitfalls and Solutions
Common Pitfalls
- Electromagnetic interference - Some monitoring devices may interfere with pacemaker function
- Misinterpretation of pacemaker artifacts - Can lead to false arrhythmia detection
- Inadequate monitoring duration - May miss intermittent events
Solutions
- Use remote pacemaker monitoring when available - Provides direct data from the device itself 4
- Select monitors with proven compatibility - Research supports certain devices like AliveCor Kardia 3
- Ensure bipolar pacing mode when possible - Reduces interference with external monitoring devices 6
- Consider different ECG monitoring leads to better visualize pacemaker function if diagnosis is unclear 2
Conclusion
Event monitors can be safely and effectively used in patients with pacemakers when appropriate precautions are taken. The selection of monitoring device should be based on the specific clinical indication, pacemaker type (unipolar vs. bipolar), and frequency of symptoms. Remote pacemaker monitoring, when available, offers advantages for detecting both arrhythmias and device malfunctions.