From the Guidelines
Pacemaker spikes can be detected on an EKG, but their visibility depends on the duration and amplitude of the stimulus output, as well as the sampling rate of the ECG system, as noted in the 2007 American Heart Association electrocardiography and arrhythmias committee report 1. The detection of pacemaker spikes on an EKG is crucial for assessing the proper functioning of the pacemaker. According to the report, pacemaker stimulus outputs are generally shorter in duration than 0.5 ms, and therefore, they cannot be reliably detected by ordinary signal processing techniques at 500 to 1000 Hz 1. Key factors affecting the visibility of pacemaker spikes on an EKG include:
- The duration of the pacemaker stimulus output
- The amplitude of the stimulus output, with modern bipolar pacemaker stimulus outputs often being too small to be recognized on a standard ECG
- The sampling rate of the ECG system, with oversampling improving the detection of narrow pacemaker pulses 1 In clinical practice, it is essential to consider these factors when interpreting an EKG with a pacemaker, to ensure accurate assessment of pacemaker function and proper patient care.
From the Research
Pacemaker Spikes on EKG
- Pacemaker spikes can be seen on an EKG, but their interpretation can be challenging [(2,3,4,5,6)].
- A systematic approach to EKG interpretation is crucial to identify pacemaker spikes and diagnose potential issues [(2,6)].
- The analysis of a pacemaker EKG should include:
- Basic rhythm and rate
- QRS axis
- PQ, QRS, and QT intervals
- Morphology of P waves, QRS, ST segments, and T(U) waves
- Presence of arrhythmias 6
- Pacemaker spikes can be misleading, especially in emergency situations where only a three-lead EKG is available 3.
- Understanding pacemaker EKGs can improve patient care and outcomes by allowing for the identification and correction of pacemaker malfunctions [(2,4,5,6)].