17 May 2021
The implanted cardiac pacemaker has evolved from simple, non-programmable, asynchronous ventricular pacing to sophisticated multi-programmable dual chamber and biventricular models. A consequence of this technological evolution has been the appearance of bizarre pacing rhythms on both 12-lead electrocardiograph (ECG) and ambulatory Holter monitor recordings. Even to the experienced ECG reporter and cardiac technologist, these appearances may suggest pacing malfunction, which may lead to patient anxiety, needless investigations, inappropriate programming and even unnecessary surgery. Today, 12-lead ECGs and Holter recordings are frequently performed in patients with implanted pacemakers. They are indicated to confirm correct pacemaker programming, evaluate palpitations, dizziness or syncope and to determine if there is an appropriate rate response to physiologic demand.
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