Letter to the Editor Advanced algorithms can lead to electrocardiographic misinterpretations

We observed a patient with syncope, who implanted a pacemaker with advanced algorithms such as “atrial-tachy response” and “dynamic atrio-ventricular delay”. After one year, conventional ECG Holter showed pacemaker malfunction, wrongly attributed to exposure to electromagnetic field. In fact, telemetry revealed an inappropriate programming and solved our case. Holter monitoring is commonly performed in the evaluation of pacemaker malfunction, albeit it remains a quite shallow diagnostic method especially to detect electromagnetic interferences. New algorithms seem important, but it is reasonable to obtain more suitable analytical tools, too. © 2008 Elsevier Ireland Ltd. All rights reserved.

[1]  J. Daubert,et al.  Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. , 2007, European heart journal.

[2]  B. Nowak,et al.  Holter Recordings with Continuous Marker Annotation to Evaluate Pacemaker Function , 2001, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[3]  A. Coats,et al.  Ethical authorship and publishing. , 2009, International journal of cardiology.

[4]  M. Sweesy.  Understanding electromagnetic interference. , 2004, Heart rhythm.

[5]  Joe Wiart,et al.  Risk of cellular phone interference with an implantable loop recorder. , 2007, International journal of cardiology.

[6]  A. Bahl,et al.  Inappropriate shock delivery by implantable cardioverter defibrillator due to electrical interference with washing machine. , 2007, International journal of cardiology.

[7]  Mehul B. Patel,et al.  Electromagnetic interference with pacemakers caused by portable media players. , 2008, Heart rhythm.

[8]  Richard Sutton,et al.  Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. , 2007, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.