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TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers
Affiliations- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
- Unidad de Arritmias, Hospital Clínico San Carlos y CIBER-CV, Madrid, Spain
open access
Abstract
Background: The aim of the study was to create a straightforward method to rule out abnormalities in electrocardiograms (ECGs) performed in patients with pacemakers.
Methods: The TBC method screens the ECG for any of the following findings: Tachycardia with pacing spikes, Bradycardia without spikes and Chaos with spikes unrelated to QRS-T complexes. T was considered to advise for patient assessment and B and C to require referral for urgent pacemaker evaluation. The diagnostic accuracy of the algorithm was validated using a cohort of 151 ECGs with normal and dysfunctional pacemakers. The effect of the algorithm was then evaluated for diagnostic skills and management of patients with pacemakers by non-cardiologists, comparing their diagnostic accuracy before and after teaching the algorithm.
Results: The TBC algorithm had a sensitivity of 86% and a specificity of 94% in diagnosing a malfunctioning pacemaker. The diagnostic skills and patient referral were significantly improved (74.8% vs. 89.5%, p < 0.001; and 57.4% vs. 83%, p < 0.001).
Conclusions: TBC is an easy to remember and apply method to rule out severe abnormalities in ECGs of patients with pacemakers. TBC algorithm has a very good diagnostic capability and is easily applied by non-expert physicians with good results.
Abstract
Background: The aim of the study was to create a straightforward method to rule out abnormalities in electrocardiograms (ECGs) performed in patients with pacemakers.
Methods: The TBC method screens the ECG for any of the following findings: Tachycardia with pacing spikes, Bradycardia without spikes and Chaos with spikes unrelated to QRS-T complexes. T was considered to advise for patient assessment and B and C to require referral for urgent pacemaker evaluation. The diagnostic accuracy of the algorithm was validated using a cohort of 151 ECGs with normal and dysfunctional pacemakers. The effect of the algorithm was then evaluated for diagnostic skills and management of patients with pacemakers by non-cardiologists, comparing their diagnostic accuracy before and after teaching the algorithm.
Results: The TBC algorithm had a sensitivity of 86% and a specificity of 94% in diagnosing a malfunctioning pacemaker. The diagnostic skills and patient referral were significantly improved (74.8% vs. 89.5%, p < 0.001; and 57.4% vs. 83%, p < 0.001).
Conclusions: TBC is an easy to remember and apply method to rule out severe abnormalities in ECGs of patients with pacemakers. TBC algorithm has a very good diagnostic capability and is easily applied by non-expert physicians with good results.
Keywords
(MeSH; *: major): pacemaker, artificial*; pacemaker, artificial/education; pacemaker, artificial/therapy; electrocardiography*; electrocardiography/education
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About this articleTitle
TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers
Journal
Issue
Pages
136-141
Published online
2018-08-14
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3339
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1136
DOI
Pubmed
Bibliographic record
Cardiol J 2020;27(2):136-141.
Keywords
(MeSH
*: major): pacemaker
artificial*
pacemaker
artificial/education
pacemaker
artificial/therapy
electrocardiography*
electrocardiography/education
Authors
Javier Higueras
Carmen Olmos
Julián Palacios-Rubio
Juan Carlos Gómez-Polo
Pedro Martínez-Losas
Virginia Ruiz-Pizarro
Ramón Bover
Julián Pérez-Villacastín
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