open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-08-14
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TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers

Javier Higueras, Carmen Olmos, Julián Palacios-Rubio, Juan Carlos Gómez-Polo, Pedro Martínez-Losas, Virginia Ruiz-Pizarro, Ramón Bover, Julián Pérez-Villacastín
DOI: 10.5603/CJ.a2018.0079
·
Pubmed: 30155867
·
Cardiol J 2020;27(2):136-141.

open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-08-14

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.

Get Citation

Keywords

(MeSH; *: major): pacemaker, artificial*; pacemaker, artificial/education; pacemaker, artificial/therapy; electrocardiography*; electrocardiography/education

Supplementary Files (1)
ECGs used for testing TBC
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About this article
Title

TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers

Journal

Cardiology Journal

Issue

Vol 27, No 2 (2020)

Pages

136-141

Published online

2018-08-14

DOI

10.5603/CJ.a2018.0079

Pubmed

30155867

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

References (11)
  1. Cano Pérez Ó, Pombo Jiménez M, Fidalgo Andrés ML, et al. Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016). Rev Esp Cardiol (Engl Ed). 2017; 70(12): 1083–1097.
  2. Raatikainen MJ, Arnar DO, Zeppenfeld K, et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. 2015; 17 Suppl 1: i1–75.
  3. Martínez-Losas P, Higueras J, Gómez-Polo JC, et al. The influence of computerized interpretation of an electrocardiogram reading. Am J Emerg Med. 2016; 34(10): 2031–2032.
  4. Gómez-Polo JC, Higueras Nafría J, Martínez-Losas P, et al. Poor knowledge of potentially lethal electrocardiographic patterns in asymptomatic patients among noncardiologist physicians, and underestimation of their seriousness. Rev Esp Cardiol (Engl Ed). 2017; 70(6): 507–508.
  5. Pinkerton RE, Francis CK, Ljungquist KA, et al. Electrocardiographic training in primary care residency programs. JAMA. 1981; 246(2): 148–150.
  6. Woolley D, Henck M, Luck J. Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service. J Fam Pract. 1992; 34(4): 428–432.
  7. Goy JJ, Schlaepfer J, Stauffer JC. Competency in interpretation of 12-lead electrocardiogram among Swiss doctors. Swiss Med Wkly. 2013; 143: w13806.
  8. Mahler SA, Wolcott CJ, Swoboda TK, et al. Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture. Med Educ. 2011; 45(4): 347–353.
  9. Rankin J, Brown V. Creative teaching method as a learning strategy for student midwives: A qualitative study. Nurse Educ Today. 2016; 38: 93–100.
  10. Chew KS, Durning SJ, van Merriënboer JJg. Teaching metacognition in clinical decision-making using a novel mnemonic checklist: an exploratory study. Singapore Med J. 2016; 57(12): 694–700.
  11. Breen CJ, Bond R, Finlay D. An evaluation of eye tracking technology in the assessment of 12 lead electrocardiography interpretation. J Electrocardiol. 2014; 47(6): 922–929.

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