Cardiostimulator rhythm
Cardiostimulator significantly changes the picture of the electrocardiogram (ECG). At the same time, the operating cardiostimulator changes the shape of the complexes on the ECG so that it becomes impossible to judge anything from them. In particular, the work of the cardiostimulator can mask ischemic changes and myocardial infarction. On the other hand, since modern cardiostimulators work "on demand", the absence of signs of the cardiostimulator's work on the electrocardiogram does not mean its breakdown. Although it is not uncommon for paramedics, and sometimes for doctors, without the right reasons, to declare to the patient "your cardiostimulator is not working ", which greatly irritates the patient. In addition, the prolonged presence of right ventricular stimulation alters the shape of ECG complexes, sometimes imitating ischemic changes. This phenomenon is called " Chatterjee syndrome" (Kanu Chatterjee).
Thus, the interpretation of the ECG in the presence of a cardiostimulator is difficult and requires special training. If an acute pathology of the heart (ischemia, myocardial infarction) is suspected, its presence / absence should be confirmed by other methods (more often - laboratory methods). The criterion of correct / incorrect operation of the cardiostimulator is more often not the usual ECG, but a check with the programmer and in some cases daily ECG monitoring.
It should be noted that in analyzing the work of modern cardiostimulators, a number of functions can mimic the improper operation of the cardiostimulator. And there are no ways to distinguish the correct / incorrect operation of the cardiostimulator on the ECG. The physician of functional diagnostics, if he does not have a special training on cardiostimulator programming and does not have exhaustive data on the programmed regimens of this particular cardiostimulator in this patient, cannot make final judgments about the adequacy of the work of the cardiostimulator (except for cases of obvious violation of the functions of the device). In case of doubt, patients should be referred for consultations at the site of programming / testing of the cardiostimulator.
