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The Nuts and bolts of Paced ECG Interpretation

Tom Kenny

ISBN: 978-1-444-35707-3 September 2011 Wiley-Blackwell 488 Pages



Nothing is more perplexing to the clinician new to device therapy than having to deal with cardiac electrocardiograms from a device patient. Pacemakers and other implantable cardiac rhythm management devices leave their “imprint” on ECGs and can significantly change what clinicians see - or expect to see. Evaluating paced ECGs can be challenging, yet nowhere is it taught in any sort of comprehensive manner.

Designed specifically for clinicians new to device therapy, The Nuts and Bolts of Interpreting Paced ECGs and EGMs offers practical, reliable and objective information on paced cardiac electrograms. Written in a lively, intelligent and easy to navigate style, emphasizing real-life clinical practice and practical tips, this book includes illustrated paced ECGs by skilled artists to help minimize “fuzzy” lines and emphasize key points. Each chapter concludes with a checklist of key points from each subject (“Nuts and Bolts”).


Before We Start ….

Part I Timing Cycles and Troubleshooting Review.

1 Calculating Rates and Intervals.

2 Pacing Spikes.

3 The Basics of Capture and Sensing.

4 In Depth: Modes.

5 Ventricular Sensing.

6 Pacing Intervals.

7 Loss of Capture.

8 Oversensing.

9 In Depth: Sensing.

10 QRS Morphologies.

11 Fusion and Pseudofusion.

12 In Depth: Single-Chamber Timing Cycles.

13 Intermittent Oversensing.

14 Undersensing.

15 Hysteresis Intervals.

16 In Depth: Hysteresis.

17 Rate Response.

18 Annotated ECGs.

19 AV Synchrony.

20 Atrial Tracking.

21 AV Conduction.

22 States of Dual-Chamber Pacing.

23 Maximum Tracking Rate.

24 Pacemaker Multiblock.

25 Pacemaker Wenckebach.

26 Pacemaker-Mediated Tachycardia.

27 Mode Switching.

28 In Depth: Upper-Rate Behavior in Dual-Chamber Pacemakers.

29 Troubleshooting the Paced ECG.

30 More Troubleshooting the Paced ECG.

31 Automatic Capture Algorithms.

32 Capture Testing.

33 In Depth: Basic Troubleshooting Guide.

34 Navigating the Intracardiac Electrogram.

35 Tracings from a Programmer (Combining E-grams with the ECG).

36 Stored Electrograms.

37 In Depth: Electrograms.

38 Conclusion.

Part II Workbook.

Introduction to Workbook.






?This is a concise, well-written introduction to the interpretation of paced rhythms with many well-done recreated practice ECGs that both educate and challenge readers.? (Doody?s Reviews , October 2009)
Practical, reliable and objective information on paced cardiac electrograms for clinicians new to device therapy

  • A lively, intelligent and easy to navigate style
  • Includes several illustrated paced ECGs per chapter, all done by artists to minimize unnecessary “fuzzy” lines, enhance anonymity, and emphasize key points
  • Emphasizes real-life clinical practice and practical tips
  • Each chapter ends with a checklist of “Nuts & Bolts” (key points on each subject)
  • Starts with the basics and concludes with advanced concepts