Electrocardiographic predictors of pacemaker battery depletion: Diagnostic sensitivity, specificity, and clinical risk

Daniel Carlson, Joseph E. Marine, Charles J. Love, Jonathan Chrispin, Andreas S. Barth, John “Jack” Rickard, David D. Spragg, Ronald Berger, Hugh Calkins, Gordon F. Tomaselli, Sunil K. Sinha

Research output: Contribution to journalArticle

Abstract

Background: Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events. Objective: Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk. Methods: This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. Results: We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2%) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0%), high specificity (92.6%), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P <.001) and adverse clinical events (P <.025). Conclusions: The “Rules of Ten” provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

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Electrocardiography
Sensitivity and Specificity
Electronic Health Records
Cohort Studies

Keywords

  • elective replacement indicator
  • elective replacement time
  • electrocardiogram
  • pacemaker battery depletion
  • pacemaker generator replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{bc95de9d8daf408fa92c87e4bd16b516,
title = "Electrocardiographic predictors of pacemaker battery depletion: Diagnostic sensitivity, specificity, and clinical risk",
abstract = "Background: Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events. Objective: Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk. Methods: This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. Results: We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2{\%}) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0{\%}), high specificity (92.6{\%}), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P <.001) and adverse clinical events (P <.025). Conclusions: The “Rules of Ten” provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.",
keywords = "elective replacement indicator, elective replacement time, electrocardiogram, pacemaker battery depletion, pacemaker generator replacement",
author = "Daniel Carlson and Marine, {Joseph E.} and Love, {Charles J.} and Jonathan Chrispin and Barth, {Andreas S.} and Rickard, {John “Jack”} and Spragg, {David D.} and Ronald Berger and Hugh Calkins and Tomaselli, {Gordon F.} and Sinha, {Sunil K.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/pace.13831",
language = "English (US)",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Electrocardiographic predictors of pacemaker battery depletion

T2 - Diagnostic sensitivity, specificity, and clinical risk

AU - Carlson, Daniel

AU - Marine, Joseph E.

AU - Love, Charles J.

AU - Chrispin, Jonathan

AU - Barth, Andreas S.

AU - Rickard, John “Jack”

AU - Spragg, David D.

AU - Berger, Ronald

AU - Calkins, Hugh

AU - Tomaselli, Gordon F.

AU - Sinha, Sunil K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events. Objective: Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk. Methods: This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. Results: We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2%) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0%), high specificity (92.6%), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P <.001) and adverse clinical events (P <.025). Conclusions: The “Rules of Ten” provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.

AB - Background: Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events. Objective: Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk. Methods: This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. Results: We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2%) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0%), high specificity (92.6%), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P <.001) and adverse clinical events (P <.025). Conclusions: The “Rules of Ten” provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.

KW - elective replacement indicator

KW - elective replacement time

KW - electrocardiogram

KW - pacemaker battery depletion

KW - pacemaker generator replacement

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U2 - 10.1111/pace.13831

DO - 10.1111/pace.13831

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