Will Kardia or similar show atrial pacing vs ventricular pacing?

Can I tell from my Kardia (or similar) if I am being atrially or ventricularly paced?  Any ideas folks?


8 Comments

Kardia

by AgentX86 - 2020-07-16 13:46:15

It won't show the difference directly but you should be able to see the difference on the EKG. Pacing spikes are obvious so aligning them with the QRS waveform should tell you that it's ventricular pacing. I gave my Kardia Mobile to .y son (I don't need it anymore) so I can't test the above. I may have some old strips on my laptop that I may be able to find later.

Kardia

by Old_Mainer - 2020-07-16 14:07:42

I understand "QRS" but the term "pacing spikes" is new.  Can you explain that?

Thanks.

spikes

by Tracey_E - 2020-07-16 15:07:06

Pacing shows up on an ecg as a big sharp spike among the bumps the heart does on its own. You can't miss it. If you google it, you can find images. 

Pacing Spikes

by Old_Mainer - 2020-07-16 21:00:21

Further research suggest the pacing spikes are 2 milliseconds or less.  The Kardia filters out such brief signals as noise.  So I'm outta luck there. 

Pacing spikes

by AgentX86 - 2020-07-16 23:36:05

Pacing spikes are visible on the Kardia trace.  Normal P-waves are unipolar and fairly small.  Pacing waves, at least on modern pacemakers, are bipolar. I can't paste an example trace here.

 

Pacing Spikes

by Old_Mainer - 2020-07-17 10:37:46

Thanks AgentX86.

Here is a trace from a little bit ago with a PVC in the middle:
https://sharableimages.shutterfly.com/pictures

My pacemaker is set at 55 minimum HR and stays there unless I am quite active (I have an "athletes heart".  Pre-pacemaker I'd be in the 40s at rest.  I can't detect any spikes.

Could spikes from pacing the ventrical be visible but not pacing the atrium?

 

Kardia pacing spikes

by AgentX86 - 2020-07-17 14:23:37

It looks to me like you're paced 100%. Mine has a very pronounced bipolar pacing spike, perhaps because I'm paced 100% in the ventricles. Yours doesn't show that so clearly, though it is there.

Yours shows the pacing spike as being larger than the QRS following it. Normally,  the R wave will be a lot smaller that the QRS and about the same size as the T.

What's interesting about the PVC is that you can clearly see that the PM inhibits during that cycle, restarts its timer, and continues at the same pace offset by the time the PVC occurs after the previous pacing impulse.

Spikes

by Old_Mainer - 2020-07-17 14:58:29

I've added a non-afib trace from before the pacemaker was installed.  The p,qrs and t wave appearance looks about the same to me.  By that logic on today's trace the pvc's qrs wave doubles in amplitude and its t wave inverts.

I'm trying to reconcile our views.  Do you think that the traces are sufficiently different that I am confusing what parts of the new trace are what?.

https://sharableimages.shutterfly.com/pictures

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