Vector-based pacemaker pulse detection algorithm for the surface ECG

The recent advancement of pacemaker technology: low power, biventricular (biV) pacing and adaptive pacing rate, has brought challenges for detection of pacemaker pulses (PPs) in the surface ECG. False positive PPs and undetected and unresolved PPs may consequently have a detrimental impact on a diagnostic ECG algorithm´s rhythm or morphology interpretations. We have developed an algorithm to strengthen an existing PP detection algorithm using vector information to reject false positive PPs and detect the existence of a second biV PP closely spaced in time. We collected ECGs from both biV and non-biV pacemakers for algorithm development and performance validation. After training on the development dataset, our algorithm showed a biV paced rhythm detection sensitivity of 94.3% with a detection specificity of 99.3%.