TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers

• Published in: Cardiology journal Vol. 27; no. 2; pp. 136 - 141
• Main Authors: Higueras, Javier, Olmos, Carmen, Palacios-Rubio, Julián, Gómez-Polo, Juan Carlos, Martínez-Losas, Pedro, Ruiz-Pizarro, Virginia, Bover, Ramón, Pérez-Villacastín, Julián
• Format: Journal Article
• Language: English
• Published: Poland Wydawnictwo Via Medica 18.05.2020; Via Medica
• Subjects: Algorithms; Clinical Cardiology; Electrocardiography; Pacemakers; Patients; electrocardiography/education; major): pacemaker; artificial; pacemaker; MeSH; artificial/education; artificial/therapy; electrocardiography
• ISSN: 1897-5593; 1898-018X; 1897-5593
• DOI: 10.5603/CJ.a2018.0079

The aim of the study was to create a straightforward method to rule out abnormalities in electrocardiograms (ECGs) performed in patients with pacemakers. The TBC method screens the ECG for any of the following findings: Tachycardia with pacing spikes, Bradycardia without spikes and Chaos with spikes unrelated to QRS-T complexes. T was considered to advise for patient assessment and B and C to require referral for urgent pacemaker evaluation. The diagnostic accuracy of the algorithm was validated using a cohort of 151 ECGs with normal and dysfunctional pacemakers. The effect of the algorithm was then evaluated for diagnostic skills and management of patients with pacemakers by non-cardiologists, comparing their diagnostic accuracy before and after teaching the algorithm. The TBC algorithm had a sensitivity of 86% and a specificity of 94% in diagnosing a malfunctioning pacemaker. The diagnostic skills and patient referral were significantly improved (74.8% vs. 89.5%, p < 0.001; and 57.4% vs. 83%, p < 0.001). TBC is an easy to remember and apply method to rule out severe abnormalities in ECGs of patients with pacemakers. TBC algorithm has a very good diagnostic capability and is easily applied by non-expert physicians with good results.