Accuracy of the pacemaker event recorder versus Holter‐ECG to detect both symptomatic and asymptomatic ventricular arrhythmias

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Cardiac arrhythmias are risk markers for cardiovascular mortality. Compared to patients with similar ejection fraction, those with higher occurrence of ventricular arrhythmias have significantly greater mortality risk. Ventricular tachycardias, even in the absence of structural heart disease, are considered independent risk markers of sudden cardiac death (SCD).1 The analysis of ventricular arrhythmias therefore is very useful for risk stratification and the follow‐up management of patients with cardiac diseases.1 The 24 hour Holter is considered the gold standard method for monitoring the ambulatory electrocardiogram (ECG).4
Current implantable pacemakers offer to the patients a better quality of life due to the existence of mathematical algorithms that aim to mimic the physiological behavior of the heart by individualized programming.6 They also provide the possibility of monitoring the patient’s cardiac rhythm through the intracavitary register of electrograms. Some authors call them as “intelligent pacemakers,” because of their more precise information storage, such as electrocardiographic telemetry and event markers and counters. This set of resources is supposed to allow a constant diagnostic monitoring and, consequently, an improvement of the therapeutic management of the patients.10
Given the clinical relevance of ventricular arrhythmias allied to the diagnostic opportunity provided by the current implantable pacemaker systems, it becomes very important to assess the accuracy of detection and recording of arrhythmias using this monitoring approach. Few studies were performed evaluating the quality of the pacemakers’ recordings of ventricular arrhythmias. It is of utmost importance to verify the consistency of these records in order to consolidate the usefulness of this tool for long‐term follow‐up of patients who carry implanted pacemakers.
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