6 ECG, Arrhythmia, ST and QT Monitoring
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• the normal QRS complex should be either completely above or below the baseline and it should
not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace
pulses.
• the QRS complex should be tall and narrow
• the P-waves and the T-waves should be less than 0.2 mV.
For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They
are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave
channel height and is independent of the actual pacer amplitude.
Setting the Paced Mode (Pace Pulse Rejection)
Avoiding Pace Pulse Repolarization Tails
Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as
QRSs in the event of cardiac arrest or other arrhythmias.
If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.
Changing the Size of the ECG Wave
If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the
ECG waves on the screen.
In the
Setup ECG menu, select Paced Mode to switch between On, Off or
Unconfirmed.
You can also change the paced mode in the
Patient Demographics window.
When
Paced Mode is set to On:
– Pace Pulse Rejection is switched on. This means that pacemaker pulses
are not counted as extra QRS complexes.
– pace pulse marks are shown on the ECG wave as a small dash (only
when the pacer spikes are not configured to have a fixed size).
– The paced symbol is displayed next to the HR numeric.
When
Paced Mode is set to Off, pacer spikes are not shown in the ECG wave.
Be aware that switching pace pulse rejection off for paced patients may result
in pace pulses being counted as regular QRS complexes, which could prevent
an asystole event from being detected.
When the paced mode has not yet been set for a patient, the paced symbol will
have a question mark indicating the
Unconfirmed mode. When the paced
mode is
Unconfirmed, pace pulse rejection is switched on.
Paced Mode On
Paced Mode Off
Paced Mode
Unconfirmed
1 Repolarization tail (note width)
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