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The first spike indicates stimuli to the atria, while the second pacemaker spike indicates initiation of ventricular contraction.
Pacemakers have one to three leads which provide pacing and sensing activity.
They are classified using three, four and sometimes even five letters which describe the function of the pacemaker.
This electrocardiogram demonstrates an artificial cardiac pacemaker which is responsible for initiating contractions within the atria as well as the ventricles.
Note the double pacemaker spikes associated with each complete cycle of contraction.
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Accepting the NEJM cookie is necessary to use the website.This chapter addresses the different types of pacemakers with their various functions and classifications.In addition, it will review what to look for on the ECG in order to identify pacemaker malfunctions.In order to interpret ECGs with paced rhythms, it is important to understand the basic functions of pacemakers and how these functions manifest on the surface ECG.After the basic functions are understood, pacemaker malfunctions and other subtle functions can be interpreted on the ECG.These functions include which chambers are sensed, which chambers are potentially paced, which chambers cause inhibition of the pacemaker and if the pacemaker has the ability to be responsive to activity. The letter can be A (atrial only), V (ventricular only) or D (dual or both chambers).