Teaching the TBC algorithm to non-cardiologists significantly improved their diagnostic accuracy for pacemaker ECGs from 74.8% to 89.5% (p<0.001) and appropriate patient referral from 57.4% to 83%.
Cohort (n=151)
Does teaching the TBC algorithm improve the ability of non-cardiologists to diagnose pacemaker abnormalities on ECGs?
The TBC algorithm is a simple, highly sensitive and specific tool that significantly improves the ability of non-cardiologists to identify severe pacemaker abnormalities on surface ECGs.
Absolute Event Rate: 89.5% vs 74.8%
p-value: p=<0.001
BACKGROUND: The aim of the study was to create a straightforward method to rule out abnormalities in electrocardiograms (ECGs) performed in patients with pacemakers. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Higueras et al. (Wed,) conducted a cohort in Patients with pacemakers (n=151). TBC algorithm vs. Before teaching the algorithm was evaluated on Diagnostic skills of non-cardiologists (p=<0.001). Teaching the TBC algorithm to non-cardiologists significantly improved their diagnostic accuracy for pacemaker ECGs from 74.8% to 89.5% (p<0.001) and appropriate patient referral from 57.4% to 83%.