Furthermore, some ECG information such as pacemaker spike signal may become weaker and even get lost during the remote transmission. However, the small spike signal is becoming more and more difficult to discern with the widely use of dipolar pacemakers. The identification of pacemaker spike is important for the accurate diagnosis of pacemaker ECG. Different from general ECG, 1 key feature of pacemaker ECG is the pacemaker spike, which is a small signal just before the P wave or QRS wave. As we know, ECG is a primary evaluating tool for the patients with pacemaker implantation during follow-up, whether bedside or remote. And there is still no evidence-based minimum number of ECG interpretations that is ideal for attaining or maintaining competency in ECG interpretation skills. But the problem is that interpretations by several cardiologists reading the same ECG often vary substantially, especially for the remote ECG of pacemaker. Recently, remote ECG diagnostic system developed rapidly and achieved more and more attention with the development of information and communication techniques. Electrocardiogram (ECG) is widely used by routine clinical practices to better understand the working of the heart in all its details, and the cause of a large variety of cardiovascular disease, since it was invented by Willem Einthoven in 1902.
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