Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes

In a clinical study, a novel wireless electrocardiogram (ECG) recorder has been evaluated with regard to its ability to perform arrhythmia diagnostics. As the ECG recorder will detect a “non-standard” ECG signal, it has been necessary to compare those signals to “standard” ECG recording signals in order to evaluate the arrhythmia detection ability of the new system. Simultaneous recording of ECG signals from both the new wireless ECG recorder and a conventional Holter recorder was compared by two independent cardiology specialists with regard to signal quality for performing arrhythmia diagnosis. In addition, calculated R–R intervals from the two systems were correlated. A total number of 16 patients participated in the study. It can be considered that recorded ECG signals obtained from the wireless ECG system had an acceptable quality for arrhythmia diagnosis. Some of the patients used the wireless sensor while doing physical sport activities, and the quality of the recorded ECG signals made it possible to perform arrhythmia diagnostics even under such conditions. Consequently, this makes possible improvements in correlating arrhythmias to physical activities.     

A wearable real-time telemonitoring electrocardiogram device compared with traditional Holter monitoring

Arrhythmias are very common in the healthy populations as well as patients with cardiovascular diseases. Among them, atrial fibrillation (AF) and malignant ventricular arrhythmias are usually associated with some clinical events. Early diagnosis of arrhythmias, particularly AF and ventricular arrhythmias, is very important for the treatment and prognosis of patients. Holter is a gold standard commonly recommended for noninvasive detection of paroxysmal arrhythmia. However, it has some shortcomings such as fixed detection timings, delayed report and inability of remote real-time detection. To deal with such problems, we designed and applied a new wearable 72-hour triple-lead H3-electrocardiogram (ECG) device with a remote cloud-based ECG platform and an expert-supporting system. In this study, 31 patients were recruited and 24-hour synchronous ECG data by H3-ECG and Holter were recorded. In the H3-ECG group, ECG signals were transmitted using remote real-time modes, and confirmed reports were made by doctors in the remote expert-supporting system, while the traditional modes and detection systems were used in the Holter group. The results showed no significant differences between the two groups in 24-hour total heart rate (HR), averaged HR, maximum HR, minimum HR, premature atrial complexes (PACs) and premature ventricular complexes (PVCs) (P>0.05). The sensitivity and specificity of capture and remote automatic cardiac events detection of PACs, PVCs, and AF by H3-ECG were 93% and 99%, 98% and 99%, 94% and 98%, respectively. Therefore, the long-term limb triple-lead H3-ECG device can be utilized for domiciliary ECG self-monitoring and remote management of patients with common arrhythmia under medical supervision.     

基于80C196KC单片机的便携式家庭心/电血压监护仪的研制

应用80C196KC构成一个循环存储8小时心电数据的便携式心电／血压监护仪,其核心单元是80C196KC单片机,还包括Flash Memory（闪速存储器）存贮模块,Socket Modem通讯模块,薄膜键盘,血压数据接口,液晶显示模块和电源转换模块。其特点是集心电图采集、分析、存储和显示等功能于一体,实现动态心电分析监护及心律失常的识别和报警,并把出现病变时的心电、血压数据通过电话线传到医院中心站,接收返回医嘱。心电信号实时自动分析系统包括QRS复合波的实时检测算法和心律失常自动分析软件,可以显示心电波,心率（HR）和早搏（室早、房早）累积数;自动识别6种心律失常报警。通过对MIT心电数据库的部分数据进行测试,结果表明仪器硬件设计合理,心电分析算法和疾病判出的实时性和准确性基本满足要求,其中QRS波群检出正确率为99.9%,停搏、漏搏和心动过速过缓检出的准确率均在98％以上,而早搏（室早、房早）和R on T检出的准确率在95％以上。     

融合单导联心电图传统与深度特征的常见心律失常识别方法研究

心律失常是心血管疾病中最为常见的疾病类型之一.基于便携式设备,对少数导联的心电图进行长期智能监护,有利于提高心律失常的检出率,但产生的海量长程ECG数据会给临床医生带来极大的工作负担,也容易导致漏检和误判.为此,提出一种融合单导联心电图传统与深度特征的常见心律失常自动识别方法.首先针对常见心律失常,提取频域、时域和形态...     

Development and preliminary clinical tests of an impedance sensing VDD recording pacemaker for diagnosis and research

Episodes of serious but infrequently occurring cardiac arrhythmias can be difficult to detect and analyse, even with modern Holter monitoring. A previous diagnostic pacemaker developed by this group provided VVI pacing therapy and recorded intracardiac ECG signals but had no atrial sensing or impedance measuring capability. A new external diagnostic pacemaker system is described that has been developed to assist in diagnosing intermittent arrhythmias by selectively recording intracardiac signals. Unlike other ambulatory monitors, in addition to recording ECG, the device combines VDD pacing therapy with the capability of monitoring and recording intracardiac impedance and pressure waveforms through a temporary intracardiac lead. A PCMCIA memory card allows storage of 48 arrhythmic events of 21 seconds each. Twelve seconds of waveform are retained before the event occurs and nine seconds after. Data retrieval and processing is performed with a PC which reconstructs each waveform for display. The ECG provides data on cardiac rhythm while cardiac function is inferred from the haemodynamic signals. During simulated trials, 14 event types were presented to the system. All events were successfully detected and recorded. During in vivo clinical tests 83 waveform recordings were made. Impedance fluctuations with typical peak-to-peak values of 64 ohms were successfully recorded.     

Development and preliminary clinical tests of an impedance sensing VDD recording pacemaker for diagnosis and research

Episodes of serious but infrequently occurring cardiac arrhythmias can be difficult to detect and analyse, even with modern Holter monitoring. A previous diagnostic pacemaker developed by this group provided VVI pacing therapy and recorded intracardiac ECG signals but had no atrial sensing or impedance measuring capability. A new external diagnostic pacemaker system is described that has been developed to assist in diagnosing intermittent arrhythmias by selectively recording intracardiac signals. Unlike other ambulatory monitors, in addition to recording ECG, the device combines VDD pacing therapy with the capability of monitoring and recording intracardiac impedance and pressure waveforms through a temporary intracardiac lead. A PCMCIA memory card allows storage of 48 arrhythmic events of 21 seconds each. Twelve seconds of waveform are retained before the event occurs and nine seconds after. Data retrieval and processing is performed with a PC which reconstructs each waveform for display. The ECG provides data on cardiac rhythm while cardiac function is inferred from the haemodynamic signals. During simulated trials, 14 event types were presented to the system. All events were successfully detected and recorded. During in vivo clinical tests 83 waveform recordings were made. Impedance fluctuations with typical peak-to-peak values of 64 ohms were successfully recorded.     

Mobile telemonitoring for arrhythmias in outpatients in the republic of georgia: a brief report of a pilot study

Abstract As the very first trial of mobile telemedicine in the Republic of Georgia, in June-December 2010 we investigated 35 outpatients with different types of arrhythmia (male/female ratio=16/19; 12-80 years old), among them 5 patients with concomitant epilepsy. The control group comprised 7 clinically healthy sportsmen (soccer players, all men; 15-17 years old), during a 30-min velo ergometer stress test. A three-lead electrocardiogram (ECG) loop recorder (Vitaphone BT 3300; Vitasystems GmbH, Mannheim, Germany) was used in automatic mode, using special LRMA software (MDT, Lázně Bohdane?, Czech Republic) and a Nokia (Espoo, Finland) model 6730 Symbian phone. Automatically recorded arrhythmia events were transmitted from the loop recorder by Bluetooth(?) (Bluetooth SIG, Inc., Kirkland, WA) to a phone and then by 3G (through our partner mobile operator, MagtiCom Ltd. [Tbilsi, Georgia]) to the Vitasystems server in Germany and were available to Georgian physicians via e-mail/Internet. Arrhythmias were recorded/monitored during 7-68?h of observation. The number of automatically recorded ECG events varied between 3 and 170 per observation, or 0.4-10.7 hourly. Cases of sinus brady- and tachyarrhythmia, sinus node weakness syndrome, atrial fibrillation, supraventricular tachycardia, supraventricular premature complexes, and ventricular premature complexes were correctly recognized by automatic recognition software and recorded. In 3 patients and 1 sportsman previously unspecified (despite multiple investigations), arrhythmias were recorded: paroxysmal tachycardia (n=1), sinus node weakness syndrome (n=1), and ventricular premature complexes (n=2). In 3 cases (all women) light insomnia and nervousness were reported. In 2 patients with neurosis (both elderly men, 1 with epilepsy) we had to stop investigation prematurely because of anxiety/agitation. Mobile telecardiology represents feasible methodology to monitor arrhythmias in outpatients in Georgia, promoting earlier discharge of non-life-threatening cases, improving patients' comfort of life, and increasing their mobility with enhanced safety. Mobile telehealth might also represent significant cost-saving for insurance companies (this is an ongoing study). Finally, in remote areas mobile telemonitoring of patients will improve quality of care by timely provision of a second opinion in cases when local expertise is not sufficient.     

携带式远程实时心电监测仪在心律失常诊断中的应用

目的通过与动态心电图（Hoher）记录的心电图比较,检验携带式远程实时心电检洲仪（AKM—N1型,简称心电检测仪）临床应用的价值。方法选取2011年10～11月存北京安贞医院心内科住院和门诊以心律失常为主要表现的心脏病患者36例,其中男性2l例,女性15例,平均年龄（43．0±14．8）岁。所有人选患者同时行心电检测仪和Holier监测,比刈’两行同步记录的心电蚓数据（包括P波时限、PR间期、QRS波群时限、QT间期、RR间期、有无伪差与干扰、有无心律失常及心律失常类,型）足否一致。两组分别选取相同时间点比对上述参数,包括记录的第10分钟、第20分钟、第30分钟、筇40分钟和第50分钟开始的30S心电数据,以及在受试者心脏不适或临床医生指示的情情下,2次同步按压两者的“捕捉键”进行心电捕捉的30S记录。结果36例入选患者有29例检测到心律失常。两种榆测方法得到的不同时间的P波时限、QRS波群时限、PR间期、QTM期与RR间期无差异,两种方法检出心律失常的情况高度关联（P〈0．001）,检出心律失常的比例无差异（P=1．0）。两种检测方法出现伪差与干扰的比例无差别,但出现伪差与干扰情况的关联性不肯定。临床试验过程无不良反应。结论携带式远程实时心电监测仪（AKM—N1型）获得的心电数据准确,对心律失常的诊断能力与Holter相当,借助网络传输,可及时指导患者治疗。     

Clinical evaluation of ECG at the onset subjective symptoms using real-time analysis electrocardiograph (event recorder)

Examination of patient complaining of palpitation, chest pain and chest discomfort is usually performed by 12-lead electrocardiograph. However, the recording time is short and there are few opportunities to capture an ECG demonstrating conditions during subjective symptoms. To investigate the cause, we need to obtain an ECG during subjective symptoms. Thus, we frequently use a Holter ECG, which can be recorded for 24 hours. However, some patients have a low frequency of subjective symptoms, which may not appear during a 24-hour examination. We used a real-time electrocardiograph (Event Recorder CG-6106 made by Card Guard Scientific Survival Limited) as a monitor during subjective symptoms. Thereafter, ECG findings at the onset of subjective symptoms could be analyzed in 30 patients who did not have a clear cardiac disease. In this examination, arrhythmia was recorded in 25 of 30 cases. Although in these cases ECG during subjective symptoms could not be captured even when Holter examination was performed several times ECG during subjective symptoms was captured using an Event Recorder. This method using an Event Recorder is simple and convenient, moreover, is considered very useful for investigation of subjective symptoms. In the future, the use of an Event Recorder for heart-health-care in the daily life of healthy people and/or cardiac disease patient is highly anticipated.     

三通道动态心电记录分析系统

作者介绍中心研制的一种三通道Ｈｏｌｔｅｒ系统，用于和时间动态心电图的记录和分析。此系统在硬件线路中采用了专门的校正技术，以补偿记录器因带速不稳带来的误差，该系统的记录器功耗十分低，可以连接记录７２小时的动态心电图，系统软件内容丰富，功能完善，整个系统性能稳定可靠，具有较高的性能价格比。     

Interrelationship between cardiac structure and function and incidence of arrhythmia in peritoneal dialysis patients

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1+/-13.8 years) underwent twice (interval of 20+/-4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.     

基于PDA的嵌入式ECG监护分析仪

目的为了方便快捷地实时监测心律失常,设计一种基于PDA的嵌入式ECG监护分析仪。方法仪器功能包括低功耗MSP430系列单片机控制心电信号的采集、放大、滤波、转换和在PDA上实时显示、存储和分析,并实现心电数据的远程传输。对仪器工作原理进行分析,把监护分析仪总体结构划分为子模块,并具体介绍各子模块的功能与实现。结果与结论与医院现有的三导全自动心电图机、Holter动态心电图机进行对照,本监护分析仪携带方便、操作简单、接收的心电信号无失真,连续工作时间大于20h等。各高频干扰信号对ECG信号无影响;软件可对心电信号进行实时显示,可连续记录15h的原始心电数据。     

动态心电采集记录系统的发展与展望

动态心电图(DCG)有助于及时发现一些导致心脏猝死(SCD)的危险因素,是检测及发现心律失常的最佳设备,而其采集记录系统是影响心电数据质量及佩戴舒适性的主要原因,因此本文通过归纳和分析国内外DCG监测技术的最新研究近展,阐明了在DCG监测领域中,新型心电电极、无导联线连接的动态监测等研究的重要性。最后对动态心电采集记录系统存在的问题作了总结与分类,并对其发展前景作了展望。     

基于嵌入式调制解调器的心电数据远程传输系统的设计

本文介绍了一种通过嵌入式调制解调器与公共电话网实现心电数据远程传输的系统,系统由家庭单元、公共电话网和中心工作站组成.该系统通过嵌入式调制解调器与公共电话网可将家庭单元的心电记录器采集的心电信号传输到远处的中心工作站(医院或监护中心),由中心工作站对患者进行心电监护.系统特点在于数据传输采用并行嵌入式调制解调器,它具有体积小、功耗低、携带方便、传输速度快等特点.     

A ECG Tele-monitoring Method and System Based on Embedded Web Server

This paper describes the development of a new ECG tele-monitoring method and system based on the embedded web server.The system consists of ECG recorders with network interface and the embedded web server,internet networks and computers,with the system operating on browser/server(B/S) mode.The ECG recorder was designed by ARM9 (S3C2410X) and embedded operating system (Linux).Once the ECG recorder has been connected to the internet network,medical experts can use the internet to access the server of the ECG recorder,monitor ECG signals,and diagnose patients by browsing the dynamic web pages in the embedded web server.The experimental results reveal that the designed system is stable,reliable,and suitable for the use in real-time ECG tele-monitoring for both family and community health care.     

基于工控机的除颤仪的研究

目的：研制一台基于工控机的具有心电监护和除颤功能的除颤仪。方法：本项研究利用一块工控机主板（PⅡ/233CPU），心电电极，除颤电极，心电监护模块，12位模/数转换器，自行设计的除颤高压发生和控制模块，除颤执行模块，保护和隔离模块等构成本仪器的硬件，本项研究主要利用C语言设计本实验样机的软件，包括主控制程序，心电监视中断子程序和除颤中断子程序等，本项研究还利用电刺激方法建立实验犬的室颤模型，并利用4条实验犬进行体内和体外的除颤实验。结果：本项研究所采用的电刺激方法可以建立实验犬的室颤模型。所研制的实验样机可实时监护实验犬的心电信号和成功进行实验犬的体内和体外的除颤实验。结论：所研制的实验样机是一个新型的有临床应用前景的心电监护和除颤仪。     

Recent progress in electrocardiography

Recent advances in electrocardiography (ECG) have revealed new and useful information concerning the electrophysiologic properties of the normal and diseased heart. 1) Evaluation of the frequency of ventricular premature contractions (VPCs) as a function of underlying heart rate with Holter ECG recordings is a useful approach to elucidate the mechanisms of ventricular arrhythmias and to predict the response of ventricular arrhythmias to antiarrhythmic agents. 2) Decreased heart rate variability, presence of late potential, prolonged QT interval, increased QT interval dispersion, and T wave alternans indicate lethal ventricular tachyarrhythmias and sudden cardiac death. 3) The multiple reentrant wave hypothesis has been widely accepted for the mechanism of atrial fibrillation (AF). Recently, spontaneous initiation of AF by ectopic beats originating from the superior vena cava and the pulmonary veins has been reported. Radiofrequency ablation of the focal source of AF completely prevented the recurrence of AF.     

脑电与心电同步检测对癫痫性与心律失常性晕厥的鉴别诊断价值

目的 :探讨 2 4小时脑电 /心电同步监测对癫性晕厥和心律失常性晕厥的诊断和鉴别诊断价值。方法 :对 72例临床怀疑癫性晕厥和心律失常性晕厥患者进行 2 4小时动态脑电图 (AEEG) /心电图 (ECG)同步监测。结果 :①癫性晕厥 42例中 ,EEG总异常率 83 91%。样放电出现率71 2 4% ;心电图显著异常率 19% ;②心律失常性晕厥 2 1例中 ,EEG总异常率 2 4% ,样放电出现率 5 % ,心电图显著异常 91% ;③可疑癫性晕厥 4例中 ,AEEG样放电 1例 ;④可疑心律失常性晕厥 3例 ,ECG均为非显著异常 ;⑤晕厥原因不明 (癫与心律失常两种疾病并存 ) 2例 ,均检出样放电及显著心律失常。结论 :2 4小时EEG/ECG同步监测对癫性晕厥和心律失常性晕厥有重要的诊断和鉴别诊断的价值。     

急性乌头碱中毒心电图分析

目的：探讨急性乌头碱中毒患者的心电图特点.方法：对我院2009年1月至2013年12月收治的32例急性乌头碱中毒病例分析心电图的特点.结果：乌头碱中毒主要表现为心脏及神经系统损害症状.32例患者心电图检查均发现不同程度异常,室性心律失常为主,经及时彻底地洗胃和抗心律失常治疗,心律失常迅速消失,心电图转为正常.结论：乌头碱中毒的心电图表现多样化,以室性心律失常最多见,其严重性直接反映临床急性中毒的严重程度,及时应用利多卡因可有效控制心律失常.