MYBPC3 hypertrophic cardiomyopathy can be detected by using advanced ECG in children and young adults.

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Fernlund, E; Liuba, P; Carlson, J; Platonov, P G; Schlegel, T T

2016-01-01

The conventional ECG is commonly used to screen for hypertrophic cardiomyopathy (HCM), but up to 25% of adults and possibly larger percentages of children with HCM have no distinctive abnormalities on the conventional ECG, whereas 5 to 15% of healthy young athletes do. Recently, a 5-min resting advanced 12-lead ECG test ("A-ECG score") showed superiority to pooled criteria from the strictly conventional ECG in correctly identifying adult HCM. The purpose of this study was to evaluate whether in children and young adults, A-ECG scoring could detect echocardiographic HCM associated with the MYBPC3 genetic mutation with greater sensitivity than conventional ECG criteria and distinguish healthy young controls and athletes from persons with MYBPC3 HCM with greater specificity. Five-minute 12-lead ECGs were obtained from 15 young patients (mean age 13.2years, range 0-30years) with MYBPC3 mutation and phenotypic HCM. The conventional and A-ECG results of these patients were compared to those of 198 healthy children and young adults (mean age 13.2, range 1month-30years) with unremarkable echocardiograms, and to those of 36 young endurance-trained athletes, 20 of whom had athletic (physiologic) left ventricular hypertrophy. Compared with commonly used, age-specific pooled criteria from the conventional ECG, a retrospectively generated A-ECG score incorporating results from just 2 derived vectorcardiographic parameters (spatial QRS-T angle and the change in the vectorcardiographic QRS azimuth angle from the second to the third eighth of the QRS interval) increased the sensitivity of ECG for identifying MYBPC3 HCM from 46% to 87% (pyoung endurance-trained athletes (100% vs. 69% for conventional ECG criteria, pyoung adults, a 2-parameter 12-lead A-ECG score is retrospectively significantly more sensitive and specific than pooled, age-specific conventional ECG criteria for detecting MYBPC3-HCM and in distinguishing such patients from healthy controls, including endurance

Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

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Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

2004-01-01

Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

Vectorcardiographic diagnostic & prognostic information derived from the 12-lead electrocardiogram: Historical review and clinical perspective.

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Man, Sumche; Maan, Arie C; Schalij, Martin J; Swenne, Cees A

2015-01-01

In the course of time, electrocardiography has assumed several modalities with varying electrode numbers, electrode positions and lead systems. 12-lead electrocardiography and 3-lead vectorcardiography have become particularly popular. These modalities developed in parallel through the mid-twentieth century. In the same time interval, the physical concepts underlying electrocardiography were defined and worked out. In particular, the vector concept (heart vector, lead vector, volume conductor) appeared to be essential to understanding the manifestations of electrical heart activity, both in the 12-lead electrocardiogram (ECG) and in the 3-lead vectorcardiogram (VCG). Not universally appreciated in the clinic, the vectorcardiogram, and with it the vector concept, went out of use. A revival of vectorcardiography started in the 90's, when VCGs were mathematically synthesized from standard 12-lead ECGs. This facilitated combined electrocardiography and vectorcardiography without the need for a special recording system. This paper gives an overview of these historical developments, elaborates on the vector concept and seeks to define where VCG analysis/interpretation can add diagnostic/prognostic value to conventional 12-lead ECG analysis. Copyright © 2015 Elsevier Inc. All rights reserved.

Sparse Matrix for ECG Identification with Two-Lead Features

Directory of Open Access Journals (Sweden)

Kuo-Kun Tseng

2015-01-01

Full Text Available Electrocardiograph (ECG human identification has the potential to improve biometric security. However, improvements in ECG identification and feature extraction are required. Previous work has focused on single lead ECG signals. Our work proposes a new algorithm for human identification by mapping two-lead ECG signals onto a two-dimensional matrix then employing a sparse matrix method to process the matrix. And that is the first application of sparse matrix techniques for ECG identification. Moreover, the results of our experiments demonstrate the benefits of our approach over existing methods.

Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT.

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Rowe, Matthew K; Moore, Peter; Pratap, Jit; Coucher, John; Gould, Paul A; Kaye, Gerald C

2017-05-01

Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12-lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG-gated multidetector contrast-enhanced computed tomography (MDCT) with the position derived from the surface 12-lead ECG. Eighteen patients with permanent RV leads were prospectively enrolled. Leads were placed in the RV septum (RVS) in 10 and the RV apex (RVA) in eight using fluoroscopy with anteroposterior and left anterior oblique 30° views. All patients underwent MDCT imaging and paced ECG analysis. ECG criteria were: QRS duration; QRS axis; positive or negative net QRS amplitude in leads I, aVL, V1, and V6; presence of notching in the inferior leads; and transition point in precordial leads at or after V4. Of the 10 leads implanted in the RVS, computed tomography (CT) imaging revealed seven to be at the anterior RV wall, two at the anteroseptal junction, and one in the true septum. For the eight RVA leads, four were anterior, two septal, and two anteroseptal. All leads implanted in the RVS met at least one ECG criteria (median 3, range 1-6). However, no criteria were specific for septal position as judged by MDCT. Mean QRS duration was 160 ± 24 ms in the RVS group compared with 168 ± 14 ms for RVA pacing (P = 0.38). We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT. © 2017 Wiley Periodicals, Inc.

Human Identification by Cross-Correlation and Pattern Matching of Personalized Heartbeat: Influence of ECG Leads and Reference Database Size.

Science.gov (United States)

Jekova, Irena; Krasteva, Vessela; Schmid, Ramun

2018-01-27

Human identification (ID) is a biometric task, comparing single input sample to many stored templates to identify an individual in a reference database. This paper aims to present the perspectives of personalized heartbeat pattern for reliable ECG-based identification. The investigations are using a database with 460 pairs of 12-lead resting electrocardiograms (ECG) with 10-s durations recorded at time-instants T1 and T2 > T1 + 1 year. Intra-subject long-term ECG stability and inter-subject variability of personalized PQRST (500 ms) and QRS (100 ms) patterns is quantified via cross-correlation, amplitude ratio and pattern matching between T1 and T2 using 7 features × 12-leads. Single and multi-lead ID models are trained on the first 230 ECG pairs. Their validation on 10, 20, ... 230 reference subjects (RS) from the remaining 230 ECG pairs shows: (i) two best single-lead ID models using lead II for a small population RS = (10-140) with identification accuracy AccID = (89.4-67.2)% and aVF for a large population RS = (140-230) with AccID = (67.2-63.9)%; (ii) better performance of the 6-lead limb vs. the 6-lead chest ID model-(91.4-76.1)% vs. (90.9-70)% for RS = (10-230); (iii) best performance of the 12-lead ID model-(98.4-87.4)% for RS = (10-230). The tolerable reference database size, keeping AccID > 80%, is RS = 30 in the single-lead ID scenario (II); RS = 50 (6 chest leads); RS = 100 (6 limb leads), RS > 230-maximal population in this study (12-lead ECG).

Diagnosing ARVC in Pediatric Patients Applying the Revised Task Force Criteria: Importance of Imaging, 12-Lead ECG, and Genetics.

Science.gov (United States)

Steinmetz, Michael; Krause, Ulrich; Lauerer, Peter; Konietschke, Frank; Aguayo, Randolph; Ritter, Christian Oliver; Schuster, Andreas; Lotz, Joachim; Paul, Thomas; Staab, Wieland

2018-05-12

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a potentially lethal disease that is well described in adults. In pediatric patients, however, identification of patients at risk of adverse events of ARVC remains a challenge. We aimed to determine which criteria of the revised Task Force Criteria (rTFC), alone or combined, have an impact on diagnosis of ARVC when compared to disease-specific genetic mutations in pediatric patients ≤ 18 years. Between September 2010 and December 2013, 48 consecutive young patients ≤ 18 years of age (mean 14, range of 12.9-15.1 years) underwent contrast-enhanced magnetic resonance imaging (CMR), genetic testing, and comprehensive clinical work-up for ARVC criteria to test for clinically suspected ARVC. As specified by the rTFC, patients were grouped into four categories: "definite," "borderline," "possible," and "none" ARVC. Of the 48 patients, 12 were found to have gene mutations of either the desmoplakin (9/12) or plakophilin (3/12) locus. According to rTFC 12/48 patients were considered as "definite" ARVC (25%), while 10/12 (83.3%) had an ARVC-specific gene mutation. Of the remaining 36 patients, 6 (12.5%) were grouped as "borderline" ARVC, 7 (14.6%) as "possible" ARVC (including the remaining two genetic mutations), and 22 (45.8%) as "none" ARVC, respectively. Statistical analysis of ARVC criteria in patients diagnosed with "definite" ARVC revealed high prevalence of positive findings by imaging (CMR and echocardiography) and positive genetics. The positive predictive value to detect "definite" ARVC by genotyping was 83.3%, while the negative predictive value was 94%. Logistic regression analyses for different criteria combinations revealed that imaging modalities (echo and CMR combined) and abnormalities of 12-lead ECG were significant markers (p < 0.01). Positive results of endomyocardial biopsies or arrhythmia on ECG or Holter as defined by the rTFC were not significant in this analysis. The rTFC for

Matrix of regularity for improving the quality of ECGs

International Nuclear Information System (INIS)

Xia, Henian; Garcia, Gabriel A; Zhao, Xiaopeng; Bains, Jujhar; Wortham, Dale C

2012-01-01

The 12-lead electrocardiography (ECG) is the gold standard for diagnosis of abnormalities of the heart. However, the ECG is susceptible to artifacts, which may lead to wrong diagnosis and thus mistreatment. It is a clinical challenge of great significance differentiating ECG artifacts from patterns of diseases. We propose a computational framework, called the matrix of regularity, to evaluate the quality of ECGs. The matrix of regularity is a novel mechanism to fuse results from multiple tests of signal quality. Moreover, this method can produce a continuous grade, which can more accurately represent the quality of an ECG. When tested on a dataset from the Computing in Cardiology/PhysioNet Challenge 2011, the algorithm achieves up to 95% accuracy. The area under the receiver operating characteristic curve is 0.97. The developed framework and computer program have the potential to improve the quality of ECGs collected using conventional and portable devices. (paper)

Observer variability and optimal criteria of transient ischemia during ST monitoring with continuous 12-lead ECG.

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Jernberg, Tomas; Cronblad, Jörgen; Lindahl, Bertil; Wallentin, Lars

2002-07-01

ST monitoring with continuous 12-lead ECG is a well-established method in patients with unstable coronary artery disease (CAD). However, the method lacks documentation on optimal criteria for episodes of transient ischemia and on observer variability. Observer variability was evaluated in 24-hour recordings from 100 patients with unstable CAD with monitoring in the coronary care unit. Influence on ST changes by variations in body position were evaluated by monitoring 50 patients in different body positions. Different criteria of transient ischemia and their predictive importance were evaluated in 630 patients with unstable CAD who underwent 12 hours of monitoring and thereafter were followed for 1 to13 months. Two sets of criteria were tested: (1) ST deviation > or = 0.1 mV for at least 1 minute, and (2) ST depression > or = 0.05 mV or elevation > or = 0.1 mV for at least 1 minute. When the first set of criteria were used, the interobserver agreement was good (kappa = 0.72) and 8 (16%) had significant ST changes in at least one body position. Out of 100 patients with symptoms suggestive of unstable CAD and such ischemia, 24 (24%) had a cardiac event during follow-up. When the second set of criteria were used, the interobserver agreement was poor (kappa = 0.32) and 21 (42%) had significant ST changes in at least one body position. Patients fulfilling the second but not the first set of criteria did not have a higher risk of cardiac event than those without transient ischemia (5.3 vs 4.3%). During 12-lead ECG monitoring, transient ischemic episodes should be defined as ST deviations > or = 0.1 mV for at least 1 minute, based on a low observer variability, minor problems with postural ST changes and an important predictive value.

Technology-based vs. traditional instruction. A comparison of two methods for teaching the skill of performing a 12-lead ECG.

Science.gov (United States)

Jeffries, Pamela R; Woolf, Shirley; Linde, Beverly

2003-01-01

The purpose of this study was to compare the effectiveness of an interactive, multimedia CD-ROM with traditional methods of teaching the skill of performing a 12-lead ECG. A randomized pre/posttest experimental design was used. Seventy-seven baccalaureate nursing students in a required, senior-level critical-care course at a large midwestern university were recruited for the study. Two teaching methods were compared. The traditional method included a self-study module, a brief lecture and demonstration by an instructor, and hands-on experience using a plastic manikin and a real 12-lead ECG machine in the learning laboratory. The second method covered the same content using an interactive, multimedia CD-ROM embedded with virtual reality and supplemented with a self-study module. There were no significant (p method, or perception of self-efficacy in performing the skill. Overall results indicated that both groups were satisfied with their instructional method and were similar in their ability to demonstrate the skill correctly on a live, simulated patient. This evaluation study is a beginning step to assess new and potentially more cost-effective teaching methods and their effects on student learning outcomes and behaviors, including the transfer of skill acquisition via a computer simulation to a real patient.

A decision support system and rule-based algorithm to augment the human interpretation of the 12-lead electrocardiogram.

Science.gov (United States)

Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Guldenring, Daniel; Badilini, Fabio; Libretti, Guido; Peace, Aaron J; Leslie, Stephen J

The 12-lead Electrocardiogram (ECG) has been used to detect cardiac abnormalities in the same format for more than 70years. However, due to the complex nature of 12-lead ECG interpretation, there is a significant cognitive workload required from the interpreter. This complexity in ECG interpretation often leads to errors in diagnosis and subsequent treatment. We have previously reported on the development of an ECG interpretation support system designed to augment the human interpretation process. This computerised decision support system has been named 'Interactive Progressive based Interpretation' (IPI). In this study, a decision support algorithm was built into the IPI system to suggest potential diagnoses based on the interpreter's annotations of the 12-lead ECG. We hypothesise semi-automatic interpretation using a digital assistant can be an optimal man-machine model for ECG interpretation. To improve interpretation accuracy and reduce missed co-abnormalities. The Differential Diagnoses Algorithm (DDA) was developed using web technologies where diagnostic ECG criteria are defined in an open storage format, Javascript Object Notation (JSON), which is queried using a rule-based reasoning algorithm to suggest diagnoses. To test our hypothesis, a counterbalanced trial was designed where subjects interpreted ECGs using the conventional approach and using the IPI+DDA approach. A total of 375 interpretations were collected. The IPI+DDA approach was shown to improve diagnostic accuracy by 8.7% (although not statistically significant, p-value=0.1852), the IPI+DDA suggested the correct interpretation more often than the human interpreter in 7/10 cases (varying statistical significance). Human interpretation accuracy increased to 70% when seven suggestions were generated. Although results were not found to be statistically significant, we found; 1) our decision support tool increased the number of correct interpretations, 2) the DDA algorithm suggested the correct

Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction.

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Scott, Peter J; Navarro, Cesar; Stevenson, Mike; Murphy, John C; Bennett, Johan R; Owens, Colum; Hamilton, Andrew; Manoharan, Ganesh; Adgey, A A Jennifer

2011-01-01

For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). We analyzed 528 (38% anterior [200], 44% inferior [233], and 18% lateral [95]) patients with STEMI with both a 12-lead ECG and an 80-lead body surface map (BSM) ECG (Prime ECG, Heartscape Technologies, Bangor, Northern Ireland). Body surface map was recorded within 15 minutes of the 12-lead ECG during the acute event and before revascularization. ST-segment elevation of each lead on the BSM was compared with the corresponding 12-lead precordial leads (V(1)-V(6)) for anterior STEMI. In addition, for lateral STEMI, leads I and aVL of the BSM were also compared; and limb leads II, III, aVF of the BSM were compared with inferior unipolar BSM leads for inferior STEMI. Leads with the greatest mean ST-segment elevation were selected, and significance was determined by analysis of variance of the mean ST segment. For anterior STEMI, leads V(1), V(2), 32, 42, 51, and 57 had the greatest mean ST elevation. These leads are located in the same horizontal plane as that of V(1) and V(2). Lead 32 had a significantly greater mean ST elevation than the corresponding precordial lead V(3) (P = .012); and leads 42, 51, and 57 were also significantly greater than corresponding leads V(4), V(5), V(6), respectively (P mean ST-segment elevation; and lead III was significantly superior to the inferior unipolar leads (7, 17, 27, 37, 47, 55, and 61) of the BSM (P optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and

The Normal Electrocardiogram: Resting 12-Lead and Electrocardiogram Monitoring in the Hospital.

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Harris, Patricia R E

2016-09-01

The electrocardiogram (ECG) is a well-established diagnostic tool extensively used in clinical settings. Knowledge of cardiac rhythm and mastery of cardiac waveform interpretation are fundamental for intensive care nurses. Recognition of the normal findings for the 12-lead ECG and understanding the significance of changes from baseline in continuous cardiac monitoring are essential steps toward ensuring safe patient care. This article highlights historical developments in electrocardiography, describes the normal resting 12-lead ECG, and discusses the need for continuous cardiac monitoring. In addition, future directions for the ECG are explored briefly. Copyright © 2016 Elsevier Inc. All rights reserved.

New approach for T-wave peak detection and T-wave end location in 12-lead paced ECG signals based on a mathematical model.

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Madeiro, João P V; Nicolson, William B; Cortez, Paulo C; Marques, João A L; Vázquez-Seisdedos, Carlos R; Elangovan, Narmadha; Ng, G Andre; Schlindwein, Fernando S

2013-08-01

This paper presents an innovative approach for T-wave peak detection and subsequent T-wave end location in 12-lead paced ECG signals based on a mathematical model of a skewed Gaussian function. Following the stage of QRS segmentation, we establish search windows using a number of the earliest intervals between each QRS offset and subsequent QRS onset. Then, we compute a template based on a Gaussian-function, modified by a mathematical procedure to insert asymmetry, which models the T-wave. Cross-correlation and an approach based on the computation of Trapezium's area are used to locate, respectively, the peak and end point of each T-wave throughout the whole raw ECG signal. For evaluating purposes, we used a database of high resolution 12-lead paced ECG signals, recorded from patients with ischaemic cardiomyopathy (ICM) in the University Hospitals of Leicester NHS Trust, UK, and the well-known QT database. The average T-wave detection rates, sensitivity and positive predictivity, were both equal to 99.12%, for the first database, and, respectively, equal to 99.32% and 99.47%, for QT database. The average time errors computed for T-wave peak and T-wave end locations were, respectively, -0.38±7.12 ms and -3.70±15.46 ms, for the first database, and 1.40±8.99 ms and 2.83±15.27 ms, for QT database. The results demonstrate the accuracy, consistency and robustness of the proposed method for a wide variety of T-wave morphologies studied. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Can Functional Cardiac Age be Predicted from ECG in a Normal Healthy Population

Science.gov (United States)

Schlegel, Todd; Starc, Vito; Leban, Manja; Sinigoj, Petra; Vrhovec, Milos

2011-01-01

In a normal healthy population, we desired to determine the most age-dependent conventional and advanced ECG parameters. We hypothesized that changes in several ECG parameters might correlate with age and together reliably characterize the functional age of the heart. Methods: An initial study population of 313 apparently healthy subjects was ultimately reduced to 148 subjects (74 men, 84 women, in the range from 10 to 75 years of age) after exclusion criteria. In all subjects, ECG recordings (resting 5-minute 12-lead high frequency ECG) were evaluated via custom software programs to calculate up to 85 different conventional and advanced ECG parameters including beat-to-beat QT and RR variability, waveform complexity, and signal-averaged, high-frequency and spatial/spatiotemporal ECG parameters. The prediction of functional age was evaluated by multiple linear regression analysis using the best 5 univariate predictors. Results: Ignoring what were ultimately small differences between males and females, the functional age was found to be predicted (R2= 0.69, P ECGs, functional cardiac age can be estimated by multiple linear regression analysis of mostly advanced ECG results. Because some parameters in the regression formula, such as QTcorr, high frequency QRS amplitude and P-wave width also change with disease in the same direction as with increased age, increased functional age of the heart may reflect subtle age-related pathologies in cardiac electrical function that are usually hidden on conventional ECG.

ECG movement artefacts can be greatly reduced with the aid of a movement absorbing device

DEFF Research Database (Denmark)

Harrison, Adrian Paul; Wandall, Kirsten; Thorball, Jørgen

2007-01-01

Accurate ECG signal analysis can be confounded by electric lead, and/or electrode movements varying in origin from, for example, hiccups, tremor or patient restlessness. ECG signals recorded using either a conventional electrode holder or with the aid of an electrode holder capable of absorbing...... movement artefacts, were measured on a healthy human subject. Results show a greatly improved stability of the ECG signal recorded using an electrode holder capable of absorbing movement artefacts during periods of lead disturbance, and highlight the movement artefacts that develop when the recording lead...... of a conventional ECG electrode holder is tugged or pulled during theperiod of monitoring. It is concluded that the new design of ECG electrode holder will not only enable clearer signal recordings for clinical assessment, but will reduce the ECG artefacts associated with the transportation of patients, and may...

Development of a portable wireless system for bipolar concentric ECG recording

International Nuclear Information System (INIS)

Prats-Boluda, G; Ye-Lin, Y; Bueno Barrachina, J M; Senent, E; Rodriguez de Sanabria, R; Garcia-Casado, J

2015-01-01

Cardiovascular diseases (CVDs) remain the biggest cause of deaths worldwide. ECG monitoring is a key tool for early diagnosis of CVDs. Conventional monitors use monopolar electrodes resulting in poor spatial resolution surface recordings and requiring extensive wiring. High-spatial resolution surface electrocardiographic recordings provide valuable information for the diagnosis of a wide range of cardiac abnormalities, including infarction and arrhythmia. The aim of this work was to develop and test a wireless recording system for acquiring high spatial resolution ECG signals, based on a flexible tripolar concentric electrode (TCE) without cable wiring or external reference electrode which would make more comnfortable its use in clinical practice. For this, a portable, wireless sensor node for analogue conditioning, digitalization and transmission of a bipolar concentric ECG signal (BC-ECG) using a TCE and a Mason-likar Lead-I ECG (ML-Lead-I ECG) signal was developed. Experimental results from a total of 32 healthy volunteers showed that the ECG fiducial points in the BC-ECG signals, recorded with external and internal reference electrode, are consistent with those of simultaneous ML-Lead-I ECG. No statistically significant difference was found in either signal amplitude or morphology, regardless of the reference electrode used, being the signal-to-noise similar to that of ML-Lead-I ECG. Furthermore, it has been observed that BC-ECG signals contain information that could not available in conventional records, specially related to atria activity. The proposed wireless sensor node provides non-invasive high-local resolution ECG signals using only a TCE without additional wiring, which would have great potential in medical diagnosis of diseases such as atrial or ventricular fibrillations or arrhythmias that currently require invasive diagnostic procedures (catheterization). (paper)

Using the 12-Lead Electrocardiogram in the Care of Athletic Patients.

Science.gov (United States)

Yeo, Tee Joo; Sharma, Sanjay

2016-11-01

This article summarizes the role of the 12-lead electrocardiogram (ECG) for the clinical care of athletes, with particular reference to the influence of age, gender, ethnicity, and type of sport on the appearance of the ECG, and its role in differentiating physiologic exercise-related changes from pathologic conditions implicated in sudden cardiac death (SCD). The article also explores the potential role of the ECG in detecting athletes at risk of SCD. In addition, the article reviews the evolution of ECG interpretation criteria and emphasizes the limitations of the ECG as well as the potential for future research. Copyright © 2016 Elsevier Inc. All rights reserved.

Multi-purpose ECG telemetry system.

Science.gov (United States)

Marouf, Mohamed; Vukomanovic, Goran; Saranovac, Lazar; Bozic, Miroslav

2017-06-19

The Electrocardiogram ECG is one of the most important non-invasive tools for cardiac diseases diagnosis. Taking advantage of the developed telecommunication infrastructure, several approaches that address the development of telemetry cardiac devices were introduced recently. Telemetry ECG devices allow easy and fast ECG monitoring of patients with suspected cardiac issues. Choosing the right device with the desired working mode, signal quality, and the device cost are still the main obstacles to massive usage of these devices. In this paper, we introduce design, implementation, and validation of a multi-purpose telemetry system for recording, transmission, and interpretation of ECG signals in different recording modes. The system consists of an ECG device, a cloud-based analysis pipeline, and accompanied mobile applications for physicians and patients. The proposed ECG device's mechanical design allows laypersons to easily record post-event short-term ECG signals, using dry electrodes without any preparation. Moreover, patients can use the device to record long-term signals in loop and holter modes, using wet electrodes. In order to overcome the problem of signal quality fluctuation due to using different electrodes types and different placements on subject's chest, customized ECG signal processing and interpretation pipeline is presented for each working mode. We present the evaluation of the novel short-term recorder design. Recording of an ECG signal was performed for 391 patients using a standard 12-leads golden standard ECG and the proposed patient-activated short-term post-event recorder. In the validation phase, a sample of validation signals followed peer review process wherein two experts annotated the signals in terms of signal acceptability for diagnosis.We found that 96% of signals allow detecting arrhythmia and other signal's abnormal changes. Additionally, we compared and presented the correlation coefficient and the automatic QRS delineation results

Conventional QT Variability Measurement vs. Template Matching Techniques: Comparison of Performance Using Simulated and Real ECG

Science.gov (United States)

Baumert, Mathias; Starc, Vito; Porta, Alberto

2012-01-01

Increased beat-to-beat variability in the QT interval (QTV) of ECG has been associated with increased risk for sudden cardiac death, but its measurement is technically challenging and currently not standardized. The aim of this study was to investigate the performance of commonly used beat-to-beat QT interval measurement algorithms. Three different methods (conventional, template stretching and template time shifting) were subjected to simulated data featuring typical ECG recording issues (broadband noise, baseline wander, amplitude modulation) and real short-term ECG of patients before and after infusion of sotalol, a QT interval prolonging drug. Among the three algorithms, the conventional algorithm was most susceptible to noise whereas the template time shifting algorithm showed superior overall performance on simulated and real ECG. None of the algorithms was able to detect increased beat-to-beat QT interval variability after sotalol infusion despite marked prolongation of the average QT interval. The QTV estimates of all three algorithms were inversely correlated with the amplitude of the T wave. In conclusion, template matching algorithms, in particular the time shifting algorithm, are recommended for beat-to-beat variability measurement of QT interval in body surface ECG. Recording noise, T wave amplitude and the beat-rejection strategy are important factors of QTV measurement and require further investigation. PMID:22860030

Conventional QT variability measurement vs. template matching techniques: comparison of performance using simulated and real ECG.

Directory of Open Access Journals (Sweden)

Mathias Baumert

Full Text Available Increased beat-to-beat variability in the QT interval (QTV of ECG has been associated with increased risk for sudden cardiac death, but its measurement is technically challenging and currently not standardized. The aim of this study was to investigate the performance of commonly used beat-to-beat QT interval measurement algorithms. Three different methods (conventional, template stretching and template time shifting were subjected to simulated data featuring typical ECG recording issues (broadband noise, baseline wander, amplitude modulation and real short-term ECG of patients before and after infusion of sotalol, a QT interval prolonging drug. Among the three algorithms, the conventional algorithm was most susceptible to noise whereas the template time shifting algorithm showed superior overall performance on simulated and real ECG. None of the algorithms was able to detect increased beat-to-beat QT interval variability after sotalol infusion despite marked prolongation of the average QT interval. The QTV estimates of all three algorithms were inversely correlated with the amplitude of the T wave. In conclusion, template matching algorithms, in particular the time shifting algorithm, are recommended for beat-to-beat variability measurement of QT interval in body surface ECG. Recording noise, T wave amplitude and the beat-rejection strategy are important factors of QTV measurement and require further investigation.

Reliability of Computer Analysis of Electrocardiograms (ECG) of ...

African Journals Online (AJOL)

Background: Computer programmes have been introduced to electrocardiography (ECG) with most physicians in Africa depending on computer interpretation of ECG. This study was undertaken to evaluate the reliability of computer interpretation of the 12-Lead ECG in the Black race. Methodology: Using the SCHILLER ...

On Recording the Unipolar ECG Limb Leads via the Wilson's vs the Goldberger's Terminals: aVR, aVL, and aVF Revisited

Directory of Open Access Journals (Sweden)

John E. Madias

2008-11-01

Full Text Available The augmented unipolar limb leads aVR, aVL, and aVF, introduced by Goldberger in 1942, are an integral part of the 12-lead ECG.1,2 Leads I, II, and III have 2 dedicated electrodes, but the other 9 leads have a single dedicated electrode, and another one constructed from the averaged inputs of multiple electrodes. This Viewpoint discusses whether an indifferent pole for the recording of unipolar limb leads is best provided by the Wilson's central terminal (WCT, or by inputs from 2 limb electrodes (Goldberger's central terminal (GCT, as done currently, and whether the latter have any advantages over the former. The term "unipolar", popularized by Wilson, is a misnomer, since no leads can be truly "unipolar", all requiring positive and negative poles. Thus the term unipolar is used herein in the quasi-unipolar sense, as when first introduced by Wilson and Goldberger, who also realized that such leads were not truly unipolar. The popularity of the unipolar leads reflected the quest of recording the ECG from various vantage points of the body, considering the limitations of the 3 bipolar leads, introduced by Einthoven,3 which register the difference of 2 ECG curves recorded at the 2 poles of these leads, and no variation in potential at each of these poles.4 In contrast the unipolar leads were thought to register such variation of absolute potential, something not really true. Initially the WCT was used to record the unipolar limb leads,5 but the amplitude was low, and the inscribed ECGs, then, and for many decades later,6 were thick-lined (≥2 mm (Figure 1.

Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study.

Science.gov (United States)

Muhlestein, Joseph Boone; Le, Viet; Albert, David; Moreno, Fidela Ll; Anderson, Jeffrey L; Yanowitz, Frank; Vranian, Robert B; Barsness, Gregory W; Bethea, Charles F; Severance, Harry W; Ramo, Barry; Pierce, John; Barbagelata, Alejandro; Muhlestein, Joseph Brent

2015-01-01

12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care. To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG. 6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory. The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL. Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology. Copyright © 2015 Elsevier Inc. All rights reserved.

A novel application of deep learning for single-lead ECG classification.

Science.gov (United States)

Mathews, Sherin M; Kambhamettu, Chandra; Barner, Kenneth E

2018-06-04

Detecting and classifying cardiac arrhythmias is critical to the diagnosis of patients with cardiac abnormalities. In this paper, a novel approach based on deep learning methodology is proposed for the classification of single-lead electrocardiogram (ECG) signals. We demonstrate the application of the Restricted Boltzmann Machine (RBM) and deep belief networks (DBN) for ECG classification following detection of ventricular and supraventricular heartbeats using single-lead ECG. The effectiveness of this proposed algorithm is illustrated using real ECG signals from the widely-used MIT-BIH database. Simulation results demonstrate that with a suitable choice of parameters, RBM and DBN can achieve high average recognition accuracies of ventricular ectopic beats (93.63%) and of supraventricular ectopic beats (95.57%) at a low sampling rate of 114 Hz. Experimental results indicate that classifiers built into this deep learning-based framework achieved state-of-the art performance models at lower sampling rates and simple features when compared to traditional methods. Further, employing features extracted at a sampling rate of 114 Hz when combined with deep learning provided enough discriminatory power for the classification task. This performance is comparable to that of traditional methods and uses a much lower sampling rate and simpler features. Thus, our proposed deep neural network algorithm demonstrates that deep learning-based methods offer accurate ECG classification and could potentially be extended to other physiological signal classifications, such as those in arterial blood pressure (ABP), nerve conduction (EMG), and heart rate variability (HRV) studies. Copyright © 2018. Published by Elsevier Ltd.

The evolution of ambulatory ECG monitoring.

Science.gov (United States)

Kennedy, Harold L

2013-01-01

Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health. © 2013.

Referral of patients with ST-segment elevation acute myocardial infarction directly to the catheterization suite based on prehospital teletransmission of 12-lead electrocardiogram

DEFF Research Database (Denmark)

Sillesen, Martin; Sejersten, Maria; Strange, Søren

2008-01-01

BACKGROUND: Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-lead electrocardiogram (ECG) transmission can reduce time to reperfusion. PURPOSE: Determine 12-lead ECG transmission...

Development of a portable Linux-based ECG measurement and monitoring system.

Science.gov (United States)

Tan, Tan-Hsu; Chang, Ching-Su; Huang, Yung-Fa; Chen, Yung-Fu; Lee, Cheng

2011-08-01

This work presents a portable Linux-based electrocardiogram (ECG) signals measurement and monitoring system. The proposed system consists of an ECG front end and an embedded Linux platform (ELP). The ECG front end digitizes 12-lead ECG signals acquired from electrodes and then delivers them to the ELP via a universal serial bus (USB) interface for storage, signal processing, and graphic display. The proposed system can be installed anywhere (e.g., offices, homes, healthcare centers and ambulances) to allow people to self-monitor their health conditions at any time. The proposed system also enables remote diagnosis via Internet. Additionally, the system has a 7-in. interactive TFT-LCD touch screen that enables users to execute various functions, such as scaling a single-lead or multiple-lead ECG waveforms. The effectiveness of the proposed system was verified by using a commercial 12-lead ECG signal simulator and in vivo experiments. In addition to its portability, the proposed system is license-free as Linux, an open-source code, is utilized during software development. The cost-effectiveness of the system significantly enhances its practical application for personal healthcare.

Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Directory of Open Access Journals (Sweden)

Getaw Worku Hassen

2015-01-01

Full Text Available Background. Computerized electrocardiogram (ECG analysis has been of tremendous help for noncardiologists, but can we rely on it? The importance of ST depression and T wave inversions in lead aVL has not been emphasized and not well recognized across all specialties. Objective. This study’s goal was to analyze if there is a discrepancy of interpretation by physicians from different specialties and a computer-generated ECG reading in regard to a TWI in lead aVL. Methods. In this multidisciplinary prospective study, a single ECG with isolated TWI in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing. The readings by all physicians were compared by level of education and by specialty to one another and to the computer interpretation. Results. A total of 191 physicians participated in the study. Of the 191 physicians 48 (25.1% identified and 143 (74.9% did not identify the isolated TWI in lead aVL. Conclusion. Our study demonstrated that 74.9% did not recognize the abnormality. New and subtle ECG findings should be emphasized in their training so as not to miss significant findings that could cause morbidity and mortality.

Effect of Cardiac Phases and Conductivity Inhomogeneities of the Thorax Models on ECG Lead Selection and Reconstruction

National Research Council Canada - National Science Library

Takano, Noriyuki

2001-01-01

ECG lead selection and reconstruction were investigated in the present study using ECG source-to-measurement transfer matrices computed in inhomogeneous and homogeneous conductor thorax-heart models...

Challenges of ECG monitoring and ECG interpretation in dialysis units.

Science.gov (United States)

Poulikakos, Dimitrios; Malik, Marek

Patients on hemodialysis (HD) suffer from high cardiovascular morbidity and mortality due to high rates of coronary artery disease and arrhythmias. Electrocardiography (ECG) is often performed in the dialysis units as part of routine clinical assessment. However, fluid and electrolyte changes have been shown to affect all ECG morphologies and intervals. ECG interpretation thus depends on the time of the recording in relation to the HD session. In addition, arrhythmias during HD are common, and dialysis-related ECG artifacts mimicking arrhythmias have been reported. Studies using advanced ECG analyses have examined the impact of the HD procedure on selected repolarization descriptors and heart rate variability indices. Despite the challenges related to the impact of the fluctuant fluid and electrolyte status on conventional and advanced ECG parameters, further research in ECG monitoring during dialysis has the potential to provide clinically meaningful and practically useful information for diagnostic and risk stratification purposes. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Hazardous situation in the MR bore: induction in ECG leads causes fire

International Nuclear Information System (INIS)

Kugel, Harald; Bremer, Christoph; Fischbach, Roman; Lenzen, Horst; Tombach, Bernd; Heindel, Walter; Pueschel, Marco; Aken, Hugo van

2003-01-01

There is a potential hazard during examinations of patients with attached or implanted long conductors, e.g. ECG leads: an MR exam of the lumbar spine of a patient was performed in a 1.5-T scanner under ECG monitoring using equipment marked as MR compatible. Standard cabling of 370-cm length was guided without loops from the electrodes through the caudal opening of the magnet bore. During a sagittal T1-weighted turbo-spin-echo scan suddenly a flame of approximately 3 cm arose from the patient's shirt, close to the position of the electrodes. The supervising anaesthesiologist extinguished the flames with his hands. A subsequent physical examination revealed second- to third-degree burns. The analysis of the incident revealed that high voltages can be induced in straight conductors without loops as ECG cables by coupling with the electric component of the HF field. Local heating or sparking can cause an open flame at the position of the electrodes. This danger exists even with ECG equipment that is specifically marked as MR compatible. (orig.)

Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Directory of Open Access Journals (Sweden)

James J McCarthy

2011-05-01

Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

Impact of the 12-lead electrocardiogram on ED evaluation and management.

Science.gov (United States)

Benner, John P; Borloz, Matthew P; Adams, Madeline; Brady, William J

2007-10-01

This study was conducted to assess the impact (diagnostic, therapeutic, and disposition) of the 12-lead electrocardiogram (ECG) on emergency department (ED) patient evaluation and management. This project was a prospective study of a convenience sample of 304 ED patients undergoing ECG analysis during their evaluation in the ED of a level 1 trauma center. The data collection for this study was divided into 4 parts. In part I, the treating physicians determined the specific reasons for ECG analysis; categories include complaint-based (eg, chest pain), syndrome-based (eg, overdose/poisoning), and system-based (eg, "requested by consult"). In part II, all treating physicians were surveyed before ECG interpretation regarding the future diagnostic, therapeutic, and disposition plans for the patient based only on history and physical examination. Their comments were recorded on a standardized data sheet. In part III, the physicians were surveyed after their interpretation of the ECG as to whether the results could suggest any further diagnostic information (eg, normal vs abnormal), or provide enough information for the patient care plan to be altered. In part IV of the study period, alterations to the original diagnostic, therapeutic, and disposition plans made by information provided by the ECG were obtained from the treating physician. A total of 304 patients underwent ECG examination and were used for data analysis. The average age of patients, of which 48% were men, was 60 years. The most common complaints that prompted electrocardiographic evaluation were chest pain and dyspnea. The most common reason an ECG was ordered was nursing staff protocol. Physicians determined that they were able to make a diagnosis based primarily on ECG in 33 (10.9%) cases. The total number of ECGs that were determined to be normal was 95 (31.3%), 7 (2.3%) of which allowed a rule-out diagnosis; 209 (68.7%) of total ECGs were determined to be abnormal, 72 (23.6%) of which were considered

Deployment of an Advanced Electrocardiographic Analysis (A-ECG) to Detect Cardiovascular Risk in Career Firefighters

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Dolezal, B. A.; Storer, T. W.; Abrazado, M.; Watne, R.; Schlegel, T. T.; Batalin, M.; Kaiser, W.; Smith, D. L.; Cooper, C. B.

2011-01-01

INTRODUCTION Sudden cardiac death is the leading cause of line of duty death among firefighters, accounting for approximately 45% of fatalities annually. Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high ambient temperatures, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events like myocardial infarction, serious dysrhythmias, or cerebrovascular accidents in firefighters with underlying cardiovascular disease. Screening for cardiovascular risk factors is recommended but not always followed in this population. PHASER is a project charged with identifying and prioritizing risk factors in emergency responders. We have deployed an advanced ECG (A-ECG) system developed at NASA for improved sensitivity and specificity in the detection of cardiac risk. METHODS Forty-four professional firefighters were recruited to perform comprehensive baseline assessments including tests of aerobic performance and laboratory tests for fasting lipid profiles and glucose. Heart rate and conventional 12-lead ECG were obtained at rest and during incremental treadmill exercise testing (XT). In addition, a 5-min resting 12-lead A-ECG was obtained in a subset of firefighters (n=18) and transmitted over a secure networked system to a physician collaborator at NASA for advanced-ECG analysis. This A-ECG system has been proven, using myocardial perfusion and other imaging, to accurately identify a number of cardiac pathologies including coronary artery disease (CAD), left ventricular hypertrophy, hypertrophic cardiomyopathy, non-ischemic cardiomyopathy, and ischemic cardiomyopathy. RESULTS Subjects mean (SD) age was 43 (8) years, weight 91 (13) kg, and BMI of 28 (3) kg/square meter. Maximum oxygen uptake (VO2max) was 39 (9) ml/kg/min. This compares with the 45th %ile in healthy reference values and a recommended standard of 42 ml/kg/min for firefighters. The metabolic threshold (VO

Textile Concentric Ring Electrodes for ECG Recording Based on Screen-Printing Technology

Directory of Open Access Journals (Sweden)

José Vicente Lidón-Roger

2018-01-01

Full Text Available Among many of the electrode designs used in electrocardiography (ECG, concentric ring electrodes (CREs are one of the most promising due to their enhanced spatial resolution. Their development has undergone a great push due to their use in recent years; however, they are not yet widely used in clinical practice. CRE implementation in textiles will lead to a low cost, flexible, comfortable, and robust electrode capable of detecting high spatial resolution ECG signals. A textile CRE set has been designed and developed using screen-printing technology. This is a mature technology in the textile industry and, therefore, does not require heavy investments. Inks employed as conductive elements have been silver and a conducting polymer (poly (3,4-ethylenedioxythiophene polystyrene sulfonate; PEDOT:PSS. Conducting polymers have biocompatibility advantages, they can be used with flexible substrates, and they are available for several printing technologies. CREs implemented with both inks have been compared by analyzing their electric features and their performance in detecting ECG signals. The results reveal that silver CREs present a higher average thickness and slightly lower skin-electrode impedance than PEDOT:PSS CREs. As for ECG recordings with subjects at rest, both CREs allowed the uptake of bipolar concentric ECG signals (BC-ECG with signal-to-noise ratios similar to that of conventional ECG recordings. Regarding the saturation and alterations of ECGs captured with textile CREs caused by intentional subject movements, silver CREs presented a more stable response (fewer saturations and alterations than those of PEDOT:PSS. Moreover, BC-ECG signals provided higher spatial resolution compared to conventional ECG. This improved spatial resolution was manifested in the identification of P1 and P2 waves of atrial activity in most of the BC-ECG signals. It can be concluded that textile silver CREs are more suitable than those of PEDOT:PSS for obtaining

Textile Concentric Ring Electrodes for ECG Recording Based on Screen-Printing Technology.

Science.gov (United States)

Lidón-Roger, José Vicente; Prats-Boluda, Gema; Ye-Lin, Yiyao; Garcia-Casado, Javier; Garcia-Breijo, Eduardo

2018-01-21

Among many of the electrode designs used in electrocardiography (ECG), concentric ring electrodes (CREs) are one of the most promising due to their enhanced spatial resolution. Their development has undergone a great push due to their use in recent years; however, they are not yet widely used in clinical practice. CRE implementation in textiles will lead to a low cost, flexible, comfortable, and robust electrode capable of detecting high spatial resolution ECG signals. A textile CRE set has been designed and developed using screen-printing technology. This is a mature technology in the textile industry and, therefore, does not require heavy investments. Inks employed as conductive elements have been silver and a conducting polymer (poly (3,4-ethylenedioxythiophene) polystyrene sulfonate; PEDOT:PSS). Conducting polymers have biocompatibility advantages, they can be used with flexible substrates, and they are available for several printing technologies. CREs implemented with both inks have been compared by analyzing their electric features and their performance in detecting ECG signals. The results reveal that silver CREs present a higher average thickness and slightly lower skin-electrode impedance than PEDOT:PSS CREs. As for ECG recordings with subjects at rest, both CREs allowed the uptake of bipolar concentric ECG signals (BC-ECG) with signal-to-noise ratios similar to that of conventional ECG recordings. Regarding the saturation and alterations of ECGs captured with textile CREs caused by intentional subject movements, silver CREs presented a more stable response (fewer saturations and alterations) than those of PEDOT:PSS. Moreover, BC-ECG signals provided higher spatial resolution compared to conventional ECG. This improved spatial resolution was manifested in the identification of P1 and P2 waves of atrial activity in most of the BC-ECG signals. It can be concluded that textile silver CREs are more suitable than those of PEDOT:PSS for obtaining BC-ECG records

New methodologies for measuring Brugada ECG patterns cannot differentiate the ECG pattern of Brugada syndrome from Brugada phenocopy.

Science.gov (United States)

Gottschalk, Byron H; Garcia-Niebla, Javier; Anselm, Daniel D; Jaidka, Atul; De Luna, Antoni Bayés; Baranchuk, Adrian

2016-01-01

Brugada phenocopies (BrP) are clinical entities characterized by ECG patterns that are identical to true Brugada syndrome (BrS), but are elicited by various clinical circumstances. A recent study demonstrated that the patterns of BrP and BrS are indistinguishable under the naked eye, thereby validating the concept that the patterns are identical. The aim of our study was to determine whether recently developed ECG criteria would allow for discrimination between type-2 BrS ECG pattern and type-2 BrP ECG pattern. Ten ECGs from confirmed BrS (aborted sudden death, transformation into type 1 upon sodium channel blocking test and/or ventricular arrhythmias, positive genetics) cases and 9 ECGs from confirmed BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format for blind measurement of two values: (i) β-angle; and (ii) the base of the triangle. Cut-off values of ≥58° for the β-angle and ≥4mm for the base of the triangle were used to determine the BrS ECG pattern. Mean values for the β-angle in leads V1 and V2 were 66.7±25.5 and 55.4±28.1 for BrS and 54.1±26.5 and 43.1±16.1 for BrP respectively (p=NS). Mean values for the base of the triangle in V1 and V2 were 7.5±3.9 and 5.7±3.9 for BrS and 5.6±3.2 and 4.7±2.7 for BrP respectively (p=NS). The β-angle had a sensitivity of 60%, specificity of 78% (LR+ 2.7, LR- 0.5). The base of the triangle had a sensitivity of 80%, specificity of 40% (LR+ 1.4, LR- 0.5). New ECG criteria presented relatively low sensitivity and specificity, positive and negative predictive values to discriminate between BrS and BrP ECG patterns, providing further evidence that the two patterns are identical. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between obesity and ECG variables in children and adolescents: A cross-sectional study.

Science.gov (United States)

Sun, Guo-Zhe; Li, Yang; Zhou, Xing-Hu; Guo, Xiao-Fan; Zhang, Xin-Gang; Zheng, Li-Qiang; Li, Yuan; Jiao, Yun-DI; Sun, Ying-Xian

2013-12-01

Obesity exhibits a wide variety of electrocardiogram (ECG) abnormalities in adults, which often lead to cardiovascular events. However, there is currently no evidence of an association between obesity and ECG variables in children and adolescents. The present study aimed to explore the associations between obesity and ECG intervals and axes in children and adolescents. A cross-sectional observational study of 5,556 students aged 5-18 years was performed. Anthropometric data, blood pressure and standard 12-lead ECGs were collected for each participant. ECG variables were measured manually based on the temporal alignment of simultaneous 12 leads using a CV200 ECG Work Station. Overweight and obese groups demonstrated significantly longer PR intervals, wider QRS durations and leftward shifts of frontal P-wave, QRS and T-wave axes, while the obese group also demonstrated significantly higher heart rates, compared with normal weight groups within normotensive or hypertensive subjects (Pobesity was also associated with longer PR intervals, wider QRS duration and a leftward shift of frontal ECG axes compared with normal waist circumference (WC) within normotensive or hypertensive subjects (Paffecting the ECG variables. Furthermore, the ECG variables, including PR interval, QRS duration and frontal P-wave, QRS and T-wave axes, were significantly linearly correlated with body mass index, WC and waist-to-height ratio adjusted for age, gender, ethnicity and blood pressure. However, there was no significant association between obesity and the corrected QT interval (P>0.05). The results of the current study indicate that in children and adolescents, general and abdominal obesity is associated with longer PR intervals, wider QRS duration and a leftward shift of frontal P-wave, QRS and T-wave axes, independent of age, gender, ethnicity and blood pressure.

Response of the ECG to short-term diuresis in patients with heart failure.

Science.gov (United States)

Madias, John E; Song, Jessica; White, C Michael; Kalus, James S; Kluger, Jeffrey

2005-07-01

Increase in the amplitude of electrocardiogram (ECG) QRS complexes has been observed in patients treated for heart failure (HF), but the underlying mechanism has not been delineated. Also, correlation of augmentation of the QRS potentials with loss of weight has been noted in patients recovering from anasarca of varying etiology, or after hemodialysis. We assessed the effect of diuresis-based fluid loss in patients treated for HF on the amplitude of ECG QRS complexes. This is a cohort study based on ECG and other data from a previously published investigation of patients with HF conducted at a university affiliated hospital, which used new measurements and analysis, performed by a totally blinded investigator based at another institution. Twenty-one patients (10 men) aged 70.5+/-12.7 years, 13 with ischemic, and 8 with nonischemic cardiomyopathy, were admitted to the hospital for management of exacerbated HF and were observed for 48 hours. The patients received diuresis, and had routine laboratory testing, documentation of the net fluid lost, and recording of ECGs prior to the initiation of therapy and at 24 and 48 hours. Percent change (%Delta) over the course of observation in the sums of the amplitude of QRS complexes from 12 leads (SigmaQRS12), 6-limb leads (SigmaQRS6), and leads 1+2 (SigmaQRS2) in mm of standard ECGs were correlated with net fluid loss corrected for admission weight in mL/kg. Fluid loss amounted to 3204.9+/-1399.5 mL in the course of 40+/-23 hours of diuresis. SigmaQRS12 was 160.9+/-42.3 mm before and 170.0+/-50.7 mm after diuresis (P=0. 024). Percent change in SigmaQRS12, SigmaQRS6, and SigmaQRS2 correlated well with the net fluid loss (r=-0.70, -0.82, -0.61, and P=0.002, 0.0005, 0.001) correspondingly. Changes in sums of the amplitude of QRS complexes of the standard ECG correlates well with net fluid loss in response to short-term diuresis in patients with HF. Change in the SigmaQRS12, SigmaQRS6, and SigmaQRS2 from ECGs before and after

Performance study of the wearable one-lead wireless electrocardiographic monitoring system.

Science.gov (United States)

Hong, Sungyoup; Yang, Yougmo; Kim, Seunghwan; Shin, Seungcheol; Lee, Inbum; Jang, Yongwon; Kim, Kiseong; Yi, Hwayeon

2009-03-01

This study attempts to compare and assess the performance of a wearable electrocardiogram (ECG) using a sensing fabric electrode and a Bluetooth network with a conventional ECG. A one-lead ECG examination was performed using Bioshirt and an iWorx 214 while walking or running at 3, 6, and 9 km per hour. A correlation coefficient of a heart rate variability (HRV) between these two devices was higher than 0.96 and power spectral density of HRV measured also showed an excellent agreement. Thus, both of these two ECG devices showed similar detection capability for R peaks. The measured values for wave duration and intervals of both devices concur with each other. The intensity of noise is controversial. The ECG device using a sensing fabric electrode and a wireless network showed an ECG signal detection and transmission capability similar to that of a conventional ECG device.

Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT

Energy Technology Data Exchange (ETDEWEB)

Horiguchi, Jun; Fujioka, Chikako; Kiguchi, Masao; Kohno, Shingo [Hiroshima University Hospital, Department of Clinical Radiology, Hiroshima (Japan); Yamamoto, Hideya; Kitagawa, Toshiro [Hiroshima University, Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan); Ito, Katsuhide [Hiroshima University, Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan)

2009-10-15

The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n=12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p=0.12-0.91). However, the visibility scores of in-stent restenosis were different (p<0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA. (orig.)

'Brugada ECG' elicited by imipramine overdose

NARCIS (Netherlands)

van den Berg, M. P.; Tulleken, J. E.; Wilde, A. A. M.

2004-01-01

The ECG hallmark of the Brugada syndrome is ST-segment elevation in the right precordial leads. However, a 'Brugada ECG' may also occasionally be caused by other conditions. We report a case of a Brugada ECG due to an overdose of imipramine, a tricyclic antidepressant. The patient, a 66-year-old

A 0.7-V 17.4- μ W 3-lead wireless ECG SoC.

Science.gov (United States)

Khayatzadeh, Mahmood; Zhang, Xiaoyang; Tan, Jun; Liew, Wen-Sin; Lian, Yong

2013-10-01

This paper presents a fully integrated sub-1 V 3-lead wireless ECG System-on-Chip (SoC) for wireless body sensor network applications. The SoC includes a two-channel ECG front-end with a driven-right-leg circuit, an 8-bit SAR ADC, a custom-designed 16-bit microcontroller, two banks of 16 kb SRAM, and a MICS band transceiver. The microcontroller and SRAM blocks are able to operate at sub-/near-threshold regime for the best energy consumption. The proposed SoC has been implemented in a standard 0.13- μ m CMOS process. Measurement results show the microcontroller consumes only 2.62 pJ per instruction at 0.35 V . Both microcontroller and memory blocks are functional down to 0.25 V. The entire SoC is capable of working at single 0.7-V supply. At the best case, it consumes 17.4 μ W in heart rate detection mode and 74.8 μW in raw data acquisition mode under sampling rate of 500 Hz. This makes it one of the best ECG SoCs among state-of-the-art biomedical chips.

Threshold-based system for noise detection in multilead ECG recordings

International Nuclear Information System (INIS)

Jekova, Irena; Krasteva, Vessela; Christov, Ivaylo; Abächerli, Roger

2012-01-01

This paper presents a system for detection of the most common noise types seen on the electrocardiogram (ECG) in order to evaluate whether an episode from 12-lead ECG is reliable for diagnosis. It implements criteria for estimation of the noise corruption level in specific frequency bands, aiming to identify the main sources of ECG quality disruption, such as missing signal or limited dynamics of the QRS components above 4 Hz; presence of high amplitude and steep artifacts seen above 1 Hz; baseline drift estimated at frequencies below 1 Hz; power–line interference in a band ±2 Hz around its central frequency; high-frequency and electromyographic noises above 20 Hz. All noise tests are designed to process the ECG series in the time domain, including 13 adjustable thresholds for amplitude and slope criteria which are evaluated in adjustable time intervals, as well as number of leads. The system allows flexible extension toward application-specific requirements for the noise levels in acceptable quality ECGs. Training of different thresholds’ settings to determine different positive noise detection rates is performed with the annotated set of 1000 ECGs from the PhysioNet database created for the Computing in Cardiology Challenge 2011. Two implementations are highlighted on the receiver operating characteristic (area 0.968) to fit to different applications. The implementation with high sensitivity (Se = 98.7%, Sp = 80.9%) appears as a reliable alarm when there are any incidental problems with the ECG acquisition, while the implementation with high specificity (Sp = 97.8%, Se = 81.8%) is less susceptible to transient problems but rather validates noisy ECGs with acceptable quality during a small portion of the recording. (paper)

Improving ECG Services at a Children’s Hospital: Implementation of a Digital ECG System

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Frank A. Osei

2015-01-01

Full Text Available Background. The use of digital ECG software and services is becoming common. We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted at our children’s hospital. Methods. As part of a hospital wide quality improvement initiative, a digital ECG service (MUSE, GE was implemented at the Children’s Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era was compared to 18 months of the predigital era. Predigital and postdigital data were compared via t-tests. Results. The mean ECGs interpreted per month were 53 ± 16 in the predigital era and 216 ± 37 in the postdigital era (p<0.001, a fourfold increase in ECG volume after introduction of the digital system. There was no significant change in inpatient or outpatient service volume during that time. The mean billing time decreased from 21 ± 27 days in the postdigital era to 12 ± 5 days in the postdigital era (p<0.001. Conclusion. Implementation of a digital ECG system increased the volume of ECGs officially interpreted and reported.

ECG-manifest and ECG-silent dipyridamole technetium-99m sestamibi SPET perfusion defects in patients with ischaemic heart disease

International Nuclear Information System (INIS)

Galli, M.; Marcassa, C.; Bosimini, E.; Zoccarato, O.; Comazzi, F.; Giannuzzi, P.

1997-01-01

To investigate the relationship between ECG changes and perfusion abnormalities, body surface maps were recorded during dipyridamole infusion in 55 subjects (11 normals and 44 patients with ischaemic heart disease) undergoing dipyridamole technetium-99m sestamibi single-photon emission tomography (SPET). All had a normal resting ECG. The extent and severity of the sestamibi defect were quantified. New negative areas in the isointegral maps and rest-dipyridamole map differences >2 SD from normal limits were considered abnormal. After dipyridamole in normals, neither perfusion defects nor ≥1 mm ST segment depression on 12-lead ECG nor new negative areas in isointegral maps occurred. In patients, dipyridamole induced new perfusion defects in 35 (80%) but ST segment depression in only 18 (41%, P<0.001). Of the 35 patients with perfusion defects, 17 (49%, group 1) showed ST segment depression, while the other 18 (51%, group 2) did not. Abnormal body surface maps were found in 100% of group 1 and 88% of group 2 patients (NS). In group 1, the provoked hypoperfusion was of greater extent (P=0.007) and severity (P=0.01) and the onset of map abnormalities was significantly earlier (P<0.001) than in group 2; time to map abnormalities was also significantly shorter than time to ST segment depression (P=0.01). In the 35 patients with complete scintigraphic, body map and angiographic data, the severity of reversible perfusion defect proved to be the strongest correlate of ST segment depression upon logistic regression analysis. Thus, sestamibi SPET abnormalities after dipyridamole are almost always associated with electrical changes on body surface maps, suggesting myocardial ischaemia as their cause. The much less common 12-lead ECG changes are slower to appear and reflect a more severe hypoperfusion. (orig./MG). With 5 figs., 4 tabs

Evaluating ECG and carboxyhemoglobin changes due to smoking narghile.

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Yıldırım, Fazıl; Çevik, Yunsur; Emektar, Emine; Çorbacıoğlu, Şeref Kerem; Katırcı, Yavuz

2016-10-01

This study aimed to investigate whether increased carboxyhemoglobin (COHB) levels and ECG changes, which associated with fatal ventricular dysrhythmias, including increased QT, P-wave and T peak (Tp)-Tend (Te) dispersion, can be detected after smoking narghile, which is a traditional method of smoking tobacco that is smoked from hookah device. After local ethics committee approval, this prospective study was conducted using healthy volunteer subjects at a "narghile café," which is used by people smoking narghile in an open area. Before beginning to smoke narghile, all subjects' 12-lead electrocardiographs (ECG), measurements of COHB levels, and vital signs were recorded. After smoking narghile for 30 min, the recording of the 12-lead ECGs and the measurements of COHB level and all vital signs were repeated. The mean age of subjects was 26.8 ± 6.2 years (min-max: 18-40), and 28 subjects (84.8%) were male. Before smoking narghile, the median value of subjects' COHB levels was 1.3% (min-max: 0-6), whereas after smoking, the median value of COHB was 23.7% (min-max: 6-44), a statistically significant increase (p < 0.001). Analysis of the subjects' ECG changes after smoking narghile showed that dispersions of QT, QTc, P-wave and Tp-Te were increased, and all changes were statistically significant (p < 0.001 for all parameters). Although, especially among young people, it is commonly thought that smoking narghile has less harmful or toxic effects than other tobacco products. The results of this study and past studies clearly demonstrated that smoking narghile can cause several ECG changes - including increased QT, P-wave and Tp-Te dispersion - which can be associated with ventricular dysrhythmias.

Concept Design for a 1-Lead Wearable/Implantable ECG Front-End: Power Management.

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George, Libin; Gargiulo, Gaetano Dario; Lehmann, Torsten; Hamilton, Tara Julia

2015-11-19

Power supply quality and stability are critical for wearable and implantable biomedical applications. For this reason we have designed a reconfigurable switched-capacitor DC-DC converter that, aside from having an extremely small footprint (with an active on-chip area of only 0.04 mm²), uses a novel output voltage control method based upon a combination of adaptive gain and discrete frequency scaling control schemes. This novel DC-DC converter achieves a measured output voltage range of 1.0 to 2.2 V with power delivery up to 7.5 mW with 75% efficiency. In this paper, we present the use of this converter as a power supply for a concept design of a wearable (15 mm × 15 mm) 1-lead ECG front-end sensor device that simultaneously harvests power and communicates with external receivers when exposed to a suitable RF field. Due to voltage range limitations of the fabrication process of the current prototype chip, we focus our analysis solely on the power supply of the ECG front-end whose design is also detailed in this paper. Measurement results show not just that the power supplied is regulated, clean and does not infringe upon the ECG bandwidth, but that there is negligible difference between signals acquired using standard linear power-supplies and when the power is regulated by our power management chip.

The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.

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Novotny, Tomas; Bond, Raymond; Andrsova, Irena; Koc, Lumir; Sisakova, Martina; Finlay, Dewar; Guldenring, Daniel; Spinar, Jindrich; Malik, Marek

2017-05-01

Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters. Copyright © 2017 Elsevier B.V. All rights reserved.

ECG abnormalities in patients with chronic kidney disease

International Nuclear Information System (INIS)

Shafi, S.; Saleem, M.; Anjum, R.; Abdullah, W.; Shafi, T.

2017-01-01

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Electrocardiographic (ECG) abnormalities are common in CKD patients. However, there is variation in literature regarding frequency of ECG abnormalities in CKD patients and limited information in local population. Methods: The study design was cross-sectional in nature. All patients between ages of 20-80 years with CKD not previously on renal replacement therapy who were admitted to nephrology ward at a tertiary care facility over a 6-month period were included. All patients underwent 12 lead electrocardiograms (ECG). ECG abnormalities were defined based on accepted standard criteria. Results: Total number of patients included in the study was 124. Mean age of all patients was 49.9+-13.8 years, 106 (84.8%) had hypertension, 84 (70%) had diabetes mellitus, and 35 (29.9%) had known cardiovascular disease. Mean serum creatinine was 7.2+-3.4 mg/dl, mean eGFR was 10.6+-9.2 ml/min/1.73 m/sup 2/. Overall 78.4% of all CKD patients have one or more ECG abnormality. Left ventricular hypertrophy (40%), Q waves (27.2%), ST segment elevation or depression (23.4%), prolonged QRS duration (19.2%), tachycardia (17.6%) and left and right atrial enlargement (17.6%) were the most common abnormalities. Conclusion: ECG abnormalities are common in hospitalized CKD patients in local population. All hospitalized CKD patients should undergo ECG to screen for cardiovascular disease. (author)

Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke.

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Pirinen, Jani; Putaala, Jukka; Aro, Aapo L; Surakka, Ida; Haapaniemi, Anita; Kaste, Markku; Haapaniemi, Elena; Tatlisumak, Turgut; Lehto, Mika

2015-11-01

The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS. The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1-14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n=78) and other/undetermined causes (n=612). We used multivariate logistic regression to study the association between ECG parameters and HRCE. Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio=44.32, 95% confidence interval=[10.51-186.83]), followed by a QRS-T angle >110° (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]). Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

V–V delay interval optimization in CRT using echocardiography compared to QRS width in surface ECG

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Amr Nawar

2012-09-01

Conclusion: Significant correlation appeared to exist during optimization of CRT between VV programming based on the shortest QRS interval at 12-lead ECG pacing and that based on highest LVOT VTI by echocardiography. A combined ECG and echocardiographic approach could be a more convenient solution in performing V–V optimization.

A mixed signal ECG processing platform with an adaptive sampling ADC for portable monitoring applications.

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Kim, Hyejung; Van Hoof, Chris; Yazicioglu, Refet Firat

2011-01-01

This paper describes a mixed-signal ECG processing platform with an 12-bit ADC architecture that can adapt its sampling rate according to the input signals rate of change. This enables the sampling of ECG signals with significantly reduced data rate without loss of information. The presented adaptive sampling scheme reduces the ADC power consumption, enables the processing of ECG signals with lower power consumption, and reduces the power consumption of the radio while streaming the ECG signals. The test results show that running a CWT-based R peak detection algorithm using the adaptively sampled ECG signals consumes only 45.6 μW and it leads to 36% less overall system power consumption.

Correlation of resting ECG, stress ECG and thallium scan in the evaluation of coronary artery disease

International Nuclear Information System (INIS)

Khan, A.; Amin, W.; Khan, M.Z.A.; Ahmed, A.; Kiani, M.R.

1987-01-01

This study includes 70 cases who underwent myocardial perfusion studies with thallium 201 during the year 1984-85. They were studied clinically, had their resting ECGs, stress ECGs and coronary angiograms. Majority of these patients were males, their ages ranged between 34-70 years. The patients population included with typical/atypical chest pain, some with resting ECG abnormalities, after coronary angiography and a few after coronary artery bypass graft surgery. The result of all the modalities were compared with the conventional gold standard for ischaemic heart disease, i.e. coronary angiogram. It is concluded that the sensitivity of resting ECG in the diagnosis of ischaemic heart disease is very low. The exercise test alone was found conclusive in about 74% of patients while sensitivity of thallium scan was 66% in this particular group of patients. (author)

Continuous ECG Monitoring in Patients With Acute Coronary Syndrome or Heart Failure: EASI Versus Gold Standard.

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Lancia, Loreto; Toccaceli, Andrea; Petrucci, Cristina; Romano, Silvio; Penco, Maria

2018-05-01

The purpose of the study was to compare the EASI system with the standard 12-lead surface electrocardiogram (ECG) for the accuracy in detecting the main electrocardiographic parameters (J point, PR, QT, and QRS) commonly monitored in patients with acute coronary syndromes or heart failure. In this observational comparative study, 253 patients who were consecutively admitted to the coronary care unit with acute coronary syndrome or heart failure were evaluated. In all patients, two complete 12-lead ECGs were acquired simultaneously. A total of 6,072 electrocardiographic leads were compared (3,036 standard and 3,036 EASI). No significant differences were found between the investigate parameters of the two measurement methods, either in patients with acute coronary syndrome or in those with heart failure. This study confirmed the accuracy of the EASI system in monitoring the main ECG parameters in patients admitted to the coronary care unit with acute coronary syndrome or heart failure.

Noninvasive Diagnosis of Coronary Artery Disease Using 12-Lead High-Frequency Electrocardiograms

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Schlegel, Todd T.; Arenare, Brian

2006-01-01

A noninvasive, sensitive method of diagnosing certain pathological conditions of the human heart involves computational processing of digitized electrocardiographic (ECG) signals acquired from a patient at all 12 conventional ECG electrode positions. In the processing, attention is focused on low-amplitude, high-frequency components of those portions of the ECG signals known in the art as QRS complexes. The unique contribution of this method lies in the utilization of signal features and combinations of signal features from various combinations of electrode positions, not reported previously, that have been found to be helpful in diagnosing coronary artery disease and such related pathological conditions as myocardial ischemia, myocardial infarction, and congestive heart failure. The electronic hardware and software used to acquire the QRS complexes and perform some preliminary analyses of their high-frequency components were summarized in Real-Time, High-Frequency QRS Electrocardiograph (MSC- 23154), NASA Tech Briefs, Vol. 27, No. 7 (July 2003), pp. 26-28. To recapitulate, signals from standard electrocardiograph electrodes are preamplified, then digitized at a sampling rate of 1,000 Hz, then analyzed by the software that detects R waves and QRS complexes and analyzes them from several perspectives. The software includes provisions for averaging signals over multiple beats and for special-purpose nonrecursive digital filters with specific low- and high-frequency cutoffs. These filters, applied to the averaged signal, effect a band-pass operation in the frequency range from 150 to 250 Hz. The output of the bandpass filter is the desired high-frequency QRS signal. Further processing is then performed in real time to obtain the beat-to-beat root mean square (RMS) voltage amplitude of the filtered signal, certain variations of the RMS voltage, and such standard measures as the heart rate and R-R interval at any given time. A key signal feature analyzed in the present

Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

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Carel, R S

1982-04-01

The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

A capacitive ECG array with visual patient feedback.

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Eilebrecht, Benjamin; Schommartz, Antje; Walter, Marian; Wartzek, Tobias; Czaplik, Michael; Leonhardt, Steffen

2010-01-01

Capacitive electrocardiogram (ECG) sensing is a promising technique for less constraining vital signal measurement and close to a commercial application. Even bigger trials testing the diagnostic significance were already done with single lead systems. Anyway, most applications to be found in research are limited to one channel and thus limited in its diagnostic relevance as only diseases coming along with a change of the heart rate can be diagnosed adequately. As a consequence the need for capacitive multi-channel ECGs combining the diagnostic relevance and the advantages of capacitive ECG sensing emerges. This paper introduces a capacitive ECG measurement system which allows the recording of standardized ECG leads according to Einthoven and Goldberger by means of an electrode array with nine electrodes.

The 12-lead electrocardiogram and risk of sudden death: current utility and future prospects.

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Narayanan, Kumar; Chugh, Sumeet S

2015-10-01

More than 100 years after it was first invented, the 12-lead electrocardiogram (ECG) continues to occupy an important place in the diagnostic armamentarium of the practicing clinician. With the recognition of relatively rare but important clinical entities such as Wolff-Parkinson-White and the long QT syndrome, this clinical tool was firmly established as a test for assessing risk of sudden cardiac death (SCD). However, over the past two decades the role of the ECG in risk prediction for common forms of SCD, for example in patients with coronary artery disease, has been the focus of considerable investigation. Especially in light of the limitations of current risk stratification approaches, there is a renewed focus on this broadly available and relatively inexpensive test. Various abnormalities of depolarization and repolarization on the ECG have been linked to SCD risk; however, more focused work is needed before they can be deployed in the clinical arena. The present review summarizes the current knowledge on various ECG risk markers for prediction of SCD and discusses some future directions in this field. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

ECG-derived Cheyne-Stokes respiration and periodic breathing in healthy and hospitalized populations.

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Tinoco, Adelita; Drew, Barbara J; Hu, Xiao; Mortara, David; Cooper, Bruce A; Pelter, Michele M

2017-11-01

Cheyne-Stokes respiration (CSR) has been investigated primarily in outpatients with heart failure. In this study we compare CSR and periodic breathing (PB) between healthy and cardiac groups. We compared CSR and PB, measured during 24 hr of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with ACS symptoms, divided into a group of 39 (43%) with confirmed ACS, and 51 (57%) with a cardiac diagnosis but non-ACS. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with ACS symptoms. Hospitalized patients with suspected ACS had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed ACS had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-ACS patients. Continuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients. © 2017 Wiley Periodicals, Inc.

ECG-Based Detection of Early Myocardial Ischemia in a Computational Model: Impact of Additional Electrodes, Optimal Placement, and a New Feature for ST Deviation.

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Loewe, Axel; Schulze, Walther H W; Jiang, Yuan; Wilhelms, Mathias; Luik, Armin; Dössel, Olaf; Seemann, Gunnar

2015-01-01

In case of chest pain, immediate diagnosis of myocardial ischemia is required to respond with an appropriate treatment. The diagnostic capability of the electrocardiogram (ECG), however, is strongly limited for ischemic events that do not lead to ST elevation. This computational study investigates the potential of different electrode setups in detecting early ischemia at 10 minutes after onset: standard 3-channel and 12-lead ECG as well as body surface potential maps (BSPMs). Further, it was assessed if an additional ECG electrode with optimized position or the right-sided Wilson leads can improve sensitivity of the standard 12-lead ECG. To this end, a simulation study was performed for 765 different locations and sizes of ischemia in the left ventricle. Improvements by adding a single, subject specifically optimized electrode were similar to those of the BSPM: 2-11% increased detection rate depending on the desired specificity. Adding right-sided Wilson leads had negligible effect. Absence of ST deviation could not be related to specific locations of the ischemic region or its transmurality. As alternative to the ST time integral as a feature of ST deviation, the K point deviation was introduced: the baseline deviation at the minimum of the ST-segment envelope signal, which increased 12-lead detection rate by 7% for a reasonable threshold.

On the resolution of ECG acquisition systems for the reliable analysis of the P-wave

International Nuclear Information System (INIS)

Censi, Federica; Calcagnini, Giovanni; Mattei, Eugenio; Triventi, Michele; Bartolini, Pietro; Corazza, Ivan; Boriani, Giuseppe

2012-01-01

The analysis of the P-wave on surface ECG is widely used to assess the risk of atrial arrhythmias. In order to provide reliable results, the automatic analysis of the P-wave must be precise and reliable and must take into account technical aspects, one of those being the resolution of the acquisition system. The aim of this note is to investigate the effects of the amplitude resolution of ECG acquisition systems on the P-wave analysis. Starting from ECG recorded by an acquisition system with a less significant bit (LSB) of 31 nV (24 bit on an input range of 524 mVpp), we reproduced an ECG signal as acquired by systems with lower resolution (16, 15, 14, 13 and 12 bit). We found that, when the LSB is of the order of 128 µV (12 bit), a single P-wave is not recognizable on ECG. However, when averaging is applied, a P-wave template can be extracted, apparently suitable for the P-wave analysis. Results obtained in terms of P-wave duration and morphology revealed that the analysis of ECG at lowest resolutions (from 12 to 14 bit, LSB higher than 30 µV) could lead to misleading results. However, the resolution used nowadays in modern electrocardiographs (15 and 16 bit, LSB <10 µV) is sufficient for the reliable analysis of the P-wave. (note)

High Resolution ECG for Evaluation of Heart Function During Exposure to Subacute Hypobaric Hypoxia

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Zupet, Petra; Finderle, Zarko; Schlegel, Todd T.; Princi, Tanja; Starc, Vito

2010-01-01

High altitude climbing presents a wide spectrum of health risks, including exposure to hypobaric hypoxia. Risks are also typically exacerbated by the difficulty in appropriately monitoring for early signs of organ dysfunction in remote areas. We investigated whether high resolution advanced ECG analysis might be helpful as a non-invasive and easy-to-use tool (e.g., instead of Doppler echocardiography) for evaluating early signs of heart overload in hypobaric hypoxia. Nine non-acclimatized healthy trained alpine rescuers (age 43.7 plus or minus 7.3 years) climbed in four days to the altitude of 4,200 m on Mount Ararat. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position on different days but at the same time of day at four different altitudes: 400 m (reference altitude), 1,700 m, 3,200 m and 4,200 m. Changes in conventional and advanced resting ECG parameters, including in beat-to-beat QT and RR variability, waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG was estimated by calculation of the regression coefficients in independent linear regression models. A p-value of less than 0.05 was adopted as statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with trends k = -96 ms/1000 m with p = 0.000 and k = -9 ms/1000 m with p = 0.001, respectively. Significant changes were found in P-wave amplitude, which nearly doubled from the lowest to the highest altitude (k = 41.6 microvolt/1000 m with p = 0.000), and nearly significant changes in P-wave duration (k = 2.9 ms/1000 m with p = 0.059). Changes were less significant or non-significant in other studied parameters including those of waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG. High resolution ECG analysis, particularly of the P wave, shows promise as a tool for monitoring early changes in heart function

A first approach to Arrhythmogenic Cardiomyopathy detection through ECG and Hidden Markov Models

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Jimenez-Serrano, S.; Sanz Sanchez, J.; Martínez Hinarejos, C.D.; Igual Muñoz, B.; Millet Roig, J.; Zorio Grima, Z.; Castells, F.

2016-07-01

Arrhythmogenic Cardiomyopathy (ACM) is a heritable cardiac disease causing sudden cardiac death in young people. Its clinical diagnosis includes major and minor criteria based on alterations of the electrocardiogram (ECG). The aim of this study is to evaluate Hidden Markov Models (HMM) in order to assess its possible potential of classification among subjects affected by ACM and those relatives who do not suffer the disease through 12-lead ECG recordings. Database consists of 12-lead ECG recordings from 32 patients diagnosed with ACM, and 37 relatives of those affected, but without gene mutation. Using the HTK toolkit and a hold-out strategy in order to train and evaluate a set of HMM models, we performed a grid search through the number of states and Gaussians across these HMM models. Results show that two different HMM models achieved the best balance between sensibility and specificity. The first one needed 35 states and 2 Gaussians and its performance was 0.7 and 0.8 in sensibility and specificity respectively. The second one achieved a sensibility and specificity values of 0.8 and 0.7 respectively with 50 states and 4 Gaussians. The results of this study show that HMM models can achieve an acceptable level of sensibility and specificity in the classification among ECG registers between those affected by ACM and the control group. All the above suggest that this approach could help to detect the disease in a non-invasive way, especially within the context of family screening, improving sensitivity in detection by ECG. (Author)

A cancelable biometric scheme based on multi-lead ECGs.

Science.gov (United States)

Peng-Tzu Chen; Shun-Chi Wu; Jui-Hsuan Hsieh

2017-07-01

Biometric technologies offer great advantages over other recognition methods, but there are concerns that they may compromise the privacy of individuals. In this paper, an electrocardiogram (ECG)-based cancelable biometric scheme is proposed to relieve such concerns. In this scheme, distinct biometric templates for a given beat bundle are constructed via "subspace collapsing." To determine the identity of any unknown beat bundle, the multiple signal classification (MUSIC) algorithm, incorporating a "suppression and poll" strategy, is adopted. Unlike the existing cancelable biometric schemes, knowledge of the distortion transform is not required for recognition. Experiments with real ECGs from 285 subjects are presented to illustrate the efficacy of the proposed scheme. The best recognition rate of 97.58 % was achieved under the test condition N train = 10 and N test = 10.

Personal Verification/Identification via Analysis of the Peripheral ECG Leads: Influence of the Personal Health Status on the Accuracy

Directory of Open Access Journals (Sweden)

Irena Jekova

2015-01-01

Full Text Available Traditional means for identity validation (PIN codes, passwords, and physiological and behavioral biometric characteristics (fingerprint, iris, and speech are susceptible to hacker attacks and/or falsification. This paper presents a method for person verification/identification based on correlation of present-to-previous limb ECG leads: I (rI, II (rII, calculated from them first principal ECG component (rPCA, linear and nonlinear combinations between rI, rII, and rPCA. For the verification task, the one-to-one scenario is applied and threshold values for rI, rII, and rPCA and their combinations are derived. The identification task supposes one-to-many scenario and the tested subject is identified according to the maximal correlation with a previously recorded ECG in a database. The population based ECG-ILSA database of 540 patients (147 healthy subjects, 175 patients with cardiac diseases, and 218 with hypertension has been considered. In addition a common reference PTB dataset (14 healthy individuals with short time interval between the two acquisitions has been taken into account. The results on ECG-ILSA database were satisfactory with healthy people, and there was not a significant decrease in nonhealthy patients, demonstrating the robustness of the proposed method. With PTB database, the method provides an identification accuracy of 92.9% and a verification sensitivity and specificity of 100% and 89.9%.

Multi detector computed tomography (MDCT) of the aortic root; ECG-gated verses non-ECG-gated examinations

International Nuclear Information System (INIS)

Kristiansen, Joanna; Guenther, Anne; Aalokken, Trond Mogens; Andersen, Rune

2011-01-01

Purpose: Motion artifacts may degrade a conventional CT examination of the ascending aorta and hinder accurate diagnosis. We quantitatively compared retrospectively electrocardiographic (ECG) -gated multi detector computed tomography (MDCT) with non-ECG-gated MDCT in order to demonstrate whether or not one of the methods should be preferred. Method: The study included seventeen patients with surgically reconstructed aortic root and reimplanted coronary arteries. All patients had undergone both non-gated MDCT and retrospectively ECG-gated MDCT employing a stringently modulated tube current with single phase image reconstruction. The incidence of motion artifacts in the left main coronary artery (LM), proximal right coronary artery (RCA), and aortic root and ascending aorta were rated using a four point scale. The effective dose for each scan was calculated and normalized to a 15 cm scan length. Statistical analysis of motion artifacts and radiation dose was performed using Wilcoxon matched pairs signed rank sum test. Results: A significant reduction in motion artifacts was found in all three vessels in images from the retrospectively ECG-gated scans (LM: P = 0.005, RCA: P = 0.015, aorta: P = 0.003). The mean normalized effective radiation dose was 3.69 mSv (±1.03) for the non-ECG-gated scans and 16.37 mSv (±2.53) for the ECG-gated scans. Conclusion: Retrospective ECG-gating with single phase reconstruction significantly reduces the incidence of motion artifacts in the aortic root and the proximal portion of the coronary arteries but at the expense of a fourfold increase in radiation dose.

Bedside identification of patients at risk for PVC-induced cardiomyopathy: Is ECG useful?

Science.gov (United States)

Garster, Noelle C; Henrikson, Charles A

2017-07-01

Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10% of total beats. Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4% (n = 1,128), 3.5% (n = 32), 4.3% (n = 25), and 16.6% (n = 55), respectively, which represent statistically significant differences (P ECG for ≥10% PVC Holter burden was 58%. Negative predictive value for 0 PVCs on ECG was 98%. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72% and 93.6%, respectively, when utilizing a positive ECG result as one PVC or more, and 44% and 98.9%, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden. © 2017 Wiley Periodicals, Inc.

Tissue Doppler Imaging Combined with Advanced 12-Lead ECG Analysis Might Improve Early Diagnosis of Hypertrophic Cardiomyopathy in Childhood

Science.gov (United States)

Femlund, E.; Schlegel, T.; Liuba, P.

2011-01-01

Optimization of early diagnosis of childhood hypertrophic cardiomyopathy (HCM) is essential in lowering the risk of HCM complications. Standard echocardiography (ECHO) has shown to be less sensitive in this regard. In this study, we sought to assess whether spatial QRS-T angle deviation, which has shown to predict HCM in adults with high sensitivity, and myocardial Tissue Doppler Imaging (TDI) could be additional tools in early diagnosis of HCM in childhood. Methods: Children and adolescents with familial HCM (n=10, median age 16, range 5-27 years), and without obvious hypertrophy but with heredity for HCM (n=12, median age 16, range 4-25 years, HCM or sudden death with autopsy-verified HCM in greater than or equal to 1 first-degree relative, HCM-risk) were additionally investigated with TDI and advanced 12-lead ECG analysis using Cardiax(Registered trademark) (IMED Co Ltd, Budapest, Hungary and Houston). Spatial QRS-T angle (SA) was derived from Kors regression-related transformation. Healthy age-matched controls (n=21) were also studied. All participants underwent thorough clinical examination. Results: Spatial QRS-T angle (Figure/ Panel A) and septal E/Ea ratio (Figure/Panel B) were most increased in HCM group as compared to the HCM-risk and control groups (p less than 0.05). Of note, these 2 variables showed a trend toward higher levels in HCM-risk group than in control group (p=0.05 for E/Ea and 0.06 for QRS/T by ANOVA). In a logistic regression model, increased SA and septal E/Ea ratio appeared to significantly predict both the disease (Chi-square in HCM group: 9 and 5, respectively, p less than 0.05 for both) and the risk for HCM (Chi-square in HCM-risk group: 5 and 4 respectively, p less than 0.05 for both), with further increased predictability level when these 2 variables were combined (Chi-square 10 in HCM group, and 7 in HCM-risk group, p less than 0.01 for both). Conclusions: In this small material, Tissue Doppler Imaging and spatial mean QRS-T angle

Advanced ECG in 2016: is there more than just a tracing?

Science.gov (United States)

Reichlin, Tobias; Abächerli, Roger; Twerenbold, Raphael; Kühne, Michael; Schaer, Beat; Müller, Christian; Sticherling, Christian; Osswald, Stefan

2016-01-01

The 12-lead electrocardiogram (ECG) is the most frequently used technology in clinical cardiology. It is critical for evidence-based management of patients with most cardiovascular conditions, including patients with acute myocardial infarction, suspected chronic cardiac ischaemia, cardiac arrhythmias, heart failure and implantable cardiac devices. In contrast to many other techniques in cardiology, the ECG is simple, small, mobile, universally available and cheap, and therefore particularly attractive. Standard ECG interpretation mainly relies on direct visual assessment. The progress in biomedical computing and signal processing, and the available computational power offer fascinating new options for ECG analysis relevant to all fields of cardiology. Several digital ECG markers and advanced ECG technologies have shown promise in preliminary studies. This article reviews promising novel surface ECG technologies in three different fields. (1) For the detection of myocardial ischaemia and infarction, QRS morphology feature analysis, the analysis of high frequency QRS components (HF-QRS) and methods using vectorcardiography as well as ECG imaging are discussed. (2) For the identification and management of patients with cardiac arrhythmias, methods of advanced P-wave analysis are discussed and the concept of ECG imaging for noninvasive localisation of cardiac arrhythmias is presented. (3) For risk stratification of sudden cardiac death and the selection of patients for medical device therapy, several novel markers including an automated QRS-score for scar quantification, the QRS-T angle or the T-wave peak-to-end-interval are discussed. Despite the existing preliminary data, none of the advanced ECG markers and technologies has yet accomplished the transition into clinical practice. Further refinement of these technologies and broader validation in large unselected patient cohorts are the critical next step needed to facilitate translation of advanced ECG technologies

The application of root mean square electrocardiography (RMS ECG) for the detection of acquired and congenital long QT syndrome.

Science.gov (United States)

Lux, Robert L; Sower, Christopher Todd; Allen, Nancy; Etheridge, Susan P; Tristani-Firouzi, Martin; Saarel, Elizabeth V

2014-01-01

Precise measurement of the QT interval is often hampered by difficulty determining the end of the low amplitude T wave. Root mean square electrocardiography (RMS ECG) provides a novel alternative measure of ventricular repolarization. Experimental data have shown that the interval between the RMS ECG QRS and T wave peaks (RTPK) closely reflects the mean ventricular action potential duration while the RMS T wave width (TW) tracks the dispersion of repolarization timing. Here, we tested the precision of RMS ECG to assess ventricular repolarization in humans in the setting of drug-induced and congenital Long QT Syndrome (LQTS). RMS ECG signals were derived from high-resolution 24 hour Holter monitor recordings from 68 subjects after receiving placebo and moxifloxacin and from standard 12 lead ECGs obtained in 97 subjects with LQTS and 97 age- and sex-matched controls. RTPK, QTRMS and RMS TW intervals were automatically measured using custom software and compared to traditional QT measures using lead II. All measures of repolarization were prolonged during moxifloxacin administration and in LQTS subjects, but the variance of RMS intervals was significantly smaller than traditional lead II measurements. TW was prolonged during moxifloxacin and in subjects with LQT-2, but not LQT-1 or LQT-3. These data validate the application of RMS ECG for the detection of drug-induced and congenital LQTS. RMS ECG measurements are more precise than the current standard of care lead II measurements.

Construction of a Resting High Fidelity ECG "SuperScore" for Management and Screening of Heart Disease

Science.gov (United States)

Schlegel, Todd T.; Delgado, Reynolds; Poulin, Greg; Starc, Vito; Arenare, Brian; Rahman, M. A.

2006-01-01

Resting conventional ECG is notoriously insensitive for detecting coronary artery disease (CAD) and only nominally useful in screening for cardiomyopathy (CM). Similarly, conventional exercise stress test ECG is both time- and labor-consuming and its accuracy in identifying CAD is suboptimal for use in population screening. We retrospectively investigated the accuracy of several advanced resting electrocardiographic (ECG) parameters, both alone and in combination, for detecting CAD and cardiomyopathy (CM).

Assessing ECG signal quality indices to discriminate ECGs with artefacts from pathologically different arrhythmic ECGs.

Science.gov (United States)

Daluwatte, C; Johannesen, L; Galeotti, L; Vicente, J; Strauss, D G; Scully, C G

2016-08-01

False and non-actionable alarms in critical care can be reduced by developing algorithms which assess the trueness of an arrhythmia alarm from a bedside monitor. Computational approaches that automatically identify artefacts in ECG signals are an important branch of physiological signal processing which tries to address this issue. Signal quality indices (SQIs) derived considering differences between artefacts which occur in ECG signals and normal QRS morphology have the potential to discriminate pathologically different arrhythmic ECG segments as artefacts. Using ECG signals from the PhysioNet/Computing in Cardiology Challenge 2015 training set, we studied previously reported ECG SQIs in the scientific literature to differentiate ECG segments with artefacts from arrhythmic ECG segments. We found that the ability of SQIs to discriminate between ECG artefacts and arrhythmic ECG varies based on arrhythmia type since the pathology of each arrhythmic ECG waveform is different. Therefore, to reduce the risk of SQIs classifying arrhythmic events as noise it is important to validate and test SQIs with databases that include arrhythmias. Arrhythmia specific SQIs may also minimize the risk of misclassifying arrhythmic events as noise.

Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Sejersten, M.; Sillesen, M.; Hansen, Peter Riis

2008-01-01

the hospital. The primary study purpose was to determine whether delays could be decreased in an urban area by transmitting a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone for rapid triage and transport to a primary percutaneous coronary intervention (PCI) center, bypassing......, including 2 deaths (1%) caused by treatment-resistant arrhythmia. In conclusion, transmission of a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone decreased door-to-PCI time by >1 hour when patients were transported directly to PCI centers, bypassing local hospitals...

Real-time QRS detection using integrated variance for ECG gated cardiac MRI

Directory of Open Access Journals (Sweden)

Schmidt Marcus

2016-09-01

Full Text Available During magnetic resonance imaging (MRI, a patient’s vital signs are required for different purposes. In cardiac MRI (CMR, an electrocardiogram (ECG of the patient is required for triggering the image acquisition process. However, a reliable QRS detection of an ECG signal acquired inside an MRI scanner is a challenging task due to the magnetohydrodynamic (MHD effect which interferes with the ECG. The aim of this work was to develop a reliable QRS detector usable inside the MRI which also fulfills the standards for medical devices (IEC 60601-2-27. Therefore, a novel real-time QRS detector based on integrated variance measurements is presented. The algorithm was trained on ANSI/AAMI EC13 test waveforms and was then applied to two databases with 12-lead ECG signals recorded inside and outside an MRI scanner. Reliable results for both databases were achieved for the ECG signals recorded inside (DBMRI: sensitivity Se = 99.94%, positive predictive value +P = 99.84% and outside (DBInCarT: Se = 99.29%, +P = 99.72% the MRI. Due to the accurate R-peak detection in real-time this can be used for monitoring and triggering in MRI exams.

Efficient ECG Signal Compression Using Adaptive Heart Model

National Research Council Canada - National Science Library

Szilagyi, S

2001-01-01

This paper presents an adaptive, heart-model-based electrocardiography (ECG) compression method. After conventional pre-filtering the waves from the signal are localized and the model's parameters are determined...

Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud.

Science.gov (United States)

Al-Zaiti, Salah S; Shusterman, Vladimir; Carey, Mary G

2013-01-01

Current guidelines recommend early reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90 min of first medical encounter. Telecardiology entails the use of advanced communication technologies to transmit the prehospital 12-lead electrocardiogram (ECG) to offsite cardiologists for early triage to the cath lab; which has been shown to dramatically reduce door-to-balloon time and total mortality. However, hospitals often find adopting ECG transmission technologies very challenging. The current review identifies seven major technical challenges of prehospital ECG transmission, including: paramedics inconvenience and transport delay; signal noise and interpretation errors; equipment malfunction and transmission failure; reliability of mobile phone networks; lack of compliance with the standards of digital ECG formats; poor integration with electronic medical records; and costly hardware and software pre-requisite installation. Current and potential solutions to address each of these technical challenges are discussed in details and include: automated ECG transmission protocols; annotatable waveform-based ECGs; optimal routing solutions; and the use of cloud computing systems rather than vendor-specific processing stations. Nevertheless, strategies to monitor transmission effectiveness and patient outcomes are essential to sustain initial gains of implementing ECG transmission technologies. © 2013.

A Pilot Study Assessing ECG versus ECHO Ventriculoventricular Optimization in Pediatric Resynchronization Patients.

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Punn, Rajesh; Hanisch, Debra; Motonaga, Kara S; Rosenthal, David N; Ceresnak, Scott R; Dubin, Anne M

2016-02-01

Cardiac resynchronization therapy indications and management are well described in adults. Echocardiography (ECHO) has been used to optimize mechanical synchrony in these patients; however, there are issues with reproducibility and time intensity. Pediatric patients add challenges, with diverse substrates and limited capacity for cooperation. Electrocardiographic (ECG) methods to assess electrical synchrony are expeditious but have not been extensively studied in children. We sought to compare ECHO and ECG CRT optimization in children. Prospective, pediatric, single-center cross-over trial comparing ECHO and ECG optimization with CRT. Patients were assigned to undergo either ECHO or ECG optimization, followed for 6 months, and crossed-over to the other assignment for another 6 months. ECHO pulsed-wave tissue Doppler and 12-lead ECG were obtained for 5 VV delays. ECG optimization was defined as the shortest QRSD and ECHO optimization as the lowest dyssynchrony index. ECHOs/ECGs were interpreted by readers blinded to optimization technique. After each 6 month period, these data were collected: ejection fraction, velocimetry-derived cardiac index, quality of life, ECHO-derived stroke distance, M-mode dyssynchrony, study cost, and time. Outcomes for each optimization method were compared. From June 2012 to December 2013, 19 patients enrolled. Mean age was 9.1 ± 4.3 years; 14 (74%) had structural heart disease. The mean time for optimization was shorter using ECG than ECHO (9 ± 1 min vs. 68 ± 13 min, P cost for charges was $4,400 ± 700 less for ECG. No other outcome differed between groups. ECHO optimization of synchrony was not superior to ECG optimization in this pilot study. ECG optimization required less time and cost than ECHO optimization. © 2015 Wiley Periodicals, Inc.

Deployment of an Advanced Electrocardiographic Analysis (A-ECG) to Detect Cardiovascular Risk in Career Firefighters

Science.gov (United States)

Dolezal, B. A.; Storer, T. W.; Abrazado, M.; Watne, R.; Schlegel, T. T.; Batalin, M.; Kaiser, W.; Smith, D. L.; Cooper, C. B.

2011-01-01

INTRODUCTION: Sudden cardiac death is the leading cause of line of duty death among firefighters, accounting for approximately 45% of fatalities annually. Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high ambient temperatures, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events like myocardial infarction, serious dysrhythmias, or cerebrovascular accidents in firefighters with underlying cardiovascular disease. PURPOSE: The purpose of this study was to deploy and then evaluate the contribution of resting advanced ECG (A-ECG) in addition to other screening tools (family history, lipid profiles, and cardiopulmonary exercise tests, XT) in assessment of an individual fs cardiac risk profile. METHODS: Forty-four career firefighters were recruited to perform comprehensive baseline assessments including tests of aerobic performance, fasting lipids and glucose. Five-min resting 12-lead A-ECGs were obtained in a subset of firefighters (n=21) and transmitted over a secure networked system to a NASA physician collaborator. Using myocardial perfusion and other imaging as the gold standard, A-ECG scoring has been proven useful in accurately identifying a number of cardiac pathologies including coronary artery disease (CAD), left ventricular hypertrophy, hypertrophic cardiomyopathy, and non-ischemic and ischemic cardiomyopathy. RESULTS: Subjects f mean (SD) age was 43 (8) years, weight 91 (13) kg, and BMI 28 (3) kg/m2. Fifty-one percent of subjects had .3 cardiovascular risk factors. One subject had ST depression on XT ECG, at least one positive A-ECG score for CAD, and documented CAD based on cardiology referral. While all other subjects, including those with fewer risk factors, higher aerobic fitness, and normal exercise ECGs, were classified as healthy by A-ECG, there was no trend for association between risk factors and any of 20 A-ECG parameters in the

Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose

International Nuclear Information System (INIS)

Kim, Jeong Su; Choo, Ki Seok; Jeong, Dong Wook

2011-01-01

Background With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. Purpose To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). Material and Methods We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. Results In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. Conclusion The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates

Resting ECG findings in elite football players.

Science.gov (United States)

Bohm, Philipp; Ditzel, Roman; Ditzel, Heribert; Urhausen, Axel; Meyer, Tim

2013-01-01

The purpose of the study was to evaluate ECG abnormalities in a large sample of elite football players. Data from 566 elite male football players (57 of them of African origin) above 16 years of age were screened retrospectively (age: 20.9 ± 5.3 years; BMI: 22.9 ± 1.7 kg · m(-2), training history: 13.8 ± 4.7 years). The resting ECGs were analysed and classified according to the most current ECG categorisation of the European Society of Cardiology (ESC) (2010) and a classification of Pelliccia et al. (2000) in order to assess the impact of the new ESC-approach. According to the classification of Pelliccia, 52.5% showed mildly abnormal ECG patterns and 12% were classified as distinctly abnormal ECG patterns. According to the classification of the ESC, 33.7% showed 'uncommon ECG patterns'. Short-QT interval was the most frequent ECG pattern in this group (41.9%), followed by a shortened PR-interval (19.9%). When assessed with a QTc cut-off-point of 340 ms (instead of 360 ms), only 22.2% would have had 'uncommon ECG patterns'. Resting ECG changes amongst elite football players are common. Adjustment of the ESC criteria by adapting proposed time limits for the ECG (e.g. QTc, PR) should further reduce the rate of false-positive results.

Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

Science.gov (United States)

Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

2013-01-01

To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.

Methods for Improving the Diagnosis of a Brugada ECG Pattern.

Science.gov (United States)

Gottschalk, Byron H; Garcia-Niebla, Javier; Anselm, Daniel D; Glover, Benedict; Baranchuk, Adrian

2016-03-01

Brugada syndrome (BrS) is an inherited channelopathy that predisposes individuals to malignant arrhythmias and can lead to sudden cardiac death. The condition is characterized by two electrocardiography (ECG) patterns: the type-1 or "coved" ECG and the type-2 or "saddleback" ECG. Although the type-1 Brugada ECG pattern is diagnostic for the condition, the type-2 Brugada ECG pattern requires differential diagnosis from conditions that produce a similar morphology. In this article, we present a case that is suspicious but not diagnostic for BrS and discuss the application of ECG methodologies for increasing or decreasing suspicion for a diagnosis of BrS. © 2015 Wiley Periodicals, Inc.

Cardiac events in patients with positive exercise ECG and normal myocardial perfusion scan - a retrospective study

International Nuclear Information System (INIS)

Marshman, K.; Thomson, L.E.J.; Rowe, C.C.; Burns, A.J.; Woon, F.S.

2002-01-01

Full text: The low risk of future cardiac events following a normal myocardial perfusion study with normal stress ECG has been well documented. However, there is little literature regarding the prognosis in patients with a positive stress ECG (PosETT) and normal myocardial perfusion scan (MPS). A search of our database over an eighteen month period identified 21 patients who fitted study criteria. A PosETT was defined as stress induced horizontal or downsloping ST depression > 1mm in one or more leads with a normal baseline 12 lead ECG. Patients were divided into two subgroups depending on the severity of ST depression. A mildly PosETT was defined as ST depression of 1-1.5mm (n=10) and strongly PosETT was defined as ST depression of >2mm in at least one lead with depression in other leads (n=l 1). A normal MPS was defined as absence of reversible perfusion defects on SPECT imaging. Technetium 99m Tetrofosmin was the imaging agent used in 18/21 patients. All 21 patients exercised using the Bruce protocol for 3-12 minutes, and 9 experienced chest pain 12 months after the MPS, referring physicians were contacted. Cardiac events were defined as cardiac death, myocardial infarction, unstable angina, cardiac failure, revascularisation or a coronary angiogram demonstrating >70% stenosis. To date, follow up is complete in 11 patients with one confirmed case of single vessel revascularisation 3 months post MPS. Full follow up data will be presented. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria.

Science.gov (United States)

Assanelli, Deodato; Levaggi, Rosella; Carré, François; Sharma, Sanjay; Deligiannis, Asterios; Mellwig, Klaus Peter; Tahmi, Mohamed; Vinetti, Giovanni; Aliverti, Paola

2015-03-01

The aim of this study is to evaluate the cost-effectiveness of ECG in combination with family and personal history and physical examination in order to detect cardiovascular diseases that might cause sudden death in athletes. The study was conducted on a cohort of 6,634, mainly young professional and recreational athletes, 1,071 from Algeria and 5,563 from Europe (France, Germany and Greece). Each athlete underwent medical history, physical examination, and resting 12-lead ECG. 293 athletes (4.4 %), 149 in Europe (2.7 %) and 144 in Algeria (13.4 %) required further tests, and 56 were diagnosed with cardiovascular disease and thus disqualified. The cost-effectiveness ratio (CER) was calculated as the ratio between the cost of screening and the number of statistical life-years saved by the intervention. The estimated reduced risk of death deriving from treatment or disqualification resulted in the saving of 79.1 statistical life-years in Europe and 136.3 in Algeria. CER of screening was 4,071 purchasing-power-parity-adjusted US dollars ($PPP) in Europe and 582 $PPP in Algeria. The results of this study strongly support the utilisation of 12-lead ECG in the pre-participation screening of young athletes, especially in countries where secondary preventive care is not highly developed.

QRS detection based ECG quality assessment

International Nuclear Information System (INIS)

Hayn, Dieter; Jammerbund, Bernhard; Schreier, Günter

2012-01-01

Although immediate feedback concerning ECG signal quality during recording is useful, up to now not much literature describing quality measures is available. We have implemented and evaluated four ECG quality measures. Empty lead criterion (A), spike detection criterion (B) and lead crossing point criterion (C) were calculated from basic signal properties. Measure D quantified the robustness of QRS detection when applied to the signal. An advanced Matlab-based algorithm combining all four measures and a simplified algorithm for Android platforms, excluding measure D, were developed. Both algorithms were evaluated by taking part in the Computing in Cardiology Challenge 2011. Each measure's accuracy and computing time was evaluated separately. During the challenge, the advanced algorithm correctly classified 93.3% of the ECGs in the training-set and 91.6 % in the test-set. Scores for the simplified algorithm were 0.834 in event 2 and 0.873 in event 3. Computing time for measure D was almost five times higher than for other measures. Required accuracy levels depend on the application and are related to computing time. While our simplified algorithm may be accurate for real-time feedback during ECG self-recordings, QRS detection based measures can further increase the performance if sufficient computing power is available. (paper)

Differences in alarm events between disposable and reusable electrocardiography lead wires.

Science.gov (United States)

Albert, Nancy M; Murray, Terri; Bena, James F; Slifcak, Ellen; Roach, Joel D; Spence, Jackie; Burkle, Alicia

2015-01-01

Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To examine differences in alarm events between disposable and reusable ECG-LWs. Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types. In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0.88, [0.62-1.24], P = .02; superiority P = .44). No between-group differences existed in false or true crisis alarms. Disposable ECG-LWs were noninferior to reusable ECG-LWs for all false-alarm events (N [rate per 100 patient days], disposable 2029 [79.1] vs reusable 6673 [97.9]; adjusted relative risk [95% CI]: 0.81 [0.63-1.06], P = .002; superiority P = .12.) Disposable ECG-LWs with patented push-button design had superior performance in reducing alarms created by no telemetry, leads fail, or leads off and significant noninferiority in all false-alarm rates compared with reusable ECG-LWs. Fewer ECG alarms may save nurses time, decrease alarm fatigue, and improve patient safety. ©2015 American Association of Critical-Care Nurses.

Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

Directory of Open Access Journals (Sweden)

Wong, Hubert E

2002-10-01

Full Text Available OBJECTIVES: Electrocardiograph (ECG interpretation is a vital component of Emergency Medicine (EM resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1% [9 1- 1191, second-year residents 11 1 points (60.4% [97-1261, and third-year residents 130 points (7 1.0% [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our

Robust and Accurate Anomaly Detection in ECG Artifacts Using Time Series Motif Discovery

Science.gov (United States)

Sivaraks, Haemwaan

2015-01-01

Electrocardiogram (ECG) anomaly detection is an important technique for detecting dissimilar heartbeats which helps identify abnormal ECGs before the diagnosis process. Currently available ECG anomaly detection methods, ranging from academic research to commercial ECG machines, still suffer from a high false alarm rate because these methods are not able to differentiate ECG artifacts from real ECG signal, especially, in ECG artifacts that are similar to ECG signals in terms of shape and/or frequency. The problem leads to high vigilance for physicians and misinterpretation risk for nonspecialists. Therefore, this work proposes a novel anomaly detection technique that is highly robust and accurate in the presence of ECG artifacts which can effectively reduce the false alarm rate. Expert knowledge from cardiologists and motif discovery technique is utilized in our design. In addition, every step of the algorithm conforms to the interpretation of cardiologists. Our method can be utilized to both single-lead ECGs and multilead ECGs. Our experiment results on real ECG datasets are interpreted and evaluated by cardiologists. Our proposed algorithm can mostly achieve 100% of accuracy on detection (AoD), sensitivity, specificity, and positive predictive value with 0% false alarm rate. The results demonstrate that our proposed method is highly accurate and robust to artifacts, compared with competitive anomaly detection methods. PMID:25688284

ECG De-noising

DEFF Research Database (Denmark)

Kærgaard, Kevin; Jensen, Søren Hjøllund; Puthusserypady, Sadasivan

2015-01-01

Electrocardiogram (ECG) is a widely used noninvasive method to study the rhythmic activity of the heart and thereby to detect the abnormalities. However, these signals are often obscured by artifacts from various sources and minimization of these artifacts are of paramount important. This paper...... proposes two adaptive techniques, namely the EEMD-BLMS (Ensemble Empirical Mode Decomposition in conjunction with the Block Least Mean Square algorithm) and DWT-NN (Discrete Wavelet Transform followed by Neural Network) methods in minimizing the artifacts from recorded ECG signals, and compares...... their performance. These methods were first compared on two types of simulated noise corrupted ECG signals: Type-I (desired ECG+noise frequencies outside the ECG frequency band) and Type-II (ECG+noise frequencies both inside and outside the ECG frequency band). Subsequently, they were tested on real ECG recordings...

Relationship between echocardiographic LV mass and ECG based left ventricular voltages in an adolescent population: related or random?

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Czosek, Richard J; Cnota, James F; Knilans, Timothy K; Pratt, Jesse; Guerrier, Karine; Anderson, Jeffrey B

2014-09-01

In attempts to detect diseases that may place adolescents at risk for sudden death, some have advocated for population-based screening. Controversy exists over electrocardiography (ECG) screening due to the lack of specificity, cost, and detrimental effects of false positive or extraneous outcomes. Analyze the relationship between precordial lead voltage on ECG and left ventricle (LV) mass by echocardiogram in adolescent athletes. Retrospective cohort analysis of a prospectively obtained population of self-identified adolescent athletes during sports screening with ECG and echocardiogram. Correlation between ECG LV voltages (R wave in V6 [RV6] and S wave in lead V1 [SV1]) was compared to echocardiogram-based measurements of left ventricular mass. Potential effects on ECG voltages by body anthropometrics, including weight, body mass index (BMI), and body surface area were analyzed, and ECG voltages indexed to BMI were compared to LV mass indices to analyze for improved correlation. A total of 659 adolescents enrolled in this study (64% male). The mean age was 15.4 years (14-18). The correlations between LV mass and RV6, SV1, and RV6 + SV1 were all less than 0.20. The false positive rate for abnormal voltages was relatively high (5.5%) but improved if abnormal voltages in both RV6 and SV1 were mandated simultaneously (0%). Indexing ECG voltages to BMI significantly improved correlation to LV mass, though false positive findings were increased (12.9%). There is poor correlation between ECG precordial voltages and echocardiographic LV mass. This relationship is modified by BMI. This finding may contribute to the poor ECG screening characteristics. ©2014 Wiley Periodicals, Inc.

Improving ECG classification accuracy using an ensemble of neural network modules.

Directory of Open Access Journals (Sweden)

Mehrdad Javadi

Full Text Available This paper illustrates the use of a combined neural network model based on Stacked Generalization method for classification of electrocardiogram (ECG beats. In conventional Stacked Generalization method, the combiner learns to map the base classifiers' outputs to the target data. We claim adding the input pattern to the base classifiers' outputs helps the combiner to obtain knowledge about the input space and as the result, performs better on the same task. Experimental results support our claim that the additional knowledge according to the input space, improves the performance of the proposed method which is called Modified Stacked Generalization. In particular, for classification of 14966 ECG beats that were not previously seen during training phase, the Modified Stacked Generalization method reduced the error rate for 12.41% in comparison with the best of ten popular classifier fusion methods including Max, Min, Average, Product, Majority Voting, Borda Count, Decision Templates, Weighted Averaging based on Particle Swarm Optimization and Stacked Generalization.

Unveiling the Biometric Potential of Finger-Based ECG Signals

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Lourenço, André; Silva, Hugo; Fred, Ana

2011-01-01

The ECG signal has been shown to contain relevant information for human identification. Even though results validate the potential of these signals, data acquisition methods and apparatus explored so far compromise user acceptability, requiring the acquisition of ECG at the chest. In this paper, we propose a finger-based ECG biometric system, that uses signals collected at the fingers, through a minimally intrusive 1-lead ECG setup recurring to Ag/AgCl electrodes without gel as interface with the skin. The collected signal is significantly more noisy than the ECG acquired at the chest, motivating the application of feature extraction and signal processing techniques to the problem. Time domain ECG signal processing is performed, which comprises the usual steps of filtering, peak detection, heartbeat waveform segmentation, and amplitude normalization, plus an additional step of time normalization. Through a simple minimum distance criterion between the test patterns and the enrollment database, results have revealed this to be a promising technique for biometric applications. PMID:21837235

Unveiling the biometric potential of finger-based ECG signals.

Science.gov (United States)

Lourenço, André; Silva, Hugo; Fred, Ana

2011-01-01

The ECG signal has been shown to contain relevant information for human identification. Even though results validate the potential of these signals, data acquisition methods and apparatus explored so far compromise user acceptability, requiring the acquisition of ECG at the chest. In this paper, we propose a finger-based ECG biometric system, that uses signals collected at the fingers, through a minimally intrusive 1-lead ECG setup recurring to Ag/AgCl electrodes without gel as interface with the skin. The collected signal is significantly more noisy than the ECG acquired at the chest, motivating the application of feature extraction and signal processing techniques to the problem. Time domain ECG signal processing is performed, which comprises the usual steps of filtering, peak detection, heartbeat waveform segmentation, and amplitude normalization, plus an additional step of time normalization. Through a simple minimum distance criterion between the test patterns and the enrollment database, results have revealed this to be a promising technique for biometric applications.

Atrial flutter: from ECG to electroanatomical 3D mapping

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Livio Dei Cas

2009-08-01

Full Text Available Atrial flutter is a common arrhythmia that may cause significant symptoms, including palpitations, dyspnea, chest pain and even syncope. Frequently it’s possible to diagnose atrial flutter with a 12-lead surface ECG, looking for distinctive waves in leads II, III, aVF, aVL, V1,V2. Puech and Waldo developed the first classification of atrial flutter in the 1970s. These authors divided the arrhythmia into type I and type II. Therefore, in 2001 the European Society of Cardiology and the North American Society of Pacing and Electrophysiology developed a new classification of atrial flutter, based not only on the ECG, but also on the electrophysiological mechanism. New developments in endocardial mapping, including the electroanatomical 3D mapping system, have greatly expanded our understanding of the mechanism of arrhythmias. More recently, Scheinman et al, provided an updated classification and nomenclature. The terms like common, uncommon, typical, reverse typical or atypical flutter are abandoned because they may generate confusion. The authors worked out a new terminology, which differentiates atrial flutter only on the basis of electrophysiological mechanism. (Heart International 2006; 3-4: 161-70

WaveformECG: A Platform for Visualizing, Annotating, and Analyzing ECG Data.

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Winslow, Raimond L; Granite, Stephen; Jurado, Christian

2016-01-01

The electrocardiogram (ECG) is the most commonly collected data in cardiovascular research because of the ease with which it can be measured and because changes in ECG waveforms reflect underlying aspects of heart disease. Accessed through a browser, WaveformECG is an open source platform supporting interactive analysis, visualization, and annotation of ECGs.

When Deriving the Spatial QRS-T Angle from the 12-lead ECG, which Transform is More Frank: Regression or Inverse Dower?

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Schlegel, Todd T.; Cortez, Daniel

2010-01-01

Our primary objective was to ascertain which commonly used 12-to-Frank-lead transformation yields spatial QRS-T angle values closest to those obtained from simultaneously collected true Frank-lead recordings. Simultaneous 12-lead and Frank XYZ-lead recordings were analyzed for 100 post-myocardial infarction patients and 50 controls. Relative agreement, with true Frank-lead results, of 12-to-Frank-lead transformed results for the spatial QRS-T angle using Kors regression versus inverse Dower was assessed via ANOVA, Lin s concordance and Bland-Altman plots. Spatial QRS-T angles from the true Frank leads were not significantly different than those derived from the Kors regression-related transformation but were significantly smaller than those derived from the inverse Dower-related transformation (P less than 0.001). Independent of method, spatial mean QRS-T angles were also always significantly larger than spatial maximum (peaks) QRS-T angles. Spatial QRS-T angles are best approximated by regression-related transforms. Spatial mean and spatial peaks QRS-T angles should also not be used interchangeably.

Research on comparison of exposure with electrocardiographic gated mA modulation (ECG) and ECG and CAREDose 4D mode in coronary multi-slice spiral CT angiography

International Nuclear Information System (INIS)

Liu Bin; Guo Senlin; Wei Lan; Fei Xiaolu; Bai Mei

2009-01-01

Objective: The objective of this article was to compare patients dose with electrocardiographic gated mA modulation (ECG) and ECG and CAREDose 4D mode during coronary MSCT angiography. Methods: The research was based on phantom experiment and computer simulation to get the mean value of peak skin dose data and effective dose data respectively and to analyze deterministic and stochastic radiation risk. Results: The peak skin dose using ECG mode alone and using ECG and CAREDose 4D mode with the same image noise level was (87.4 ± 0.9) and (45.9 ± 1.2) mGy respectively. Effective dose was 17 and 10 rosy for ECG mode and ECG and CAREDose 4D mode respectively. Comparing with ECG mode alone, ECG and CAREDose 4D mode reduced organ dose of gonad, red marrow, lung, stomach, breast and thyroid by 40.0%, 36.7%, 39.3%, 37.7%, 38.8% and 38.9%, respectively. Conclusion: Results showed that ECG and CAREDose 4D mode can reduce radiation dose effectively comparing using ECG mode alone, and that ECG and CAREDose 4D mode should be widely applied clinically with appropriate initial settings. (authors)

Personal Identification Based on Vectorcardiogram Derived from Limb Leads Electrocardiogram

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Jongshill Lee

2012-01-01

Full Text Available We propose a new method for personal identification using the derived vectorcardiogram (dVCG, which is derived from the limb leads electrocardiogram (ECG. The dVCG was calculated from the standard limb leads ECG using the precalculated inverse transform matrix. Twenty-one features were extracted from the dVCG, and some or all of these 21 features were used in support vector machine (SVM learning and in tests. The classification accuracy was 99.53%, which is similar to the previous dVCG analysis using the standard 12-lead ECG. Our experimental results show that it is possible to identify a person by features extracted from a dVCG derived from limb leads only. Hence, only three electrodes have to be attached to the person to be identified, which can reduce the effort required to connect electrodes and calculate the dVCG.

2D.03: IMPROVING DIAGNOSTIC STRATEGY IN PATIENTS WITH LONG-STANDING HYPERTENSION, CHEST PAIN AND NORMAL RESTING ECG: VALUE OF THE EXERCISE HIGH-FREQUENCY QRS VERSUS ST-SEGMENT ANALYSIS.

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Conti, A; Bianchi, S; Grifoni, C; Trausi, F; Angeli, E; Paolini, D; Catarzi, S; Perrotta, M E; Covelli, A; Renzi, N; Bertolini, P; Mazzucchelli, M

2015-06-01

The novel exercise computer-assisted high-frequency QRS-analysis (ex-HF/QRS) has demonstrated improved sensitivity and specificity over the conventional exercise-ST/ECG-segment-analysis (ex-ST/ECG) in the detection of myocardial ischemia. The aim of the present study was to test the implementation in diagnostic value of the ex-HF/QRS in patient with hypertension and chest pain (CP) versus the conventional ex-ST/ECG anlysis alone. Patients with long-standing hypertension, CP, normal ECG, troponin and echocardiography were enrolled. All patients underwent the ex-ST/ECG and ex-HF/QRS. A decrease >/=50% of the signal of ex-HF/QRS intensity recorded in two contiguous leads, at least, was considered as index of ischaemia, as ST-segment depression >/=2 mm or >/=1 mm and CP on ex-ST/ECG. Exclusion criteria were QRS duration >/=120 msec and inability to exercise. The end-point was the composite of coronary stenosis >50% or acute coronary syndrome, revascularization, cardiovascular death at 3-month follow-up. Six-hundred thirty-one patients were enrolled (age 61+/-15 y). The percentage of age-adjusted maximal predicted heart rate was 88+/-10 beat-per-minute and the maximal systolic blood pressure was 169+/-22 mmHg. Twenty-seven patients achieved the end-point. On multivariate analysis, both the ex-ST/ECG and ex-HF/QRS were predictors of the end-point. The ex-HF/QRS showed higher sensitivity (88% vs 50%; p = 0.003), lower specificity (77% vs 97%; p = 0.245) and comparable negative predictive value (99% vs 99%; p = NS) when compared to ex-ST/ECG. Receiver operator characteristics (ROC) analysis showed the incremental diagnostic value of the ex-HF/QRS (area: 0.64, 95% Confidence Intervals, CI 0.51-0.77) over conventional ex-ST/ECG (0.60, CI 0.52-0.66) and Chest Pain Score (0.53, CI 0.48-0.59); p = NS on pairwise C-statistic. In patients with long-standing hypertension and CP submitted to risk stratification with exercise tolerance test, the novel ex

Development of new anatomy reconstruction software to localize cardiac isochrones to the cardiac surface from the 12 lead ECG.

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van Dam, Peter M; Gordon, Jeffrey P; Laks, Michael M; Boyle, Noel G

2015-01-01

medical image data (pixel size software tool has been introduced, which is able to reconstruct accurate cardiac anatomical models from MRI or CT within only a few hours. This new anatomical reconstruction tool might reduce the modeling errors within the cardiac isochrone positioning system and thus enable the clinical application of CIPS to localize the PVC/VT focus to the ventricular myocardium from only the standard 12 lead ECG. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

DEFF Research Database (Denmark)

Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby

2016-01-01

-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1......-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage...

ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study.

Science.gov (United States)

Rodrigues, Jonathan C L; Amadu, Antonio Matteo; Ghosh Dastidar, Amardeep; McIntyre, Bethannie; Szantho, Gergley V; Lyen, Stephen; Godsave, Cattleya; Ratcliffe, Laura E K; Burchell, Amy E; Hart, Emma C; Hamilton, Mark C K; Nightingale, Angus K; Paton, Julian F R; Manghat, Nathan E; Bucciarelli-Ducci, Chiara

2017-04-01

In hypertension, the presence of left ventricular (LV) strain pattern on 12-lead electrocardiogram (ECG) carries adverse cardiovascular prognosis. The underlying mechanisms are poorly understood. We investigated whether hypertensive ECG strain is associated with myocardial interstitial fibrosis and impaired myocardial strain, assessed by multi-parametric cardiac magnetic resonance (CMR). A total of 100 hypertensive patients [50 ± 14 years, male: 58%, office systolic blood pressure (SBP): 170 ± 30 mmHg, office diastolic blood pressure (DBP): 97 ± 14 mmHg) underwent ECG and 1.5T CMR and were compared with 25 normotensive controls (46 ± 14 years, 60% male, SBP: 124 ± 8 mmHg, DBP: 76 ± 7 mmHg). Native T1 and extracellular volume fraction (ECV) were calculated with the modified look-locker inversion-recovery sequence. Myocardial strain values were estimated with voxel-tracking software. ECG strain (n = 20) was associated with significantly higher indexed LV mass (LVM) (119 ± 32 vs. 80 ± 17 g/m2, P ECG strain (n = 80). ECG strain subjects had significantly impaired circumferential strain compared with hypertensive subjects without ECG strain and controls (-15.2 ± 4.7 vs. -17.0 ± 3.3 vs. -17.3 ± 2.4%, P ECG strain subjects to hypertensive subjects with elevated LVM but no ECG strain, a significantly higher ECV (30 ± 4 vs. 28 ± 3%, P ECG strain in multivariate logistic regression analysis [odds ratio (95th confidence interval): 1.07 (1.02-1.12), P ECG strain is a marker of advanced LVH associated with increased interstitial fibrosis and associated with significant myocardial circumferential strain impairment. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

Prehospital ECG transmission: comparison of advanced mobile phone and facsimile devices in an urban Emergency Medical Service System.

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Väisänen, Olli; Mäkijärvi, Markku; Silfvast, Tom

2003-05-01

To compare the speed and reliability of electrocardiogram (ECG) transmissions from the prehospital setting to a conventional table facsimile device and to an advanced mobile phone in a Helicopter Emergency Medical Service System (HEMS). Eighteen authentic ECGs stored in the memory module of a monitor defibrillator were used. The ECGs were (1) sent directly from the monitor defibrillator to a table fax and an advanced mobile phone at the HEMS base; (2) printed out and sent from a mobile fax connected to an ordinary mobile phone to the table fax and the advanced mobile phone at the HEMS base; (3) printed out and sent from an ordinary table fax as well as from a table fax connected to a satellite phone system to the receiving devices at the HEMS base. When the ECGs were sent from the table fax via satellite, the transmission times were longer to the advanced mobile phone than to the table fax at the HEMS base (1 min 54 s+/-0 min 21 s vs. 1 min 37 s+/-0 min 20 s, (mean+/-SD), (Ptransmission from the other fax devices, there were no differences in transmission times between the two receiving devices. The fastest way to transmit ECGs to the advanced mobile phone was to send it from conventional table fax (1 min 22 s+/-0 min 18 s) and the longest transmission times were with mobile fax connected to mobile phone (5 min 23 s+/-3 min 5 s). In all ECGs transmitted except one the cardiac rhythm and ST-changes could be recognised. An advanced mobile phone is as fast and reliable as a conventional table fax in receiving ECGs. A mobile phone with advanced features is a practical tool for HEMS physicians who need to evaluate ECGs in the prehospital setting.

Deep Arm/Ear-ECG Image Learning for Highly Wearable Biometric Human Identification.

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Zhang, Qingxue; Zhou, Dian

2018-01-01

In this study, to advance smart health applications which have increasing security/privacy requirements, we propose a novel highly wearable ECG-based user identification system, empowered by both non-standard convenient ECG lead configurations and deep learning techniques. Specifically, to achieve a super wearability, we suggest situating all the ECG electrodes on the left upper-arm, or behind the ears, and successfully obtain weak but distinguishable ECG waveforms. Afterwards, to identify individuals from weak ECG, we further present a two-stage framework, including ECG imaging and deep feature learning/identification. In the former stage, the ECG heartbeats are projected to a 2D state space, to reveal heartbeats' trajectory behaviors and produce 2D images by a split-then-hit method. In the second stage, a convolutional neural network is introduced to automatically learn the intricate patterns directly from the ECG image representations without heavy feature engineering, and then perform user identification. Experimental results on two acquired datasets using our wearable prototype, show a promising identification rate of 98.4% (single-arm-ECG) and 91.1% (ear-ECG), respectively. To the best of our knowledge, it is the first study on the feasibility of using single-arm-ECG/ear-ECG for user identification purpose, which is expected to contribute to pervasive ECG-based user identification in smart health applications.

Deep ECGNet: An Optimal Deep Learning Framework for Monitoring Mental Stress Using Ultra Short-Term ECG Signals.

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Hwang, Bosun; You, Jiwoo; Vaessen, Thomas; Myin-Germeys, Inez; Park, Cheolsoo; Zhang, Byoung-Tak

2018-02-08

Stress recognition using electrocardiogram (ECG) signals requires the intractable long-term heart rate variability (HRV) parameter extraction process. This study proposes a novel deep learning framework to recognize the stressful states, the Deep ECGNet, using ultra short-term raw ECG signals without any feature engineering methods. The Deep ECGNet was developed through various experiments and analysis of ECG waveforms. We proposed the optimal recurrent and convolutional neural networks architecture, and also the optimal convolution filter length (related to the P, Q, R, S, and T wave durations of ECG) and pooling length (related to the heart beat period) based on the optimization experiments and analysis on the waveform characteristics of ECG signals. The experiments were also conducted with conventional methods using HRV parameters and frequency features as a benchmark test. The data used in this study were obtained from Kwangwoon University in Korea (13 subjects, Case 1) and KU Leuven University in Belgium (9 subjects, Case 2). Experiments were designed according to various experimental protocols to elicit stressful conditions. The proposed framework to recognize stress conditions, the Deep ECGNet, outperformed the conventional approaches with the highest accuracy of 87.39% for Case 1 and 73.96% for Case 2, respectively, that is, 16.22% and 10.98% improvements compared with those of the conventional HRV method. We proposed an optimal deep learning architecture and its parameters for stress recognition, and the theoretical consideration on how to design the deep learning structure based on the periodic patterns of the raw ECG data. Experimental results in this study have proved that the proposed deep learning model, the Deep ECGNet, is an optimal structure to recognize the stress conditions using ultra short-term ECG data.

Heritability of ECG Biomarkers in the Netherlands Twin Registry Measured from Holter ECGs.

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Emily C Hodkinson

2016-04-01

Full Text Available INTRODUCTIONThe resting ECG is the most commonly used tool to assess cardiac electrophysiology. Previous studies have estimated heritability of ECG parameters based on these snapshots of the cardiac electrical activity. In this study we set out to determine whether analysis of heart rate specific data from Holter ECGs allows more complete assessment of the heritability of ECG parameters.METHODS and RESULTSHolter ECGs were recorded from 221 twin pairs and analyzed using a multi-parameter beat binning approach. Heart rate dependent estimates of heritability for QRS duration, QT interval, Tpeak–Tend and Theight were calculated using structural equation modelling. QRS duration is largely determined by environmental factors whereas repolarization is primarily genetically determined. Heritability estimates of both QT interval and Theight were significantly higher when measured from Holter compared to resting ECGs and the heritability estimate of each was heart rate dependent. Analysis of the genetic contribution to correlation between repolarization parameters demonstrated that covariance of individual ECG parameters at different heart rates overlap but at each specific heart rate there was relatively little overlap in the genetic determinants of the different repolarization parameters.CONCLUSIONSHere we present the first study of heritability of repolarization parameters measured from Holter ECGs. Our data demonstrate that higher heritability can be estimated from the Holter than the resting ECG and reveals rate dependence in the genetic – environmental determinants of the ECG that has not previously been tractable. Future applications include deeper dissection of the ECG of participants with inherited cardiac electrical disease.

High Resolution ECG for Evaluation of QT Interval Variability during Exposure to Acute Hypoxia

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Zupet, P.; Finderle, Z.; Schlegel, Todd T.; Starc, V.

2010-01-01

Ventricular repolarization instability as quantified by the index of QT interval variability (QTVI) is one of the best predictors for risk of malignant ventricular arrhythmias and sudden cardiac death. Because it is difficult to appropriately monitor early signs of organ dysfunction at high altitude, we investigated whether high resolution advanced ECG (HR-ECG) analysis might be helpful as a non-invasive and easy-to-use tool for evaluating the risk of cardiac arrhythmias during exposure to acute hypoxia. 19 non-acclimatized healthy trained alpinists (age 37, 8 plus or minus 4,7 years) participated in the study. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position breathing room air and then after breathing 12.5% oxygen for 30 min. For beat-to-beat RR and QT variability, the program of Starc was utilized to derive standard time domain measures such as root mean square of the successive interval difference (rMSSD) of RRV and QTV, the corrected QT interval (QTc) and the QTVI in lead II. Changes were evaluated with paired-samples t-test with p-values less than 0.05 considered statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with p = 0.000 and p = 0.005, respectively. Significant increases were found in both the rMSSDQT and the QTVI in lead II, with p = 0.002 and p = 0.003, respectively. There was no change in QTc interval length (p = non significant). QT variability parameters may be useful for evaluating changes in ventricular repolarization caused by hypoxia. These changes might be driven by increases in sympathetic nervous system activity at ventricular level.

Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points.

Science.gov (United States)

Puelacher, Christian; Wagener, Max; Abächerli, Roger; Honegger, Ursina; Lhasam, Nundsin; Schaerli, Nicolas; Prêtre, Gil; Strebel, Ivo; Twerenbold, Raphael; Boeddinghaus, Jasper; Nestelberger, Thomas; Rubini Giménez, Maria; Hillinger, Petra; Wildi, Karin; Sabti, Zaid; Badertscher, Patrick; Cupa, Janosch; Kozhuharov, Nikola; du Fay de Lavallaz, Jeanne; Freese, Michael; Roux, Isabelle; Lohrmann, Jens; Leber, Remo; Osswald, Stefan; Wild, Damian; Zellweger, Michael J; Mueller, Christian; Reichlin, Tobias

2017-07-01

Exercise ECG stress testing is the most widely available method for evaluation of patients with suspected myocardial ischemia. Its major limitation is the relatively poor accuracy of ST-segment changes regarding ischemia detection. Little is known about the optimal method to assess ST-deviations. A total of 1558 consecutive patients undergoing bicycle exercise stress myocardial perfusion imaging (MPI) were enrolled. Presence of inducible myocardial ischemia was adjudicated using MPI results. The diagnostic value of ST-deviations for detection of exercise-induced myocardial ischemia was systematically analyzed 1) for each individual lead, 2) at three different intervals after the J-point (J+40ms, J+60ms, J+80ms), and 3) at different time points during the test (baseline, maximal workload, 2min into recovery). Exercise-induced ischemia was detected in 481 (31%) patients. The diagnostic accuracy of ST-deviations was highest at +80ms after the J-point, and at 2min into recovery. At this point, ST-amplitude showed an AUC of 0.63 (95% CI 0.59-0.66) for the best-performing lead I. The combination of ST-amplitude and ST-slope in lead I did not increase the AUC. Lead I reached a sensitivity of 37% and a specificity of 83%, with similar sensitivity to manual ECG analysis (34%, p=0.31) but lower specificity (90%, pST-deviations is highest when evaluated at +80ms after the J-point, and at 2min into recovery. Copyright © 2017 Elsevier B.V. All rights reserved.

A novel biometric authentication approach using ECG and EMG signals.

Science.gov (United States)

Belgacem, Noureddine; Fournier, Régis; Nait-Ali, Amine; Bereksi-Reguig, Fethi

2015-05-01

Security biometrics is a secure alternative to traditional methods of identity verification of individuals, such as authentication systems based on user name and password. Recently, it has been found that the electrocardiogram (ECG) signal formed by five successive waves (P, Q, R, S and T) is unique to each individual. In fact, better than any other biometrics' measures, it delivers proof of subject's being alive as extra information which other biometrics cannot deliver. The main purpose of this work is to present a low-cost method for online acquisition and processing of ECG signals for person authentication and to study the possibility of providing additional information and retrieve personal data from an electrocardiogram signal to yield a reliable decision. This study explores the effectiveness of a novel biometric system resulting from the fusion of information and knowledge provided by ECG and EMG (Electromyogram) physiological recordings. It is shown that biometrics based on these ECG/EMG signals offers a novel way to robustly authenticate subjects. Five ECG databases (MIT-BIH, ST-T, NSR, PTB and ECG-ID) and several ECG signals collected in-house from volunteers were exploited. A palm-based ECG biometric system was developed where the signals are collected from the palm of the subject through a minimally intrusive one-lead ECG set-up. A total of 3750 ECG beats were used in this work. Feature extraction was performed on ECG signals using Fourier descriptors (spectral coefficients). Optimum-Path Forest classifier was used to calculate the degree of similarity between individuals. The obtained results from the proposed approach look promising for individuals' authentication.

The ECG component of thallium-201 exercise testing significantly alters patient management

International Nuclear Information System (INIS)

Deague, J.; Salehi, N.; Grigg, L.; Lichtenstein, M.; Better, N.

1998-01-01

Full text: Thallium exercise testing (Tlex) offers superior sensitivity and specificity to exercise electrocardiography (ECG), but the value of the ECG data in Tlex remains poorly studied. While a normal Tlex is associated with an excellent prognosis, patients with a positive Tlex have a higher cardiac event rate. We aimed to see if a negative ECG component of the Tlex (ECGTI) was associated with an improved outcome compared with a positive ECGTI, in those patients with a reversible Tlex defect. We followed 100 consecutive patients retrospectively with a reversible defect on Tlex (50 with negative and 50 with positive (ECGTI) for 12 months. The ECG was reviewed as positive (1 mm ST depression 0.08 seconds after J point or > 2 mm if on digoxin or prior ECG changes), negative, equivocal or uninterpretable. We excluded patients with pharmacological testing, and those with equivocal or uninterpretable ECGs. Over the ensuing 12 months no patients with negative ECGTl was admitted with unstable angina, myocardium infarction or had a cardiac death. It is concluded that in patients with reversible defects on Tlex, a negative ECGTl is associated with a low incidence of cardiac events and a decreased incidence of a cardiac intervention

A system for intelligent home care ECG upload and priorisation.

Science.gov (United States)

D'Angelo, Lorenzo T; Tarita, Eugeniu; Zywietz, Tosja K; Lueth, Tim C

2010-01-01

In this contribution, a system for internet based, automated home care ECG upload and priorisation is presented for the first time. It unifies the advantages of existing telemonitoring ECG systems adding functionalities such as automated priorisation and usability for home care. Chronic cardiac diseases are a big group in the geriatric field. Most of them can be easily diagnosed with help of an electrocardiogram. A frequent or long-term ECG analysis allows early diagnosis of e.g. a cardiac infarction. Nevertheless, patients often aren't willing to visit a doctor for prophylactic purposes. Possible solutions of this problem are home care devices, which are used to investigate patients at home without the presence of a doctor on site. As the diffusion of such systems leads to a huge amount of data which has to be managed and evaluated, the presented approach focuses on an easy to use software for ECG upload from home, a web based management application and an algorithm for ECG preanalysis and priorisation.

Left Ventricular Hypertrophy: An allometric comparative analysis of different ECG markers

International Nuclear Information System (INIS)

Bonomini, MP; Valentinuzzi, M E; Arini, P D; Ingallina, F; Barone, V

2011-01-01

Allometry, in general biology, measures the relative growth of a part in relation to the whole living organism. Left ventricular hypertrophy (LVH) is the heart adaptation to excessive load (systolic or diastolic). The increase in left ventricular mass leads to an increase in the electrocardiographic voltages. Based on clinical data, we compared the allometric behavior of three different ECG markers of LVH. To do this, the allometric fit AECG δ + β (VM) relating left ventricular mass (estimated from ecocardiographic data) and ECG amplitudes (expressed as the Cornell-Voltage, Sokolow and the ECG overall voltage indexes) were compared. Besides, sensitivity and specificity for each index were analyzed. The more sensitive the ECG criteria, the better the allometric fit. In conclusion: The allometric paradigm should be regarded as the way to design new and more sensitive ECG-based LVH markers.

Cancelable ECG biometrics using GLRT and performance improvement using guided filter with irreversible guide signal.

Science.gov (United States)

Kim, Hanvit; Minh Phuong Nguyen; Se Young Chun

2017-07-01

Biometrics such as ECG provides a convenient and powerful security tool to verify or identify an individual. However, one important drawback of biometrics is that it is irrevocable. In other words, biometrics cannot be re-used practically once it is compromised. Cancelable biometrics has been investigated to overcome this drawback. In this paper, we propose a cancelable ECG biometrics by deriving a generalized likelihood ratio test (GLRT) detector from a composite hypothesis testing in randomly projected domain. Since it is common to observe performance degradation for cancelable biometrics, we also propose a guided filtering (GF) with irreversible guide signal that is a non-invertibly transformed signal of ECG authentication template. We evaluated our proposed method using ECG-ID database with 89 subjects. Conventional Euclidean detector with original ECG template yielded 93.9% PD1 (detection probability at 1% FAR) while Euclidean detector with 10% compressed ECG (1/10 of the original data size) yielded 90.8% PD1. Our proposed GLRT detector with 10% compressed ECG yielded 91.4%, which is better than Euclidean with the same compressed ECG. GF with our proposed irreversible ECG template further improved the performance of our GLRT with 10% compressed ECG up to 94.3%, which is higher than Euclidean detector with original ECG. Lastly, we showed that our proposed cancelable ECG biometrics practically met cancelable biometrics criteria such as efficiency, re-usability, diversity and non-invertibility.

Computerized analysis of the 12-lead electrocardiogram to identify epicardial ventricular tachycardia exit sites.

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Yokokawa, Miki; Jung, Dae Yon; Joseph, Kim K; Hero, Alfred O; Morady, Fred; Bogun, Frank

2014-11-01

Twelve-lead electrocardiogram (ECG) criteria for epicardial ventricular tachycardia (VT) origins have been described. In patients with structural heart disease, the ability to predict an epicardial origin based on QRS morphology is limited and has been investigated only for limited regions in the heart. The purpose of this study was to determine whether a computerized algorithm is able to accurately differentiate epicardial vs endocardial origins of ventricular arrhythmias. Endocardial and epicardial pace-mapping were performed in 43 patients at 3277 sites. The 12-lead ECGs were digitized and analyzed using a mixture of gaussian model (MoG) to assess whether the algorithm was able to identify an epicardial vs endocardial origin of the paced rhythm. The MoG computerized algorithm was compared to algorithms published in prior reports. The computerized algorithm correctly differentiated epicardial vs endocardial pacing sites for 80% of the sites compared to an accuracy of 42% to 66% of other described criteria. The accuracy was higher in patients without structural heart disease than in those with structural heart disease (94% vs 80%, P = .0004) and for right bundle branch block (82%) compared to left bundle branch block morphologies (79%, P = .001). Validation studies showed the accuracy for VT exit sites to be 84%. A computerized algorithm was able to accurately differentiate the majority of epicardial vs endocardial pace-mapping sites. The algorithm is not region specific and performed best in patients without structural heart disease and with VTs having a right bundle branch block morphology. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

From Pacemaker to Wearable: Techniques for ECG Detection Systems.

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Kumar, Ashish; Komaragiri, Rama; Kumar, Manjeet

2018-01-11

With the alarming rise in the deaths due to cardiovascular diseases (CVD), present medical research scenario places notable importance on techniques and methods to detect CVDs. As adduced by world health organization, technological proceeds in the field of cardiac function assessment have become the nucleus and heart of all leading research studies in CVDs in which electrocardiogram (ECG) analysis is the most functional and convenient tool used to test the range of heart-related irregularities. Most of the approaches present in the literature of ECG signal analysis consider noise removal, rhythm-based analysis, and heartbeat detection to improve the performance of a cardiac pacemaker. Advancements achieved in the field of ECG segments detection and beat classification have a limited evaluation and still require clinical approvals. In this paper, approaches on techniques to implement on-chip ECG detector for a cardiac pacemaker system are discussed. Moreover, different challenges regarding the ECG signal morphology analysis deriving from medical literature is extensively reviewed. It is found that robustness to noise, wavelet parameter choice, numerical efficiency, and detection performance are essential performance indicators required by a state-of-the-art ECG detector. Furthermore, many algorithms described in the existing literature are not verified using ECG data from the standard databases. Some ECG detection algorithms show very high detection performance with the total number of detected QRS complexes. However, the high detection performance of the algorithm is verified using only a few datasets. Finally, gaps in current advancements and testing are identified, and the primary challenge remains to be implementing bullseye test for morphology analysis evaluation.

CNT/PDMS composite flexible dry electrodes for long-term ECG monitoring.

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Jung, Ha-Chul; Moon, Jin-Hee; Baek, Dong-Hyun; Lee, Jae-Hee; Choi, Yoon-Young; Hong, Joung-Sook; Lee, Sang-Hoon

2012-05-01

We fabricated a carbon nanotube (CNT)/ polydimethylsiloxane (PDMS) composite-based dry ECG electrode that can be readily connected to conventional ECG devices, and showed its long-term wearable monitoring capability and robustness to motion and sweat. While the dispersion of CNTs in PDMS is challenging, we optimized the process to disperse untreated CNTs within PDMS by mechanical force only. The electrical and mechanical characteristics of the CNT/PDMS electrode were tested according to the concentration of CNTs and its thickness. The performances of ECG electrodes were evaluated by using 36 types of electrodes which were fabricated with different concentrations of CNTs, and with a differing diameter and thickness. The ECG signals were obtained by using electrodes of diverse sizes to observe the effects of motion and sweat, and the proposed electrode was shown to be robust to both factors. The CNT concentration and diameter of the electrodes were critical parameters in obtaining high-quality ECG signals. The electrode was shown to be biocompatible from the cytotoxicity test. A seven-day continuous wearability test showed that the quality of the ECG signal did not degrade over time, and skin reactions such as itching or erythema were not observed. This electrode could be used for the long-term measurement of other electrical biosignals for ubiquitous health monitoring including EMG, EEG, and ERG.

Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography

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Thomas Penzel

2016-10-01

Full Text Available The cardiac component of cardio-respiratory polysomnography is covered by ECG and heart rate recordings. However their evaluation is often underrepresented in summarizing reports. As complements to EEG, EOG, and EMG, these signals provide diagnostic information for autonomic nervous activity during sleep. This review presents major methodological developments in sleep research regarding heart rate, ECG and cardio-respiratory couplings in a chronological (historical sequence. It presents physiological and pathophysiological insights related to sleep medicine obtained by new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in totally different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods enables us to estimate sleep stages based on the differences in autonomic nervous system regulation. Furthermore, up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology (amplitude of R wave and T wave.

Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography.

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Penzel, Thomas; Kantelhardt, Jan W; Bartsch, Ronny P; Riedl, Maik; Kraemer, Jan F; Wessel, Niels; Garcia, Carmen; Glos, Martin; Fietze, Ingo; Schöbel, Christoph

2016-01-01

The cardiac component of cardio-respiratory polysomnography is covered by ECG and heart rate recordings. However, their evaluation is often underrepresented in summarizing reports. As complements to EEG, EOG, and EMG, these signals provide diagnostic information for autonomic nervous activity during sleep. This review presents major methodological developments in sleep research regarding heart rate, ECG, and cardio-respiratory couplings in a chronological (historical) sequence. It presents physiological and pathophysiological insights related to sleep medicine obtained by new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability (HRV) analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in totally different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods enables us to estimate sleep stages based on the differences in autonomic nervous system regulation. Furthermore, up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology (amplitude of R wave and T wave).

ECG Electrocardiogram (For Parents)

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... Staying Safe Videos for Educators Search English Español ECG (Electrocardiogram) KidsHealth / For Parents / ECG (Electrocardiogram) Print en ... whether there is any damage. How Is an ECG Done? There is nothing painful about getting an ...

Manifold learning based ECG-free free-breathing cardiac CINE MRI.

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Usman, Muhammad; Atkinson, David; Kolbitsch, Christoph; Schaeffter, Tobias; Prieto, Claudia

2015-06-01

To present and validate a manifold learning (ML)-based method that can estimate both cardiac and respiratory navigator signals from electrocardiogram (ECG)-free free-breathing cardiac magnetic resonance imaging (MRI) data to achieve self-gated retrospective CINE reconstruction. In this work the use of the ML method is demonstrated for 2D cardiac CINE to achieve both cardiac and respiratory self-gating without the need of an external navigator or ECG signal. This is achieved by sequentially applying ML to two sets of retrospectively reconstructed real-time images with differing temporal resolutions. A 1D cardiac signal is estimated by applying ML to high temporal resolution real-time images reconstructed from the acquired data. Using the estimated cardiac signal, a 1D respiratory signal was obtained by applying the ML method to low temporal resolution images reconstructed from the same acquired data for each cardiac cycle. Data were acquired in five volunteers with a 2D golden angle radial trajectory in a balanced steady-state free precession (b-SSFP) acquisition. The accuracy of the estimated cardiac signal was calculated as the standard deviation of the temporal difference between the estimated signal and the recorded ECG. The correlation between the estimated respiratory signal and standard pencil beam navigator signal was evaluated. Gated CINE reconstructions (20 cardiac phases per cycle, temporal resolution ∼30 msec) using the estimated cardiac and respiratory signals were qualitatively compared against conventional ECG-gated breath-hold CINE acquisitions. Accurate cardiac signals were estimated with the proposed method, with an error standard deviation in comparison to ECG lower than 20 msec. Respiratory signals estimated with the proposed method achieved a mean cross-correlation of 94% with respect to standard pencil beam navigator signals. Good quality visual scores of 2.80 ± 0.45 (scores from 0, bad, to 4, excellent quality) were observed for the

Identifying drug-induced repolarization abnormalities from distinct ECG patterns in congenital long QT syndrome: a study of sotalol effects on T-wave morphology

DEFF Research Database (Denmark)

Graff, Claus; Andersen, Mads P; Xue, Joel Q

2009-01-01

BACKGROUND: The electrocardiographic QT interval is used to identify drugs with potential harmful effects on cardiac repolarization in drug trials, but the variability of the measurement can mask drug-induced ECG changes. The use of complementary electrocardiographic indices of abnormal repolariz......BACKGROUND: The electrocardiographic QT interval is used to identify drugs with potential harmful effects on cardiac repolarization in drug trials, but the variability of the measurement can mask drug-induced ECG changes. The use of complementary electrocardiographic indices of abnormal...... are typical ECG patterns in LQT2. Blinded to labels, the new morphology measures were tested in a third group of 39 healthy subjects receiving sotalol. Over 3 days the sotalol group received 0, 160 and 320 mg doses, respectively, and a 12-lead Holter ECG was recorded for 22.5 hours each day. Drug...... with QTcF, p ECG patterns in LQT2 carriers effectively quantified repolarization changes induced by sotalol. Further studies are needed to validate whether this measure has...

Residual motion compensation in ECG-gated interventional cardiac vasculature reconstruction

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Schwemmer, C.; Rohkohl, C.; Lauritsch, G.; Müller, K.; Hornegger, J.

2013-06-01

Three-dimensional reconstruction of cardiac vasculature from angiographic C-arm CT (rotational angiography) data is a major challenge. Motion artefacts corrupt image quality, reducing usability for diagnosis and guidance. Many state-of-the-art approaches depend on retrospective ECG-gating of projection data for image reconstruction. A trade-off has to be made regarding the size of the ECG-gating window. A large temporal window is desirable to avoid undersampling. However, residual motion will occur in a large window, causing motion artefacts. We present an algorithm to correct for residual motion. Our approach is based on a deformable 2D-2D registration between the forward projection of an initial, ECG-gated reconstruction, and the original projection data. The approach is fully automatic and does not require any complex segmentation of vasculature, or landmarks. The estimated motion is compensated for during the backprojection step of a subsequent reconstruction. We evaluated the method using the publicly available CAVAREV platform and on six human clinical datasets. We found a better visibility of structure, reduced motion artefacts, and increased sharpness of the vessels in the compensated reconstructions compared to the initial reconstructions. At the time of writing, our algorithm outperforms the leading result of the CAVAREV ranking list. For the clinical datasets, we found an average reduction of motion artefacts by 13 ± 6%. Vessel sharpness was improved by 25 ± 12% on average.

ECG-derived spatial QRS-T angle is associated with ICD implantation, mortality and heart failure admissions in patients with LV systolic dysfunction.

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Sarah Gleeson

Full Text Available Increased spatial QRS-T angle has been shown to predict appropriate implantable cardioverter defibrilIator (ICD therapy in patients with left ventricular systolic dysfunction (LVSD. We performed a retrospective cohort study in patients with left ventricular ejection fraction (LVEF 31-40% to assess the relationship between the spatial QRS-T angle and other advanced ECG (A-ECG as well as echocardiographic metadata, with all-cause mortality or ICD implantation for secondary prevention.534 patients ≤75 years of age with LVEF 31-40% were identified through an echocardiography reporting database. Digital 12-lead ECGs were retrospectively matched to 295 of these patients, for whom echocardiographic and A-ECG metadata were then generated. Data mining was applied to discover novel ECG and echocardiographic markers of risk. Machine learning was used to develop a model to predict possible outcomes.49 patients (17% had events, defined as either mortality (n = 16 or ICD implantation for secondary prevention (n = 33. 72 parameters (58 A-ECG, 14 echocardiographic were univariately different (p110° had an adjusted HR of 3.4 (95% CI 1.6 to 7.4 for secondary ICD implantation or all-cause death and adjusted HR of 4.1 (95% CI 1.2 to 13.9 for future heart failure admission. There was a loss of complexity between A-ECG and echocardiographic variables with an increasing degree of disease.Spatial QRS-T angle >110° was strongly associated with arrhythmic events and all-cause death. Deep analysis of global ECG and echocardiographic metadata revealed underlying relationships, which otherwise would not have been appreciated. Delivered at scale such techniques may prove useful in clinical decision making in the future.

An optimized lead system for long-term esophageal electrocardiography

International Nuclear Information System (INIS)

Niederhauser, T; Haeberlin, A; Vogel, R; Marisa, T; Goette, J; Jacomet, M; Mattle, D; Abächerli, R

2014-01-01

Long-term electrocardiography (ECG) featuring adequate atrial and ventricular signal quality is highly desirable. Routinely used surface leads are limited in atrial signal sensitivity and recording capability impeding complete ECG delineation, i.e. in the presence of supraventricular arrhythmias. Long-term esophageal ECG might overcome these limitations but requires a dedicated lead system and recorder design. To this end, we analysed multiple-lead esophageal ECGs with respect to signal quality by describing the ECG waves as a function of the insertion level, interelectrode distance, electrode shape and amplifier's input range. The results derived from clinical data show that two bipolar esophageal leads, an atrial lead with short (15 mm) interelectrode distance and a ventricular lead with long (80 mm) interelectrode distance provide non-inferior ventricular signal strength and superior atrial signal strength compared to standard surface lead II. High atrial signal slope in particular is observed with the atrial esophageal lead. The proposed esophageal lead system in combination with an increased recorder input range of ±20 mV minimizes signal loss due to excessive electrode motion typically observed in esophageal ECGs. The design proposal might help to standardize long-term esophageal ECG registrations and facilitate novel ECG classification systems based on the independent detection of ventricular and atrial electrical activity. (paper)

A Study on the Optimal Positions of ECG Electrodes in a Garment for the Design of ECG-Monitoring Clothing for Male.

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Cho, Hakyung; Lee, Joo Hyeon

2015-09-01

Smart clothing is a sort of wearable device used for ubiquitous health monitoring. It provides comfort and efficiency in vital sign measurements and has been studied and developed in various types of monitoring platforms such as T-shirt and sports bra. However, despite these previous approaches, smart clothing for electrocardiography (ECG) monitoring has encountered a serious shortcoming relevant to motion artifacts caused by wearer movement. In effect, motion artifacts are one of the major problems in practical implementation of most wearable health-monitoring devices. In the ECG measurements collected by a garment, motion artifacts are usually caused by improper location of the electrode, leading to lack of contact between the electrode and skin with body motion. The aim of this study was to suggest a design for ECG-monitoring clothing contributing to reduction of motion artifacts. Based on the clothing science theory, it was assumed in this study that the stability of the electrode in a dynamic state differed depending on the electrode location in an ECG-monitoring garment. Founded on this assumption, effects of 56 electrode positions were determined by sectioning the surface of the garment into grids with 6 cm intervals in the front and back of the bodice. In order to determine the optimal locations of the ECG electrodes from the 56 positions, ECG measurements were collected from 10 participants at every electrode position in the garment while the wearer was in motion. The electrode locations indicating both an ECG measurement rate higher than 80.0 % and a large amplitude during motion were selected as the optimal electrode locations. The results of this analysis show four electrode locations with consistently higher ECG measurement rates and larger amplitudes amongst the 56 locations. These four locations were abstracted to be least affected by wearer movement in this research. Based on this result, a design of the garment-formed ECG monitoring platform

Utility of Different Electrocardiographical Leads during Diagnostic Ajmaline Test for Suspected Brugada Syndrome

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Batchvarov V. N.

2009-12-01

Full Text Available In order to compare the value of different leads and lead combinations to detect the signature Brugada type ECG pattern, we analysed digital 10-second, 15-lead ECGs (12 standard leads + leads V1 to V3 from 3rd intercostal (i.c. space, V1h to V3h acquired during diagnostic Ajmaline testing in 128 patients (80 men, age 37±15 years with suspected Brugada syndrome (BS (patient group, 15-lead resting ECGs of 108 healthy subjects (53 men, age 31.9±10.5 years (control group A and standard 12-lead resting ECGs of 229 healthy subjects (111 men, age 33±4 years (control group B. Bipolar leads between V2 (positive pole and V4 or V5 (leads V2-4V2-5 were derived by subtracting leads V4 and V5 from V2 (custom-made program. The 6 peripheral, 6 right precordial leads (V1 to V3, V1h to V3h and leads V2-4 and V2-5 of the patients group, leads V1h to V3h of control group A, and leads V2-4 and V2-5 of control group B were analysed for the presence of type 1 Brugada pattern. There were 21 (16.4% positive and 107 (83.6% negative Ajmaline tests. In 7 positive tests (33%, type 1 pattern appeared only in leads V1h to V3h, whereas in 14 tests 67% it appeared in both V1 to V3 and V1h to V3h. Lead V2 displayed type 1 pattern during 10 positive tests; in all of them, plus 10 other positive tests type 1 was also noted in lead V2h (n=20, 95.2%. In all 10 cases, in which lead V2 exhibited type 1 pattern (n=10, lead V2-4 and/or V2-5 also exhibited type 1-like pattern. During 7 positive tests, in which lead V2h but not V2 exhibited type 1 pattern, lead V2-4 and/or V2-5 also demonstrated type 1 pattern. Type 1 pattern was observed in leads V3 and V3h during 1 (5% and 5 (24% positive tests, in 0 ECGs (0% in control group A and in 1 ECG (0.4% in control group B. In conclusion, the "high" V1 and V2 leads (3rd i.c. space detect more sensitively Brugada type 1 pattern than the standard V1 and V2 leads (4th i.c. space; leads V3 and V3h are not essential for the diagnosis of BS

A low-power portable ECG sensor interface with dry electrodes

International Nuclear Information System (INIS)

Pu Xiaofei; Wan Lei; Zhang Hui; Qin Yajie; Hong Zhiliang

2013-01-01

This paper describes a low-power portable sensor interface dedicated to sensing and processing electrocardiogram (ECG) signals. Dry electrodes were employed in this ECG sensor, which eliminates the need of conductive gel and avoids complicated and mandatory skin preparation before electrode attachment. This ECG sensor system consists of two ICs, an analog front-end (AFE) and a successive approximation register analog-to-digital converter (SAR ADC) containing a relaxation oscillator. This proposed design was fabricated in a 0.18 μm 1P6M standard CMOS process. The AFE for extracting the biopotential signals is essential in this ECG sensor. In measurements, the AFE obtains a mid-band gain of 45 dB, a bandwidth from 0.6 to 160 Hz, and a total input referred noise of 2.8 μV rms while consuming 1 μW from the 1.8 V supply. The noise efficiency factor (NEF) of our design is 3.4. After conditioning, the amplified ECG signal is digitized by a 12-bit SAR ADC with 61.8 dB SNDR and 220 fJ/conversion-step. Finally, a complete ECG sensor interface with three dry copper electrodes is demonstrated in real-word setting, showing successful recordings of a capture ECG waveform. (semiconductor integrated circuits)

Live ECG readings using Google Glass in emergency situations.

Science.gov (United States)

Schaer, Roger; Salamin, Fanny; Jimenez Del Toro, Oscar Alfonso; Atzori, Manfredo; Muller, Henning; Widmer, Antoine

2015-01-01

Most sudden cardiac problems require rapid treatment to preserve life. In this regard, electrocardiograms (ECG) shown on vital parameter monitoring systems help medical staff to detect problems. In some situations, such monitoring systems may display information in a less than convenient way for medical staff. For example, vital parameters are displayed on large screens outside the field of view of a surgeon during cardiac surgery. This may lead to losing time and to mistakes when problems occur during cardiac operations. In this paper we present a novel approach to display vital parameters such as the second derivative of the ECG rhythm and heart rate close to the field of view of a surgeon using Google Glass. As a preliminary assessment, we run an experimental study to verify the possibility for medical staff to identify abnormal ECG rhythms from Google Glass. This study compares 6 ECG rhythms readings from a 13.3 inch laptop screen and from the prism of Google Glass. Seven medical residents in internal medicine participated in the study. The preliminary results show that there is no difference between identifying these 6 ECG rhythms from the laptop screen versus Google Glass. Both allow close to perfect identification of the 6 common ECG rhythms. This shows the potential of connected glasses such as Google Glass to be useful in selected medical applications.

Hyperkalemia on ECG

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Bryson Hicks

2016-09-01

Full Text Available History of present illness: A 34-year-old diabetic female presented to the emergency department with chest pain status-post AICD firing. She described the pain as a “12 out of 10” which woke her from sleep at 0200, one hour prior to arrival. Vitals were unremarkable. She had no known history of renal failure. Due to frequent ED visits for chronic pain, patient had difficult vascular access and nursing was initially unable to obtain IV access. An abnormal rhythm was noted on the cardiac monitor, and ECG was ordered. Significant findings: Initial ECG shows tall, peaked T waves, most prominently in V3 and V4, as well as QRS widening. These findings are consistent with hyperkalemia, which was promptly treated. Follow-up ECG post-treatment shows narrowing of the QRS complexes and normalization of peaked T waves. Discussion: The etiology of hyperkalemia may be due to an acute insult such as crush injury, drug side effect, or in acute renal failure, but may also occur in the setting of a chronic insult such as chronic kidney disease.1 As potassium rises, several abnormalities can be identified on ECG. Initially the T waves become peaked and the QRS complexes widen.2,3 This can devolve into a wide complex rhythm, ventricular tachycardia, ventricular fibrillation, or asystole. Patients may also experience systemic symptoms such as weakness or paralysis.1 In this particular case, labs showed a potassium of 7.6-mmol/L after initial treatment (see repeat EKG. While the incidence of hyperkalemia in the general population is not defined, the incidence in hospitalized patients is 1.3-10%.4-8 Impaired kidney function is the most common risk factor found in 33-83% of affected patients.4,5,8,9 Treatment for hyperkalemia generally includes IV insulin and IV dextrose and nebulized albuterol for intracellular shift of potassium, IV furosemide and IV fluids for dilution and renal excretion of furosemide, and IV calcium for stabilization of cardiac membranes.2,3

Case report: an electrocardiogram of spontaneous pneumothorax mimicking arm lead reversal.

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Wieters, J Scott; Carlin, Joseph P; Morris, Andrew

2014-05-01

There are several previously documented findings for electrocardiograms (ECGs) of spontaneous pneumothorax. These findings include axis deviation, T-wave inversion, and right bundle branch block. When an ECG has the arm leads incorrectly placed, the ECG will display right axis deviation and inversion of the P waves in lead I. There have been no previously published ECGs of spontaneous pneumothorax that have shown the same findings as reversal of the limb leads of an ECG. A possible finding of spontaneous pneumothorax is an identical finding to that of an ECG that has been flagged for limb lead reversal. A patient presented in the emergency setting with acute chest pain and shortness of breath caused by a tension pneumothorax. An ECG was administered; findings indicated reversal of the arm leads (right axis deviation and inverted P waves in lead I), but there was no actual limb lead reversal present. ECG findings resolved upon resolution of the pneumothorax. If a patient presents with chest pain and shortness of breath, and the patient's ECG is flagged for limb lead reversal despite being set up correctly, the physician should raise clinical suspicion for a possible spontaneous pneumothorax. Copyright © 2014 Elsevier Inc. All rights reserved.

Evaluation of a web-based ECG-interpretation programme for undergraduate medical students.

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Nilsson, Mikael; Bolinder, Gunilla; Held, Claes; Johansson, Bo-Lennart; Fors, Uno; Ostergren, Jan

2008-04-23

Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institute have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity. A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group. 20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 - very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03). Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.

Detection of Acute Myocardial Infarction in a Pig Model Using the SAN-Atrial-AVN-His (SAAH) Electrocardiogram (ECG), Model PHS-A10, an Automated and Integrated Signals Recognition System.

Science.gov (United States)

Zhao, Wenjiao; Lu, Guihua; Liu, Li; Sun, Zhishan; Wu, Mingxin; Yi, Wenyan; Chen, Haiyan; Li, Yanhui; Tang, Lilong; Zeng, Jianping

2018-03-04

BACKGROUND The aim of this study was to compare the use of the standard 12-lead electrocardiogram (ECG) with the SAN-Atrial-AVN-His (SAAH) ECG (Model PHS-A10), a new automated and integrated signals recognition system that detects micro-waveforms within the P, QRS, and T-wave, in a pig model of acute myocardial infarction (MI). MATERIAL AND METHODS Six medium-sized domestic Chinese pigs underwent general anesthesia, and an angioplasty balloon was placed and dilated for 120 minutes in the first diagonal coronary artery arising from the left anterior descending (LAD) coronary artery. A standard ECG and a SAAH ECG (Model PHS-A10) were used to evaluate: 1) the number of wavelets in ST-T segment in lead V5; 2) the duration of the repolarization initial (Ri), or duration of the wavelets starting from the J-point to the endpoint of the wavelets in the ST interval; 3) the duration of the repolarization terminal (Rt), of the wavelets, starting from the endpoint of the wavelets in the ST interval to the cross-point of the T-wave and baseline; 4) the ratio Ri: Rt. RESULTS Following coronary artery occlusion, duration of Ri and Ri/Rt increased, and Rt decreased, which was detected by the SAAH ECG (Model PHS-A10) within 12 seconds, compared with standard ECG that detected ST segment depression at 24 seconds following coronary artery occlusion. CONCLUSIONS The findings from this preliminary study in a pig model of acute MI support the need for clinical studies to evaluate the SAAH ECG (Model PHS-A10) for the early detection of acute MI.

Low flip angle spin-echo MR imaging to obtain better Gd-DTPA enhanced imaging with ECG gating

International Nuclear Information System (INIS)

Sugimura, Kazuro; Kawamitsu, Hideaki; Yoshikawa, Kazuaki; Kasai, Toshifumi; Yuasa, Koji; Ishida, Tetsuya

1992-01-01

ECG-gated spin-echo imaging (ECG-SE) can reduce physiological motion artifact. However, ECG-SE does not provide strong T1-weighted images because repetition time (TR) depends on heart rate (HR). We investigated the usefulness of low flip angle spin-echo imaging (LFSE) in obtaining more T1-dependent contrast with ECG gating. In computer simulation, the predicted image contrast and single-to-noise ratio (SNR) obtained for each flip angle (0-180deg) and each TR (300 msec-1200 msec) were compared with those obtained by conventional T1-weighted spin-echo imaging (CSE: TR=500 msec, TE=20 msec). In clinical evaluation, tissue contrast [contrast index (CI): (SI of lesion-SI of muslce) 2* 100/SI of muscle] obtained by CSE and LFSE were compared in 17 patients. At a TR of 1,000 msec, T1-dependent contrast increased with decreasing flip angle and that at 38deg was identical to that with T1-weighted spin-echo. SNR increased with the flip angle until 100deg, and that at 53deg was identical to that with T1-weighted spin-echo. CI on LFSE (74.0±52.0) was significantly higher than CI on CSE (40.9±35.9). ECG-gated LFSE imaging provides better T1-dependent contrast than conventional ECG-SE. This method was especially useful for Gd-DTPA enhanced MR imaging. (author)

Extraction of SelectSecure leads compared to conventional pacing leads in patients with congenital heart disease and congenital atrioventricular block.

Science.gov (United States)

Shepherd, Emma; Stuart, Graham; Martin, Rob; Walsh, Mark A

2015-06-01

SelectSecure™ pacing leads (Medtronic Inc) are increasingly being used in pediatric patients and adults with structural congenital heart disease. The 4Fr lead is ideal for patients who may require lifelong pacing and can be advantageous for patients with complex anatomy. The purpose of this study was to compare the extraction of SelectSecure leads with conventional (stylette-driven) pacing leads in patients with structural congenital heart disease and congenital atrioventricular block. The data on lead extractions from pediatric and adult congenital heart disease (ACHD) patients from August 2004 to July 2014 at Bristol Royal Hospital for Children and the Bristol Heart Institute were reviewed. Multivariable regression analysis was used to determine whether conventional pacing leads were associated with a more difficult extraction process. A total of 57 patients underwent pacemaker lead extractions (22 SelectSecure, 35 conventional). No deaths occurred. Mean age at the time of extraction was 17.6 ± 10.5 years, mean weight was 47 ± 18 kg, and mean lead age was 5.6 ± 2.6 years (range 1-11 years). Complex extraction (partial extraction/femoral extraction) was more common in patients with conventional pacing leads at univariate (P < .01) and multivariate (P = .04) levels. Lead age was also a significant predictor of complex extraction (P < .01). SelectSecure leads can be successfully extracted using techniques that are used for conventional pacing leads. They are less likely to be partially extracted and are less likely to require extraction using a femoral approach compared with conventional pacing leads. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Application of Lead Field Theory and Computerized Thorax Modeling for the ECG Inverse Problem

National Research Council Canada - National Science Library

Puurtinen, H

2001-01-01

.... In this study, one anatomically detailed 3D FDM model of the human thorax as a volume conductor was employed for forward and inverse estimation of ECG potentials and cardiac sources, respectively...

Residual motion compensation in ECG-gated interventional cardiac vasculature reconstruction

International Nuclear Information System (INIS)

Schwemmer, C; Müller, K; Hornegger, J; Rohkohl, C; Lauritsch, G

2013-01-01

Three-dimensional reconstruction of cardiac vasculature from angiographic C-arm CT (rotational angiography) data is a major challenge. Motion artefacts corrupt image quality, reducing usability for diagnosis and guidance. Many state-of-the-art approaches depend on retrospective ECG-gating of projection data for image reconstruction. A trade-off has to be made regarding the size of the ECG-gating window. A large temporal window is desirable to avoid undersampling. However, residual motion will occur in a large window, causing motion artefacts. We present an algorithm to correct for residual motion. Our approach is based on a deformable 2D–2D registration between the forward projection of an initial, ECG-gated reconstruction, and the original projection data. The approach is fully automatic and does not require any complex segmentation of vasculature, or landmarks. The estimated motion is compensated for during the backprojection step of a subsequent reconstruction. We evaluated the method using the publicly available CAVAREV platform and on six human clinical datasets. We found a better visibility of structure, reduced motion artefacts, and increased sharpness of the vessels in the compensated reconstructions compared to the initial reconstructions. At the time of writing, our algorithm outperforms the leading result of the CAVAREV ranking list. For the clinical datasets, we found an average reduction of motion artefacts by 13 ± 6%. Vessel sharpness was improved by 25 ± 12% on average. (paper)

A configurable and low-power mixed signal SoC for portable ECG monitoring applications.

Science.gov (United States)

Kim, Hyejung; Kim, Sunyoung; Van Helleputte, Nick; Artes, Antonio; Konijnenburg, Mario; Huisken, Jos; Van Hoof, Chris; Yazicioglu, Refet Firat

2014-04-01

This paper describes a mixed-signal ECG System-on-Chip (SoC) that is capable of implementing configurable functionality with low-power consumption for portable ECG monitoring applications. A low-voltage and high performance analog front-end extracts 3-channel ECG signals and single channel electrode-tissue-impedance (ETI) measurement with high signal quality. This can be used to evaluate the quality of the ECG measurement and to filter motion artifacts. A custom digital signal processor consisting of 4-way SIMD processor provides the configurability and advanced functionality like motion artifact removal and R peak detection. A built-in 12-bit analog-to-digital converter (ADC) is capable of adaptive sampling achieving a compression ratio of up to 7, and loop buffer integration reduces the power consumption for on-chip memory access. The SoC is implemented in 0.18 μm CMOS process and consumes 32 μ W from a 1.2 V while heart beat detection application is running, and integrated in a wireless ECG monitoring system with Bluetooth protocol. Thanks to the ECG SoC, the overall system power consumption can be reduced significantly.

Design, fabrication and skin-electrode contact analysis of polymer microneedle-based ECG electrodes

Science.gov (United States)

O'Mahony, Conor; Grygoryev, Konstantin; Ciarlone, Antonio; Giannoni, Giuseppe; Kenthao, Anan; Galvin, Paul

2016-08-01

Microneedle-based ‘dry’ electrodes have immense potential for use in diagnostic procedures such as electrocardiography (ECG) analysis, as they eliminate several of the drawbacks associated with the conventional ‘wet’ electrodes currently used for physiological signal recording. To be commercially successful in such a competitive market, it is essential that dry electrodes are manufacturable in high volumes and at low cost. In addition, the topographical nature of these emerging devices means that electrode performance is likely to be highly dependent on the quality of the skin-electrode contact. This paper presents a low-cost, wafer-level micromoulding technology for the fabrication of polymeric ECG electrodes that use microneedle structures to make a direct electrical contact to the body. The double-sided moulding process can be used to eliminate post-process via creation and wafer dicing steps. In addition, measurement techniques have been developed to characterize the skin-electrode contact force. We perform the first analysis of signal-to-noise ratio dependency on contact force, and show that although microneedle-based electrodes can outperform conventional gel electrodes, the quality of ECG recordings is significantly dependent on temporal and mechanical aspects of the skin-electrode interface.

Design, fabrication and skin-electrode contact analysis of polymer microneedle-based ECG electrodes

International Nuclear Information System (INIS)

O’Mahony, Conor; Grygoryev, Konstantin; Ciarlone, Antonio; Giannoni, Giuseppe; Kenthao, Anan; Galvin, Paul

2016-01-01

Microneedle-based ‘dry’ electrodes have immense potential for use in diagnostic procedures such as electrocardiography (ECG) analysis, as they eliminate several of the drawbacks associated with the conventional ‘wet’ electrodes currently used for physiological signal recording. To be commercially successful in such a competitive market, it is essential that dry electrodes are manufacturable in high volumes and at low cost. In addition, the topographical nature of these emerging devices means that electrode performance is likely to be highly dependent on the quality of the skin-electrode contact.This paper presents a low-cost, wafer-level micromoulding technology for the fabrication of polymeric ECG electrodes that use microneedle structures to make a direct electrical contact to the body. The double-sided moulding process can be used to eliminate post-process via creation and wafer dicing steps. In addition, measurement techniques have been developed to characterize the skin-electrode contact force. We perform the first analysis of signal-to-noise ratio dependency on contact force, and show that although microneedle-based electrodes can outperform conventional gel electrodes, the quality of ECG recordings is significantly dependent on temporal and mechanical aspects of the skin-electrode interface. (paper)

Revisiting QRS Detection Methodologies for Portable, Wearable, Battery-Operated, and Wireless ECG Systems

Science.gov (United States)

Elgendi, Mohamed; Eskofier, Björn; Dokos, Socrates; Abbott, Derek

2014-01-01

Cardiovascular diseases are the number one cause of death worldwide. Currently, portable battery-operated systems such as mobile phones with wireless ECG sensors have the potential to be used in continuous cardiac function assessment that can be easily integrated into daily life. These portable point-of-care diagnostic systems can therefore help unveil and treat cardiovascular diseases. The basis for ECG analysis is a robust detection of the prominent QRS complex, as well as other ECG signal characteristics. However, it is not clear from the literature which ECG analysis algorithms are suited for an implementation on a mobile device. We investigate current QRS detection algorithms based on three assessment criteria: 1) robustness to noise, 2) parameter choice, and 3) numerical efficiency, in order to target a universal fast-robust detector. Furthermore, existing QRS detection algorithms may provide an acceptable solution only on small segments of ECG signals, within a certain amplitude range, or amid particular types of arrhythmia and/or noise. These issues are discussed in the context of a comparison with the most conventional algorithms, followed by future recommendations for developing reliable QRS detection schemes suitable for implementation on battery-operated mobile devices. PMID:24409290

Comparing twelve-lead electrocardiography with close-to-heart patch based electrocardiography

DEFF Research Database (Denmark)

Hansen, Ingeborg Helbech; Hoppe, Karsten; Gjerde, Anna

2015-01-01

used in the clinic impeding clinical interpretation. In this study, recordings from an ePatch® lead system involving three torso sites are compared with concurrently recorded standard 12-lead ECG. Pearson's correlation coefficients (CC) of −0.90 and 0.91 is found between two of the PEM signals...

Visualization of neonatal coronary arteries on multidetector row CT: ECG-gated versus non-ECG-gated technique

International Nuclear Information System (INIS)

Tsai, I.C.; Lee, Tain; Chen, Min-Chi; Fu, Yun-Ching; Jan, Sheng-Lin; Wang, Chung-Chi; Chang, Yen

2007-01-01

Multidetector CT (MDCT) seems to be a promising tool for detection of neonatal coronary arteries, but whether the ECG-gated or non-ECG-gated technique should be used has not been established. To compare the detection rate and image quality of neonatal coronary arteries on MDCT using ECG-gated and non-ECG-gated techniques. Twelve neonates with complex congenital heart disease were included. The CT scan was acquired using an ECG-gated technique, and the most quiescent phase of the RR interval was selected to represent the ECG-gated images. The raw data were then reconstructed without the ECG signal to obtain non-ECG-gated images. The detection rate and image quality of nine coronary artery segments in the two sets of images were then compared. A two-tailed paired t test was used with P values <0.05 considered as statistically significant. In all coronary segments the ECG-gated technique had a better detection rate and produced images of better quality. The difference between the two techniques ranged from 25% in the left main coronary artery to 100% in the distal right coronary artery. For neonates referred for MDCT, if evaluation of coronary artery anatomy is important for the clinical management or surgical planning, the ECG-gated technique should be used because it can reliably detect the coronary arteries. (orig.)

Cleanliness of disposable vs nondisposable electrocardiography lead wires in children.

Science.gov (United States)

Addison, Nancy; Quatrara, Beth; Letzkus, Lisa; Strider, David; Rovnyak, Virginia; Syptak, Virginia; Fuzy, Lisa

2014-09-01

Mediastinitis costs hospitals thousands of dollars a year and increases the incidence of patient morbidity and mortality. No studies have been done to evaluate adenosine triphosphate (ATP) counts on disposable and nondisposable electrocardiography (ECG) lead wires in pediatric patients. To compare the cleanliness of disposable and nondisposable ECG lead wires in postoperative pediatric cardiac surgery patients by measuring the quantity of ATP (in relative luminescence units [RLUs]). ATP levels correlate with microbial cell counts and are used by institutions to assess hospital equipment and cleanliness. A prospective, randomized trial was initiated with approval from the institutional review board. Verbal consent was obtained from the parents/guardians for each patient. Trained nurses performed ATP swabs on the right and left upper ECG cables on postoperative days 1, 2, and 3. This study enrolled 51 patients. The disposable ECG lead wire ATP count on postoperative day 1 (median, 157 RLUs) was significantly lower (P disposable ECG lead wires (median, 200 RLUs) was also lower (P = .06) than the count for the nondisposable ECG lead wires (median, 453 RLUs). Results of this study support the use of disposable ECG lead wires in postoperative pediatric cardiac surgery patients for at least the first 48 hours as a direct strategy to reduce the ATP counts on ECG lead wires. ©2014 American Association of Critical-Care Nurses.

Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG.

Science.gov (United States)

Lee, Kwang Jin; Lee, Boreom

2016-07-01

Fetal heart rate (FHR) is an important determinant of fetal health. Cardiotocography (CTG) is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs) from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB). Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR.

ECG signal processing

NARCIS (Netherlands)

2009-01-01

A system extracts an ECG signal from a composite signal (308) representing an electric measurement of a living subject. Identification means (304) identify a plurality of temporal segments (309) of the composite signal corresponding to a plurality of predetermined segments (202,204,206) of an ECG

The acquisition and retention of ECG interpretation skills after a standardized web-based ECG tutorial

DEFF Research Database (Denmark)

Rolskov Bojsen, Signe; Räder, Sune Bernd Emil Werner; Holst, Anders Gaardsdal

2015-01-01

BACKGROUND: Electrocardiogram (ECG) interpretation is of great importance for patient management. However, medical students frequently lack proficiency in ECG interpretation and rate their ECG training as inadequate. Our aim was to examine the effect of a standalone web-based ECG tutorial...... and to assess the retention of skills using multiple follow-up intervals. METHODS: 203 medical students were included in the study. All participants completed a pre-test, an ECG tutorial, and a post-test. The participants were also randomised to complete a retention-test after short (2-4 weeks), medium (10.......6), respectively). When comparing the pre-test to retention-test delta scores, junior students had learned significantly more than senior students (junior students improved 10.7 points and senior students improved 4.7 points, p = 0.003). CONCLUSION: A standalone web-based ECG tutorial can be an effective means...

Specificity of elevated intercostal space ECG recording for the type 1 Brugada ECG pattern

DEFF Research Database (Denmark)

Holst, Anders G; Tangø, Mogens; Batchvarov, Velislav

2012-01-01

Right precordial (V1-3) elevated electrode placement ECG (EEP-ECG) is often used in the diagnosis of Brugada syndrome (BrS). However, the specificity of this has only been studied in smaller studies in Asian populations. We aimed to study this in a larger European population.......Right precordial (V1-3) elevated electrode placement ECG (EEP-ECG) is often used in the diagnosis of Brugada syndrome (BrS). However, the specificity of this has only been studied in smaller studies in Asian populations. We aimed to study this in a larger European population....

Evaluation of a web-based ECG-interpretation programme for undergraduate medical students

Directory of Open Access Journals (Sweden)

Johansson Bo-Lennart

2008-04-01

Full Text Available Abstract Background Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institutet have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity. Methods A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group. Results 20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 – very good they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16 by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03. Conclusion Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and

Non-invasive prediction of catheter ablation outcome in persistent atrial fibrillation by fibrillatory wave amplitude computation in multiple electrocardiogram leads.

Science.gov (United States)

Zarzoso, Vicente; Latcu, Decebal G; Hidalgo-Muñoz, Antonio R; Meo, Marianna; Meste, Olivier; Popescu, Irina; Saoudi, Nadir

2016-12-01

Catheter ablation (CA) of persistent atrial fibrillation (AF) is challenging, and reported results are capable of improvement. A better patient selection for the procedure could enhance its success rate while avoiding the risks associated with ablation, especially for patients with low odds of favorable outcome. CA outcome can be predicted non-invasively by atrial fibrillatory wave (f-wave) amplitude, but previous works focused mostly on manual measures in single electrocardiogram (ECG) leads only. To assess the long-term prediction ability of f-wave amplitude when computed in multiple ECG leads. Sixty-two patients with persistent AF (52 men; mean age 61.5±10.4years) referred for CA were enrolled. A standard 1-minute 12-lead ECG was acquired before the ablation procedure for each patient. F-wave amplitudes in different ECG leads were computed by a non-invasive signal processing algorithm, and combined into a mutivariate prediction model based on logistic regression. During an average follow-up of 13.9±8.3months, 47 patients had no AF recurrence after ablation. A lead selection approach relying on the Wald index pointed to I, V1, V2 and V5 as the most relevant ECG leads to predict jointly CA outcome using f-wave amplitudes, reaching an area under the curve of 0.854, and improving on single-lead amplitude-based predictors. Analysing the f-wave amplitude in several ECG leads simultaneously can significantly improve CA long-term outcome prediction in persistent AF compared with predictors based on single-lead measures. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Enhancement of low sampling frequency recordings for ECG biometric matching using interpolation.

Science.gov (United States)

Sidek, Khairul Azami; Khalil, Ibrahim

2013-01-01

Electrocardiogram (ECG) based biometric matching suffers from high misclassification error with lower sampling frequency data. This situation may lead to an unreliable and vulnerable identity authentication process in high security applications. In this paper, quality enhancement techniques for ECG data with low sampling frequency has been proposed for person identification based on piecewise cubic Hermite interpolation (PCHIP) and piecewise cubic spline interpolation (SPLINE). A total of 70 ECG recordings from 4 different public ECG databases with 2 different sampling frequencies were applied for development and performance comparison purposes. An analytical method was used for feature extraction. The ECG recordings were segmented into two parts: the enrolment and recognition datasets. Three biometric matching methods, namely, Cross Correlation (CC), Percent Root-Mean-Square Deviation (PRD) and Wavelet Distance Measurement (WDM) were used for performance evaluation before and after applying interpolation techniques. Results of the experiments suggest that biometric matching with interpolated ECG data on average achieved higher matching percentage value of up to 4% for CC, 3% for PRD and 94% for WDM. These results are compared with the existing method when using ECG recordings with lower sampling frequency. Moreover, increasing the sample size from 56 to 70 subjects improves the results of the experiment by 4% for CC, 14.6% for PRD and 0.3% for WDM. Furthermore, higher classification accuracy of up to 99.1% for PCHIP and 99.2% for SPLINE with interpolated ECG data as compared of up to 97.2% without interpolation ECG data verifies the study claim that applying interpolation techniques enhances the quality of the ECG data. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Frequency of ECG abnormalities in patients of chronic obstructive pulmonary disease accordigng to disease severity

International Nuclear Information System (INIS)

Shabbir, A.; Zaidi, S. B. H.; Nisar, S.

2017-01-01

Objective: The objective of this study was to find out the frequency of ECG abnormalities in patients of COPD in relation to disease severity. Study Design: Cross Sectional study. Place and Duration of Study: This study was carried out at the Department of Medicine, Military Hospital Rawalpindi, from Oct 2011 to Jun 2012. Material and Methods: All patients presenting to the Department of Medicine both inpatient and outpatient, with diagnosis of COPD were included in the study. Patients with cardiac comorbidities were excluded. Also, patients on diuretics and long term oxygen therapy were excluded. A total of three hundred and forty three patients (343) were included in the study. Spirometry of all these patients was done to determine the FEV1 and FVC in order to classify the grade of severity of COPD. Standard 12 lead ECG of all these patients was done to find out the various ECG abnormalities. Results: About 77 (22.5 percent) patients had mild COPD, while moderate COPD was seen in 121 (35.3 percent). Severe COPD was seen in 100 (29.2 percent) patients and very severe COPD was seen in 45 (13.1 percent) patients. The most common ECG abnormalities noted was right atrial enlargement (RAE) in 6 (7.8 percent) patients of mild COPD, 27 (22.3 percent) patients of moderate, 48 (48 percent) patients of severe and 24 (53.3 percent) patients of very severe COPD. Right ventricular hypertrophy (RVH) in 1 (1.3 percent) patient of mild, 7 (5.8 percent) patients of moderate, 19 (19 percent) patients of severe and 12 (26.7 percent) patients of very severe COPD. Sinus tachycardia was present in 6 (7.8 percent) patients of mild, 17 (14 percent) patients of moderate, 19 (19 percent) patients of severe and 10 (22.2 percent) patients of very severe COPD. Right bundle branch block (RBBB) was seen in 5 (6.5 percent) patients of mild, 9 (7.4 percent) patients of moderate, 13 (13 percent) patients of severe and 9 (20 percent) patients of very severe COPD. SVT was present in 1 (1.3 percent

Biometric security based on ECG

NARCIS (Netherlands)

Ma, L.; Groot, de J.A.; Linnartz, J.P.M.G.

2011-01-01

Recently the electrocardiogram (ECG) has been proposed as a novel biometric. This paper aims to construct a reliable ECG verification system, in terms of privacy protection. To this end, an improved expression to estimate the capacity in the autocorrelation (AC) of the ECG is derived, which not only

Clinical usefullness of ECG-triggered single photon emission comuter tomography of blood-pool

International Nuclear Information System (INIS)

Eilles, Chr.; Boerner, W.; Strauss, P.; Gerhards, W.; Reiners, Ch.

1982-01-01

ECT allows direct measurement of the volume of an organ and imaging without disturbing background-superposition. This makes ECT to an useful instrument for ECG-gated blood-pool imaging. Acquisition is made after the injection of 25 mCi Tc-99m HSA with a rotating Anger-Camera-System. ECG-gated imaging is done for each projection; herewith 50-70 cycles per projection are added according to the phase of the heart-cycle. Transversal-Sections of the heart are reconstructed with filtered-back-projection. For each slice a representative cycle, consisting of 10-16 frames, is computed. As shown by our group before a good quality of the reconstructed images can be obtained. Comparison is made with the results of the ECG-gated blood-pool-ECT, the results of the conventional blood-pool-studies and with the results of Laevo-Cardiography. (Author)

Competency in ECG Interpretation Among Medical Students

Science.gov (United States)

Kopeć, Grzegorz; Magoń, Wojciech; Hołda, Mateusz; Podolec, Piotr

2015-01-01

Background Electrocardiogram (ECG) is commonly used in diagnosis of heart diseases, including many life-threatening disorders. We aimed to assess skills in ECG interpretation among Polish medical students and to analyze the determinants of these skills. Material/Methods Undergraduates from all Polish medical schools were asked to complete a web-based survey containing 18 ECG strips. Questions concerned primary ECG parameters (rate, rhythm, and axis), emergencies, and common ECG abnormalities. Analysis was restricted to students in their clinical years (4th–6th), and students in their preclinical years (1st–3rd) were used as controls. Results We enrolled 536 medical students (females: n=299; 55.8%), aged 19 to 31 (23±1.6) years from all Polish medical schools. Most (72%) were in their clinical years. The overall rate of good response was better in students in years 4th–5th than those in years 1st–3rd (66% vs. 56%; pECG interpretation was higher in students who reported ECG self-learning (69% vs. 62%; pECG classes (66% vs. 66%; p=0.99). On multivariable analysis (pECG interpretation. Conclusions Polish medical students in their clinical years have a good level of competency in interpreting the primary ECG parameters, but their ability to recognize ECG signs of emergencies and common heart abnormalities is low. ECG interpretation skills are determined by self-education but not by attendance at regular ECG classes. Our results indicate qualitative and quantitative deficiencies in teaching ECG interpretation at medical schools. PMID:26541993

Quality assessment of digital annotated ECG data from clinical trials by the FDA ECG Warehouse.

Science.gov (United States)

Sarapa, Nenad

2007-09-01

The FDA mandates that digital electrocardiograms (ECGs) from 'thorough' QTc trials be submitted into the ECG Warehouse in Health Level 7 extended markup language format with annotated onset and offset points of waveforms. The FDA did not disclose the exact Warehouse metrics and minimal acceptable quality standards. The author describes the Warehouse scoring algorithms and metrics used by FDA, points out ways to improve FDA review and suggests Warehouse benefits for pharmaceutical sponsors. The Warehouse ranks individual ECGs according to their score for each quality metric and produces histogram distributions with Warehouse-specific thresholds that identify ECGs of questionable quality. Automatic Warehouse algorithms assess the quality of QT annotation and duration of manual QT measurement by the central ECG laboratory.

Dynamics and rate-dependence of the spatial angle between ventricular depolarization and repolarization wave fronts during exercise ECG.

Science.gov (United States)

Kenttä, Tuomas; Karsikas, Mari; Kiviniemi, Antti; Tulppo, Mikko; Seppänen, Tapio; Huikuri, Heikki V

2010-07-01

QRS/T angle and the cosine of the angle between QRS and T-wave vectors (TCRT), measured from standard 12-lead electrocardiogram (ECG), have been used in risk stratification of patients. This study assessed the possible rate dependence of these variables during exercise ECG in healthy subjects. Forty healthy volunteers, 20 men and 20 women, aged 34.6 +/- 3.4, underwent an exercise ECG testing. Twelve-lead ECG was recorded from each test subject and the spatial QRS/T angle and TCRT were automatically analyzed in a beat-to-beat manner with custom-made software. The individual TCRT/RR and QRST/RR patterns were fitted with seven different regression models, including a linear model and six nonlinear models. TCRT and QRS/T angle showed a significant rate dependence, with decreased values at higher heart rates (HR). In individual subjects, the second-degree polynomic model was the best regression model for TCRT/RR and QRST/RR slopes. It provided the best fit for both exercise and recovery. The overall TCRT/RR and QRST/RR slopes were similar between men and women during exercise and recovery. However, women had predominantly higher TCRT and QRS/T values. With respect to time, the dynamics of TCRT differed significantly between men and women; with a steeper exercise slope in women (women, -0.04/min vs -0.02/min in men, P exercise. The individual patterns of TCRT and QRS/T angle are affected by HR and gender. Delayed rate adaptation creates hysteresis in the TCRT/RR slopes.

WAVELET ANALYSIS OF ABNORMAL ECGS

Directory of Open Access Journals (Sweden)

Vasudha Nannaparaju

2014-02-01

Full Text Available Detection of the warning signals by the heart can be diagnosed from ECG. An accurate and reliable diagnosis of ECG is very important however which is cumbersome and at times ambiguous in time domain due to the presence of noise. Study of ECG in wavelet domain using both continuous Wavelet transform (CWT and discrete Wavelet transform (DWT, with well known wavelet as well as a wavelet proposed by the authors for this investigation is found to be useful and yields fairly reliable results. In this study, Wavelet analysis of ECGs of Normal, Hypertensive, Diabetic and Cardiac are carried out. The salient feature of the study is that detection of P and T phases in wavelet domain is feasible which are otherwise feeble or absent in raw ECGs.

The value of the 12-lead electrocardiogram in localizing the scar in non-ischaemic cardiomyopathy.

Science.gov (United States)

Oloriz, Teresa; Wellens, Hein J J; Santagostino, Giulia; Trevisi, Nicola; Silberbauer, John; Peretto, Giovanni; Maccabelli, Giuseppe; Della Bella, Paolo

2016-12-01

Patients with non-ischaemic cardiomyopathy (NICM) and ventricular tachycardia can be categorized as anteroseptal (AS) or inferolateral (IL) scar sub-types based on imaging and voltage mapping studies. The aim of this study was to correlate the baseline electrocardiogram (ECG) with endo-epicardial voltage maps created during ablation procedures and identify the ECG characteristics that may help to distinguish the scar as AS or IL. We assessed 108 baseline ECGs; 72 patients fulfilled criteria for dilated cardiomyopathy whereas 36 showed minimal structural abnormalities. Based on the unipolar low-voltage distribution, the scar pattern was classified as predominantly AS (n = 59) or IL (n = 49). Three ECG criteria (PR interval 230 ms or QRS > 170 ms or an r ≤ 0.3 mV in V3 having 92 and 81% of sensitivity and specificity, respectively, in predicting AS scar pattern. A significant negative correlation was found between the extension of the endocardial unipolar low voltage area and left ventricular EF (r s = -0.719, P < 0.001). The extent of endocardial AS unipolar low voltage was correlated with PR interval and QRS duration (r s = 0.583 and r s = 0.680, P < 0.001, respectively) and the IL epicardial unipolar low voltage with the mean voltage of the limb leads (r s = -0.639, P < 0.001). Baseline ECG features are well correlated with the distribution of unipolar voltage abnormalities in NICM and may help to predict the location of scar in this population. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Ecg manifestations in dengue infection

International Nuclear Information System (INIS)

Tarique, S.; Murtaza, G.; Asif, S.; Qureshi, I.H.

2013-01-01

To determine the frequency of ECG changes in patients with dengue fever and dengue hemorrhagic fever. Place of study: Department of Medicine, Mayo Hospital Lahore Duration of study: September to November 201 Study design: Cross sectional analytical study Patient and methods: 116 patients with dengue infection were enrolled in the study. Their clinical presentation and examination was duly noted. Each patient had baseline and then regular monitoring of blood counts, metabolic profile and fluid status. Patients with Dengue Hemorrhagic fever underwent radiological examination in form of chest radiograph and ultrasound abdomen. ECG was carried out in all patients. Results: Out of 116 patients, 61(52.6%) suffered from Dengue Fever and 55(47.4%) had Dengue Hemorrhagic Fever. Overall 78 patients had normal ECG. Abnormal ECG findings like tachycardia, bradycardia, supraventricular tachycardia, left bundle branch block, ST depression, poor progression of R wave were noted. There was no significant relationship of ECG findings with the disease. Conclusion: ECG changes can occur in dengue infection with or without cardiac symptoms. Commonly noted findings were ST depression and bradycardia. (author)

THE ROLE OF ECG IN LOCALIZING THE CULPRIT VESSEL OCCLUSION IN ACUTE ST SEGMENT ELEVATION MYOCARDICAL INFARCTION WITH ANGIOGRAPHIC CORRELATION

Directory of Open Access Journals (Sweden)

Markandeya Rao

2015-12-01

Full Text Available BACKGROUND & OBJECTIVES The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to identify the culprit vessel from ECG in patients with acute ST elevation myocardial infarction and correlate with coronary angiogram. MATERIALS & METHODS This is a prospective study, conducted on 126 patients in Osmania General Hospital, Hyderabad. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and later correlated with coronary angiogram. RESULTS Amongst 126 patients in this study, 70 patients had anterior wall and 56 patients had inferior wall myocardial infarction. ST> 1mm in V4R, ST  V3/ST  LIII Lead II was the most sensitive and ratio of STV3/STLIII >1.2 was the most specific criteria. ST in inferior leads > 1mm had maximum sensitivity in localizing occlusion in proximal D1 occlusion proximal to S1 as well. Absence of ST i in inferior leads is the most sensitive criteria in occlusion distal to S1 as well as in distal D1 in AWMI. CONCLUSION The admission ECG in patients with ST elevation AMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

Impact of heart rate and rhythm on radiation exposure in prospectively ECG triggered computed tomography

International Nuclear Information System (INIS)

Luecke, Christian; Andres, Claudia; Foldyna, Borek; Nagel, Hans Dieter; Hoffmann, Janine; Grothoff, Matthias; Nitzsche, Stefan; Gutberlet, Matthias; Lehmkuhl, Lukas

2012-01-01

Purpose: To evaluate the influence of different heart rates and arrhythmias on scanner performance, image acquisition and applied radiation exposure in prospectively ECG triggered computed tomography (pCT). Materials and methods: An ECG simulator (EKG Phantom 320, Müller and Sebastiani Elektronik GmbH, Munich, Germany) was used to generate different heart rhythms and arrhythmias: sinus rhythm (SR) at 45, 60, 75, 90 and 120/min, supraventricular arrhythmias (e.g. sinus arrhythmia, atrial fibrillation) and ventricular arrhythmias (e.g. ventricular extrasystoles), pacemaker-ECGs, ST-changes and technical artifacts. The analysis of the image acquisition process was performed on a 64-row multidetector CT (Brilliance, Philips Medical Systems, Cleveland, USA). A prospectively triggered scan protocol as used for routine was applied (120 kV; 150 mA s; 0.4 s rotation and exposure time per scan; image acquisition predominantly in end-diastole at 75% R-R-interval, in arrythmias with a mean heart rate above 80/min in systole at 45% of the R-R-interval; FOV 25 cm). The mean dose length product (DLP) and its percentage increase from baseline (SR at 60/min) were determined. Result: Radiation exposure can increase significantly when the heart rhythm deviates from sinus rhythm. ECG-changes leading to a significant DLP increase (p 8 s) could be observed in bifocal pacemaker (12.8 s), pacemaker dysfunction (10.7 s), atrial fibrillation (10.3 s) and sinus arrhythmia (9.3 s). Conclusion: In prospectively ECG triggered CT, heart rate and rhythm can provoke different types of scanner performance, which can significantly alter radiation exposure and scan time. These results might have an important implication for indication, informed consent and contrast agent injection protocols

Evaluation of a novel portable capacitive ECG system in the clinical practice for a fast and simple ECG assessment in patients presenting with chest pain: FIDET (Fast Infarction Diagnosis ECG Trial)

OpenAIRE

Rasenack, Eva C. L.; Oehler, Martin; Els?sser, Albrecht; Schilling, Meinhard; Maier, Lars S.

2012-01-01

Background Electrocardiogram (ECG) assessment plays a crucial role in patients presenting with chest pain and suspected acute coronary syndrome (ACS). In a pilot study, we previously evaluated a capacitive ECG system (cECG) as a novel ECG technique for a fast and simple ECG assessment in patients with ST-elevation myocardial infarction (STEMI). In a next step, the sensitivity and specificity of this novel ECG technique have to be assessed in patients with ACS. Hypothesis The Fast Infarction D...

Electrocardiogram voltage discordance: Interpretation of low QRS voltage only in the precordial leads.

Science.gov (United States)

Kim, Diana H; Verdino, Ralph J

To define clinical correlates of low voltage isolated to precordial leads on the surface electrocardiogram (ECG). Low voltage (V) on the ECG is defined as QRS Vvoltage isolated to the precordial leads with normal limb lead voltages is unclear. Twelve-lead ECGs with QRS V>5mm in one or more limb leads and voltage was found in 256 of 150,000 ECGs (~0.2%). 50.4% of patients had discordant ECGs that correlated with classic etiologies, with a higher incidence of LV dilation in those with classic etiologies than those without. Low precordial voltage is associated with classic etiologies and LV dilation. Copyright © 2017 Elsevier Inc. All rights reserved.

Graphite Based Electrode for ECG Monitoring: Evaluation under Freshwater and Saltwater Conditions

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Tharoeun Thap

2016-04-01

Full Text Available We proposed new electrodes that are applicable for electrocardiogram (ECG monitoring under freshwater- and saltwater-immersion conditions. Our proposed electrodes are made of graphite pencil lead (GPL, a general-purpose writing pencil. We have fabricated two types of electrode: a pencil lead solid type (PLS electrode and a pencil lead powder type (PLP electrode. In order to assess the qualities of the PLS and PLP electrodes, we compared their performance with that of a commercial Ag/AgCl electrode, under a total of seven different conditions: dry, freshwater immersion with/without movement, post-freshwater wet condition, saltwater immersion with/without movement, and post-saltwater wet condition. In both dry and post-freshwater wet conditions, all ECG-recorded PQRST waves were clearly discernible, with all types of electrodes, Ag/AgCl, PLS, and PLP. On the other hand, under the freshwater- and saltwater-immersion conditions with/without movement, as well as post-saltwater wet conditions, we found that the proposed PLS and PLP electrodes provided better ECG waveform quality, with significant statistical differences compared with the quality provided by Ag/AgCl electrodes.

Biomedical implementation of liquid metal ink as drawable ECG electrode and skin circuit.

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Yang Yu

Full Text Available BACKGROUND: Conventional ways of making bio-electrodes are generally complicated, expensive and unconformable. Here we describe for the first time the method of applying Ga-based liquid metal ink as drawable electrocardiogram (ECG electrodes. Such material owns unique merits in both liquid phase conformability and high electrical conductivity, which provides flexible ways for making electrical circuits on skin surface and a prospective substitution of conventional rigid printed circuit boards (PCBs. METHODS: Fundamental measurements of impedance and polarization voltage of the liquid metal ink were carried out to evaluate its basic electrical properties. Conceptual experiments were performed to draw the alloy as bio-electrodes to acquire ECG signals from both rabbit and human via a wireless module developed on the mobile phone. Further, a typical electrical circuit was drawn in the palm with the ink to demonstrate its potential of implementing more sophisticated skin circuits. RESULTS: With an oxide concentration of 0.34%, the resistivity of the liquid metal ink was measured as 44.1 µΩ·cm with quite low reactance in the form of straight line. Its peak polarization voltage with the physiological saline was detected as -0.73 V. The quality of ECG wave detected from the liquid metal electrodes was found as good as that of conventional electrodes, from both rabbit and human experiments. In addition, the circuit drawn with the liquid metal ink in the palm also runs efficiently. When the loop was switched on, all the light emitting diodes (LEDs were lit and emitted colorful lights. CONCLUSIONS: The liquid metal ink promises unique printable electrical properties as both bio-electrodes and electrical wires. The implemented ECG measurement on biological surface and the successfully run skin circuit demonstrated the conformability and attachment of the liquid metal. The present method is expected to innovate future physiological measurement and

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology

OpenAIRE

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M. B.

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has ...

ECG Holter monitor with alert system and mobile application

Science.gov (United States)

Teron, Abigail C.; Rivera, Pedro A.; Goenaga, Miguel A.

2016-05-01

This paper proposes a new approach on the Holter monitor by creating a portable Electrocardiogram (ECG) Holter monitor that will alert the user by detecting abnormal heart beats using a digital signal processing software. The alarm will be triggered when the patient experiences arrhythmias such as bradycardia and tachycardia. The equipment is simple, comfortable and small in size that fit in the hand. It can be used at any time and any moment by placing three leads to the person's chest which is connected to an electronic circuit. The ECG data will be transmitted via Bluetooth to the memory of a selected mobile phone using an application that will store the collected data for up to 24 hrs. The arrhythmia is identified by comparing the reference signals with the user's signal. The diagnostic results demonstrate that the ECG Holter monitor alerts the user when an arrhythmia is detected thru the Holter monitor and mobile application.

Optimization of Ecg Gating in Quantitative Femoral Angiography

International Nuclear Information System (INIS)

Nilsson, S.; Berglund, I.; Erikson, U.; Johansson, J.; Walldius, G.

2003-01-01

Purpose: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. Material and Methods: 35 patients with hypercholesterolemia underwent select ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with Ecg-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without Ecg gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1-2 and angiographies 3-4. Results: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on Ecg gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the Ecg gating device or without Ecg gating. Conclusion: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase

Optimization of Ecg Gating in Quantitative Femoral Angiography

Energy Technology Data Exchange (ETDEWEB)

Nilsson, S.; Berglund, I.; Erikson, U. [Univ. Hospital, Uppsala (Sweden). Dept. of Oncology, Radiology and Clinical Immunology; Johansson, J.; Walldius, G. [Karolinska Hospital, Stockholm (Sweden). King Gustav V Research Inst.

2003-09-01

Purpose: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. Material and Methods: 35 patients with hypercholesterolemia underwent select ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with Ecg-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without Ecg gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1-2 and angiographies 3-4. Results: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on Ecg gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the Ecg gating device or without Ecg gating. Conclusion: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase.

Deep Learning for ECG Classification

Science.gov (United States)

Pyakillya, B.; Kazachenko, N.; Mikhailovsky, N.

2017-10-01

The importance of ECG classification is very high now due to many current medical applications where this problem can be stated. Currently, there are many machine learning (ML) solutions which can be used for analyzing and classifying ECG data. However, the main disadvantages of these ML results is use of heuristic hand-crafted or engineered features with shallow feature learning architectures. The problem relies in the possibility not to find most appropriate features which will give high classification accuracy in this ECG problem. One of the proposing solution is to use deep learning architectures where first layers of convolutional neurons behave as feature extractors and in the end some fully-connected (FCN) layers are used for making final decision about ECG classes. In this work the deep learning architecture with 1D convolutional layers and FCN layers for ECG classification is presented and some classification results are showed.

Acurácia de critérios para vagotonia no eletrocardiograma de repouso de 12 derivações: uma análise com curvas ROC Accuracy of vagotonia criteria in the 12-lead resting electrocardiogram: analysis with ROC curves

Directory of Open Access Journals (Sweden)

José Kawazoe Lazzoli

2002-04-01

ível de segmento S-T em cinco ou mais derivações e presença de transição precordial rápida. DISCUSSÃO E CONCLUSÃO: O desempenho dos critérios eletrocardiográficos em termos de VPP, VPN e AC foi muito limitado, com a exceção da duração do intervalo R-R. A combinação de outros critérios como amplitude da onda T em V5 e V6, amplitude da onda R em V4 e presença de supradesnível de ponto J e do segmento S-T em várias derivações pode auxiliar na predição de vagotonia.OBJECTIVE: To determine sensitivity (Sens, specificity (Spec, positive (PPV and negative (NPV predictive value, and accuracy of different electrocardiographic criteria for vagotonia. METHODS: Seventy-four Olympic athletes (51 male and 23 female; age = 24 ± 5 years underwent an evaluation consisting of a 12-lead resting electrocardiogram (ECG, and an assessment of cardiac vagal tone (CVT by the 4-second cycling exercise testing (4-sET, with the B/C index utilized as the gold standard. The 4-sET is a well-standardized and valid protocol for CVT assessment based on the mechanism of exercise-onset tachycardia regardless of the sympathetic component. Using ROC (receiver operating characteristic curves, the authors selected the cut-point with the best sensitivity (Sens/specificity (Spec ratio for each ECG variable, and calculated the positive (PPV and negative predictive values (NPV, and accuracy (AC. The authors also correlated B/C index with ECG variables. RESULTS: B/C index showed a poor association with ECG variables, with the exception of R-R interval (r = 0.353; P = 0.004, that also presented a significant ROC curve (chi2= 0.863; P = 0.002, whereas the R-R interval > or = 990 ms criterion showed the following results: Sens - 100%; Spec - 73%; VPP 20%; VPN 100%; AC 75%. The ECG variables that presented cut-points with accuracy > 80% were: T-wave amplitude in lead V5 > or = 8.0 mm; T-wave amplitude in lead V6 > or = 7.0 mm; Q-wave amplitude in V5 > or = 7.0 mm; R-wave amplitude in V4 > or

Diagnostic accuracy of sub-mSv prospective ECG-triggering cardiac CT in young infant with complex congenital heart disease.

Science.gov (United States)

Gao, Wei; Zhong, Yu Min; Sun, Ai Min; Wang, Qian; Ouyang, Rong Zhen; Hu, Li Wei; Qiu, Han Sheng; Wang, Shi Yu; Li, Jian Ying

2016-06-01

To explore the clinical value and evaluate the diagnostic accuracy of sub-mSv low-dose prospective ECG-triggering cardiac CT (CCT) in young infants with complex congenital heart disease (CHD). A total of 102 consecutive infant patients (53 boys and 49 girls with mean age of 2.9 ± 2.4 m and weight less than 5 kg) with complex CHD were prospectively enrolled. Scans were performed on a 64-slice high definition CT scanner with low dose prospective ECG-triggering mode and reconstructed with 80 % adaptive statistical iterative reconstruction algorithm. All studies were performed during free breathing with sedation. The subjective image quality was evaluated by 5-point grading scale and interobserver variability was calculated. The objective image noise (standard deviation, SD) and contrast to noise ratio (CNR) was calculated. The effective radiation dose from the prospective ECG-triggering mode was recorded and compared with the virtual conventional retrospective ECG-gating mode. The detection rate for the origin of coronary artery was calculated. All patients also underwent echocardiography before CCT examination. 81 patients had surgery and their preoperative CCT and echocardiography findings were compared with the surgical results and sensitivity, specificity, positive and negative predictive values and accuracy were calculated for separate cardiovascular anomalies. Heart rates were 70-161 beats per minute (bpm) with mean value of 129.19 ± 14.52 bpm. The effective dose of 0.53 ± 0.15 mSv in the prospective ECG-triggering cardiac CT was lower than the calculated value in a conventional retrospective ECG-gating mode (2.00 ± 0.35 mSv) (p ECG-triggering CCT with sub-mSv effective dose provides excellent imaging quality and high diagnostic accuracy for young infants with complex CHD.

Experimental evaluations of wearable ECG monitor.

Science.gov (United States)

Ha, Kiryong; Kim, Youngsung; Jung, Junyoung; Lee, Jeunwoo

2008-01-01

Healthcare industry is changing with ubiquitous computing environment and wearable ECG measurement is one of the most popular approaches in this healthcare industry. Reliability and performance of healthcare device is fundamental issue for widespread adoptions, and interdisciplinary perspectives of wearable ECG monitor make this more difficult. In this paper, we propose evaluation criteria considering characteristic of both ECG measurement and ubiquitous computing. With our wearable ECG monitors, various levels of experimental analysis are performed based on evaluation strategy.

Noise-aware dictionary-learning-based sparse representation framework for detection and removal of single and combined noises from ECG signal.

Science.gov (United States)

Satija, Udit; Ramkumar, Barathram; Sabarimalai Manikandan, M

2017-02-01

Automatic electrocardiogram (ECG) signal enhancement has become a crucial pre-processing step in most ECG signal analysis applications. In this Letter, the authors propose an automated noise-aware dictionary learning-based generalised ECG signal enhancement framework which can automatically learn the dictionaries based on the ECG noise type for effective representation of ECG signal and noises, and can reduce the computational load of sparse representation-based ECG enhancement system. The proposed framework consists of noise detection and identification, noise-aware dictionary learning, sparse signal decomposition and reconstruction. The noise detection and identification is performed based on the moving average filter, first-order difference, and temporal features such as number of turning points, maximum absolute amplitude, zerocrossings, and autocorrelation features. The representation dictionary is learned based on the type of noise identified in the previous stage. The proposed framework is evaluated using noise-free and noisy ECG signals. Results demonstrate that the proposed method can significantly reduce computational load as compared with conventional dictionary learning-based ECG denoising approaches. Further, comparative results show that the method outperforms existing methods in automatically removing noises such as baseline wanders, power-line interference, muscle artefacts and their combinations without distorting the morphological content of local waves of ECG signal.

Extraction of the fetal ECG in noninvasive recordings by signal decompositions

International Nuclear Information System (INIS)

Christov, I; Simova, I; Abächerli, R

2014-01-01

No signal processing technique has been able to reliably deliver an undistorted fetal electrocardiographic (fECG) signal from electrodes placed on the maternal abdomen because of the low signal-to-noise ratio of the fECG recorded from the maternal body surface. As a result, this led to increased rates of Caesarean deliveries of healthy infants. In an attempt to solve the problem, Physionet/Computing in Cardiology announced the 2013 Challenge: noninvasive fetal ECG. We are suggesting a method for cancellation of the maternal ECG consisting of: maternal QRS detection, heart rate dependant P-QRS-T interval selection, location of the fiducial points inside this interval for best matching by cross correlation, superimposition of the intervals, calculation of the mean signal of the P-QRS-T interval, and sequential subtraction of the mean signal from the whole fECG recording. Three signal decomposition methods were further applied in order to enhance the fetal QRSs (fQRS): principal component analysis, root-mean-square and Hotelling’s T-squared. A combined lead of all decompositions was synthesized and fQRS detection was performed on it. The current research differs from the Challenge in that it uses three signal decomposition methods to enhance the fECG. The new results for 97 recordings of test set B are: 305.657 for Event 4: Fetal heart rate (FHR) and 23.062 for Event 5: Fetal RR interval (FRR). (paper)

Reliability and Reproducibility of Advanced ECG Parameters in Month-to-Month and Year-to-Year Recordings in Healthy Subjects

Science.gov (United States)

Starc, Vito; Abughazaleh, Ahmed S.; Schlegel, Todd T.

2014-01-01

Advanced resting ECG parameters such the spatial mean QRS-T angle and the QT variability index (QTVI) have important diagnostic and prognostic utility, but their reliability and reproducibility (R&R) are not well characterized. We hypothesized that the spatial QRS-T angle would have relatively higher R&R than parameters such as QTVI that are more responsive to transient changes in the autonomic nervous system. The R&R of several conventional and advanced ECG para-meters were studied via intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) in: (1) 15 supine healthy subjects from month-to-month; (2) 27 supine healthy subjects from year-to-year; and (3) 25 subjects after transition from the supine to the seated posture. As hypothesized, for the spatial mean QRS-T angle and many conventional ECG parameters, ICCs we-re higher, and CVs lower than QTVI, suggesting that the former parameters are more reliable and reproducible.

Impact of heart rate and rhythm on radiation exposure in prospectively ECG triggered computed tomography

Energy Technology Data Exchange (ETDEWEB)

Luecke, Christian, E-mail: neep@gmx.de [University of Leipzig – Heart Center, Department of Diagnostic and Interventional Radiology, Strümpellstrasse 39, D-04289, Leipzig (Germany); Andres, Claudia; Foldyna, Borek [University of Leipzig – Heart Center, Department of Diagnostic and Interventional Radiology, Strümpellstrasse 39, D-04289, Leipzig (Germany); Nagel, Hans Dieter [Wissenschaft and Technik für die Radiologie, Buchhholz i.d.N (Germany); Hoffmann, Janine; Grothoff, Matthias; Nitzsche, Stefan; Gutberlet, Matthias; Lehmkuhl, Lukas [University of Leipzig – Heart Center, Department of Diagnostic and Interventional Radiology, Strümpellstrasse 39, D-04289, Leipzig (Germany)

2012-09-15

Purpose: To evaluate the influence of different heart rates and arrhythmias on scanner performance, image acquisition and applied radiation exposure in prospectively ECG triggered computed tomography (pCT). Materials and methods: An ECG simulator (EKG Phantom 320, Müller and Sebastiani Elektronik GmbH, Munich, Germany) was used to generate different heart rhythms and arrhythmias: sinus rhythm (SR) at 45, 60, 75, 90 and 120/min, supraventricular arrhythmias (e.g. sinus arrhythmia, atrial fibrillation) and ventricular arrhythmias (e.g. ventricular extrasystoles), pacemaker-ECGs, ST-changes and technical artifacts. The analysis of the image acquisition process was performed on a 64-row multidetector CT (Brilliance, Philips Medical Systems, Cleveland, USA). A prospectively triggered scan protocol as used for routine was applied (120 kV; 150 mA s; 0.4 s rotation and exposure time per scan; image acquisition predominantly in end-diastole at 75% R-R-interval, in arrythmias with a mean heart rate above 80/min in systole at 45% of the R-R-interval; FOV 25 cm). The mean dose length product (DLP) and its percentage increase from baseline (SR at 60/min) were determined. Result: Radiation exposure can increase significantly when the heart rhythm deviates from sinus rhythm. ECG-changes leading to a significant DLP increase (p < 0.05) were bifocal pacemaker (61%), pacemaker dysfunction (22%), SVES (20%), ventricular salvo (20%), and atrial fibrillation (14%). Significantly (p < 0.05) prolonged scan time (>8 s) could be observed in bifocal pacemaker (12.8 s), pacemaker dysfunction (10.7 s), atrial fibrillation (10.3 s) and sinus arrhythmia (9.3 s). Conclusion: In prospectively ECG triggered CT, heart rate and rhythm can provoke different types of scanner performance, which can significantly alter radiation exposure and scan time. These results might have an important implication for indication, informed consent and contrast agent injection protocols.

An integrated bioimpedance—ECG gating technique for respiratory and cardiac motion compensation in cardiac PET

International Nuclear Information System (INIS)

Koivumäki, Tuomas; Nekolla, Stephan G; Fürst, Sebastian; Loher, Simone; Schwaiger, Markus; Vauhkonen, Marko; Hakulinen, Mikko A

2014-01-01

Respiratory motion may degrade image quality in cardiac PET imaging. Since cardiac PET studies often involve cardiac gating by ECG, a separate respiratory monitoring system is required increasing the logistic complexity of the examination, in case respiratory gating is also needed. Thus, we investigated the simultaneous acquisition of both respiratory and cardiac gating signals using II limb lead mimicking electrode configuration during cardiac PET scans of 11 patients. In addition to conventional static and ECG-gated images, bioimpedance technique was utilized to generate respiratory- and dual-gated images. The ability of the bioimpedance technique to monitor intrathoracic respiratory motion was assessed estimating cardiac displacement between end-inspiration and -expiration. The relevance of dual gating was evaluated in left ventricular volume and myocardial wall thickness measurements. An average 7.6  ±  3.3 mm respiratory motion was observed in the study population. Dual gating showed a small but significant increase (4 ml, p = 0.042) in left ventricular myocardial volume compared to plain cardiac gating. In addition, a thinner myocardial wall was observed in dual-gated images (9.3  ±  1.3 mm) compared to cardiac-gated images (11.3  ±  1.3 mm, p = 0.003). This study shows the feasibility of bioimpedance measurements for dual gating in a clinical setting. The method enables simultaneous acquisition of respiratory and cardiac gating signals using a single device with standard ECG electrodes. (paper)

Utility of 12-lead electrocardiogram for differentiating paroxysmal supraventricular tachycardias in dogs.

Science.gov (United States)

Santilli, R A; Perego, M; Crosara, S; Gardini, F; Bellino, C; Moretti, P; Spadacini, G

2008-01-01

The 12-lead surface ECG is validated for differentiating supraventricular tachycardias (SVT) in humans. Despite the description of SVT in veterinary medicine, no studies have analyzed the electrocardiographic features of this type of arrhythmias in dogs. To describe the specific electrocardiographic criteria used to differentiate the most common SVT in dogs. Twenty-three dogs examined at Clinica Veterinaria Malpensa for SVT with the mechanism documented by electrophysiologic studies (EPS). Twelve-lead electrocardiographic variables obtained from 14 dogs with orthodromic atrioventricular reciprocating tachycardia (OAVRT) and 9 dogs with focal atrial tachycardia (FAT) were compared. Dogs with FAT had faster heart rates (278 +/- 62 versus 229 +/- 42 bpm; P= .049) and less QRS alternans (33 versus 86%; P= .022). P waves appeared during tachycardia in 22 dogs, with a superior axis in 100% of OAVRT and 22% of FAT (P < .001). OAVRT was characterized by a shorter RP interval (85.0 +/- 16.8 versus 157.1 +/- 37.3 ms; P < .001) and smaller RP/PR ratio (0.60 +/- 0.18 versus 1.45 +/- 0.52; P < .001). Repolarization anomalies were present in 64% of OAVRT and no FAT (P < .001). Multivariate analysis identified QRS alternans and a positive P wave in aVR during tachycardia as independent predictors of arrhythmia type. Electrocardiographic criteria used in people for differentiating SVT can also be applied in dogs.

Anatomic distribution of culprit lesions in patients with non-ST-segment elevation myocardial infarction and normal ECG.

Science.gov (United States)

Moustafa, Abdelmoniem; Abi-Saleh, Bernard; El-Baba, Mohammad; Hamoui, Omar; AlJaroudi, Wael

2016-02-01

In patients presenting with non-ST-elevation myocardial infarction (NSTEMI), left anterior descending (LAD) coronary artery and three-vessel disease are the most commonly encountered culprit lesions in the presence of ST depression, while one third of patients with left circumflex (LCX) artery related infarction have normal ECG. We sought to determine the predictors of presence of culprit lesion in NSTEMI patients based on ECG, echocardiographic, and clinical characteristics. Patients admitted to the coronary care unit with the diagnosis of NSTEMI between June 2012 and December 2013 were retrospectively identified. Admission ECG was interpreted by an electrophysiologist that was blinded to the result of the coronary angiogram. Patients were dichotomized into either normal or abnormal ECG group. The primary endpoint was presence of culprit lesion. Secondary endpoints included length of stay, re-hospitalization within 60 days, and in-hospital mortality. A total of 118 patients that were identified; 47 with normal and 71 with abnormal ECG. At least one culprit lesion was identified in 101 patients (86%), and significantly more among those with abnormal ECG (91.5% vs. 76.6%, P=0.041).The LAD was the most frequently detected culprit lesion in both groups. There was a higher incidence of two and three-vessel disease in the abnormal ECG group (P=0.041).On the other hand, there was a trend of higher LCX involvement (25% vs. 13.8%, P=0.18) and more normal coronary arteries in the normal ECG group (23.4% vs. 8.5%, P=0.041). On multivariate analysis, prior history of coronary artery disease (CAD) [odds ratio (OR) 6.4 (0.8-52)], male gender [OR 5.0 (1.5-17)], and abnormal admission ECG [OR 3.6 (1.12-12)], were independent predictors of a culprit lesion. There was no difference in secondary endpoints between those with normal and abnormal ECG. Among patients presenting with NSTEMI, prior history of CAD, male gender and abnormal admission ECG were independent predictors of a

Smart ECG Monitoring Patch with Built-in R-Peak Detection for Long-Term HRV Analysis.

Science.gov (United States)

Lee, W K; Yoon, H; Park, K S

2016-07-01

Since heart rate variability (HRV) analysis is widely used to evaluate the physiological status of the human body, devices specifically designed for such applications are needed. To this end, we developed a smart electrocardiography (ECG) patch. The smart patch measures ECG using three electrodes integrated into the patch, filters the measured signals to minimize noise, performs analog-to-digital conversion, and detects R-peaks. The measured raw ECG data and the interval between the detected R-peaks can be recorded to enable long-term HRV analysis. Experiments were performed to evaluate the performance of the built-in R-wave detection, robustness of the device under motion, and applicability to the evaluation of mental stress. The R-peak detection results obtained with the device exhibited a sensitivity of 99.29%, a positive predictive value of 100.00%, and an error of 0.71%. The device also exhibited less motional noise than conventional ECG recording, being stable up to a walking speed of 5 km/h. When applied to mental stress analysis, the device evaluated the variation in HRV parameters in the same way as a normal ECG, with very little difference. This device can help users better understand their state of health and provide physicians with more reliable data for objective diagnosis.

e-SCP-ECG+ Protocol: An Expansion on SCP-ECG Protocol for Health Telemonitoring—Pilot Implementation

Directory of Open Access Journals (Sweden)

George J. Mandellos

2010-01-01

Full Text Available Standard Communication Protocol for Computer-assisted Electrocardiography (SCP-ECG provides standardized communication among different ECG devices and medical information systems. This paper extends the use of this protocol in order to be included in health monitoring systems. It introduces new sections into SCP-ECG structure for transferring data for positioning, allergies, and five additional biosignals: noninvasive blood pressure (NiBP, body temperature (Temp, Carbon dioxide (CO2, blood oxygen saturation (SPO2, and pulse rate. It also introduces new tags in existing sections for transferring comprehensive demographic data. The proposed enhanced version is referred to as e-SCP-ECG+ protocol. This paper also considers the pilot implementation of the new protocol as a software component in a Health Telemonitoring System.

Retrospectively ECG-gated multi-detector row CT of the chest: does ECG-gating improve three-dimensional visualization of the bronchial tree?

International Nuclear Information System (INIS)

Schertler, T.; Wildermuth, S.; Willmann, J.K.; Crook, D.W.; Marincek, B.; Boehm, T.

2004-01-01

Purpose: To determine the impact of retrospectively ECG-gated multi-detector row CT (MDCT) on three-dimensional (3D) visualization of the bronchial tree and virtual bronchoscopy (VB) as compared to non-ECG-gated data acquisition. Materials and Methods: Contrast-enhanced retrospectively ECG-gated and non-ECG-gated MDCT of the chest was performed in 25 consecutive patients referred for assessment of coronary artery bypass grafts and pathology of the ascending aorta. ECG-gated MDCT data were reconstructed in diastole using an absolute reverse delay of -400 msec in all patients. In 10 patients additional reconstructions at -200 msec, -300 msec, and -500 msec prior to the R-wave were performed. Shaded surface display (SSD) and virtual bronchoscopy (VB) for visualization of the bronchial segments was performed with ECG-gated and non-ECG-gated MDCT data. The visualization of the bronchial tree underwent blinded scoring. Effective radiation dose and signal-to-noise ratio (SNR) for both techniques were compared. Results: There was no significant difference in visualizing single bronchial segments using ECG-gated compared to non-ECG-gated MDCT data. However, the total sum of scores for all bronchial segments visualized with non-ECG-gated MDCT was significantly higher compared to ECG-gated MDCT (P [de

ECG contamination of EEG signals: effect on entropy.

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Chakrabarti, Dhritiman; Bansal, Sonia

2016-02-01

Entropy™ is a proprietary algorithm which uses spectral entropy analysis of electroencephalographic (EEG) signals to produce indices which are used as a measure of depth of hypnosis. We describe a report of electrocardiographic (ECG) contamination of EEG signals leading to fluctuating erroneous Entropy values. An explanation is provided for mechanism behind this observation by describing the spread of ECG signals in head and neck and its influence on EEG/Entropy by correlating the observation with the published Entropy algorithm. While the Entropy algorithm has been well conceived, there are still instances in which it can produce erroneous values. Such erroneous values and their cause may be identified by close scrutiny of the EEG waveform if Entropy values seem out of sync with that expected at given anaesthetic levels.

Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy.

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Giada, Franco; Gulizia, Michele; Francese, Maura; Croci, Francesco; Santangelo, Lucio; Santomauro, Maurizio; Occhetta, Eraldo; Menozzi, Carlo; Raviele, Antonio

2007-05-15

The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations. In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis. We studied 50 patients with infrequent (1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated. A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (euro 3,056 +/- euro 363 vs. euro 6,768 +/- euro 6,672, p = 0.012). In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.

ECG-gated multislice spiral CT for diagnosis of acute pulmonary embolism

International Nuclear Information System (INIS)

Marten, K.; Engelke, C.; Funke, M.; Obenauer, S.; Baum, F.; Grabbe, E.

2003-01-01

AIM: The purpose of this study was to determine the feasibility of echocardiogram (ECG)-gated multi-slice CT angiography (MCTA) in patients with clinical suspicion of acute venous thromboembolism (VTE), to investigate the effect of ECG-gating on cardiac motion artefacts, and to determine the diagnostic reader agreement of ECG-gated MCTA in comparison with conventional MCTA. MATERIALS AND METHODS: Forty-eight consecutive patients were prospectively enrolled and randomly underwent ECG-gated (n=25, group 1) or non-ECG-gated (n=23, group 2) eight-slice pulmonary MCTA. Image data were evaluated by three independent chest radiologists with respect to the presence or absence of emboli at different arterial levels (main, lobar, segmental, and subsegmental arteries), and with regard to cardiac motion artefacts. Statistical tests used to calculate inter-observer agreement were weighted κ statistics, extended κ statistics and confidence indices indicating three-reader agreement accuracy. RESULTS: Twenty-seven patients (56.3%) were diagnosed to have pulmonary embolism (13 from group 1, 14 from group 2). Cardiac motion artefacts were significantly more frequent in group 2 (70% in group 2 versus 13% in group 1, p=0.0001). The overall diagnostic agreement was excellent with both MCTA techniques (three-reader confidence index for all vascular territories: 0.76 and 0.84 for groups 1 and 2, respectively (extended κ=0.69 and 0.78, respectively); three-reader confidence index for diagnosis of VTE: 0.94 and 0.85 for groups 1 and 2, respectively (extended κ=0.91 and 0.73, respectively), weighted κ=0.81-0.83 and 0.92-0.95 for groups 1 and 2, respectively, and did not differ significantly between the two groups. In addition there was no significant difference of inter-observer agreement in either group at any assessed pulmonary arterial level. CONCLUSION: ECG-gated pulmonary MCTA is feasible in patients with clinical suspicion of VTE. However, ECG-gated image acquisition did not

[Analysis of pacemaker ECGs].

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Israel, Carsten W; Ekosso-Ejangue, Lucy; Sheta, Mohamed-Karim

2015-09-01

The key to a successful analysis of a pacemaker electrocardiogram (ECG) is the application of the systematic approach used for any other ECG without a pacemaker: analysis of (1) basic rhythm and rate, (2) QRS axis, (3) PQ, QRS and QT intervals, (4) morphology of P waves, QRS, ST segments and T(U) waves and (5) the presence of arrhythmias. If only the most obvious abnormality of a pacemaker ECG is considered, wrong conclusions can easily be drawn. If a systematic approach is skipped it may be overlooked that e.g. atrial pacing is ineffective, the left ventricle is paced instead of the right ventricle, pacing competes with intrinsic conduction or that the atrioventricular (AV) conduction time is programmed too long. Apart from this analysis, a pacemaker ECG which is not clear should be checked for the presence of arrhythmias (e.g. atrial fibrillation, atrial flutter, junctional escape rhythm and endless loop tachycardia), pacemaker malfunction (e.g. atrial or ventricular undersensing or oversensing, atrial or ventricular loss of capture) and activity of specific pacing algorithms, such as automatic mode switching, rate adaptation, AV delay modifying algorithms, reaction to premature ventricular contractions (PVC), safety window pacing, hysteresis and noise mode. A systematic analysis of the pacemaker ECG almost always allows a probable diagnosis of arrhythmias and malfunctions to be made, which can be confirmed by pacemaker control and can often be corrected at the touch of the right button to the patient's benefit.

Automatic detection of ECG electrode misplacement: a tale of two algorithms

International Nuclear Information System (INIS)

Xia, Henian; Garcia, Gabriel A; Zhao, Xiaopeng

2012-01-01

Artifacts in an electrocardiogram (ECG) due to electrode misplacement can lead to wrong diagnoses. Various computer methods have been developed for automatic detection of electrode misplacement. Here we reviewed and compared the performance of two algorithms with the highest accuracies on several databases from PhysioNet. These algorithms were implemented into four models. For clean ECG records with clearly distinguishable waves, the best model produced excellent accuracies (> = 98.4%) for all misplacements except the LA/LL interchange (87.4%). However, the accuracies were significantly lower for records with noise and arrhythmias. Moreover, when the algorithms were tested on a database that was independent from the training database, the accuracies may be poor. For the worst scenario, the best accuracies for different types of misplacements ranged from 36.1% to 78.4%. A large number of ECGs of various qualities and pathological conditions are collected every day. To improve the quality of health care, the results of this paper call for more robust and accurate algorithms for automatic detection of electrode misplacement, which should be developed and tested using a database of extensive ECG records. (paper)

Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

Science.gov (United States)

Güler, N; Bilge, M; Eryonucu, B; Cirak, B

2000-10-01

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study

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Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall

2017-01-01

Background Charted vital signs and laboratory results represent intermittent samples of a patient’s dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. Methods and findings We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Conclusions Cardiorespiratory dynamics from continuous ECG monitoring detect

Investigations of sensitivity and resolution of ECG and MCG in a realistically shaped thorax model

International Nuclear Information System (INIS)

Mäntynen, Ville; Konttila, Teijo; Stenroos, Matti

2014-01-01

Solving the inverse problem of electrocardiography (ECG) and magnetocardiography (MCG) is often referred to as cardiac source imaging. Spatial properties of ECG and MCG as imaging systems are, however, not well known. In this modelling study, we investigate the sensitivity and point-spread function (PSF) of ECG, MCG, and combined ECG+MCG as a function of source position and orientation, globally around the ventricles: signal topographies are modelled using a realistically-shaped volume conductor model, and the inverse problem is solved using a distributed source model and linear source estimation with minimal use of prior information. The results show that the sensitivity depends not only on the modality but also on the location and orientation of the source and that the sensitivity distribution is clearly reflected in the PSF. MCG can better characterize tangential anterior sources (with respect to the heart surface), while ECG excels with normally-oriented and posterior sources. Compared to either modality used alone, the sensitivity of combined ECG+MCG is less dependent on source orientation per source location, leading to better source estimates. Thus, for maximal sensitivity and optimal source estimation, the electric and magnetic measurements should be combined. (paper)

The T wave in the V10 precordial electrocardiographic lead is negative in healthy Chihuahua dogs.

Science.gov (United States)

Dijkstra, Marieke; Szatmári, Viktor

2009-12-01

The T wave polarity in the V10 precordial electrocardiographic (ECG) lead in Chihuahuas is described as positive in the veterinary literature. The aim of this study was to investigate the polarity of the T wave in the V10 precordial ECG lead in clinically healthy Chihuahuas. Our null hypothesis was that healthy Chihuahuas have a negative T wave in V10. In this prospective study, 67 healthy breeder-owned Chihuahuas were used. A physical examination, 10-lead ECG and an echocardiogram were performed on each dog. No cardio-respiratory abnormalities were revealed in any of the otherwise healthy dogs. Three out of 67 ECGs were of insufficient quality because of baseline artifacts due to movement of the animal. Two other ECGs showed a nearly iso-electric T wave in the V10 lead. The remaining 62 ECGs showed negative T waves in the V10 lead. Right ventricular hypertrophy was excluded with echocardiography in all dogs. In contrast to previous reports, we found that healthy Chihuahuas have negative T wave in the V10 precordial ECG lead.

Are lead-free hunting rifle bullets as effective at killing wildlife as conventional lead bullets? A comparison based on wound size and morphology

Energy Technology Data Exchange (ETDEWEB)

Trinogga, Anna, E-mail: anna_trinogga@gmx.de; Fritsch, Guido; Hofer, Heribert; Krone, Oliver

2013-01-15

Fragmentation of the lead core of conventional wildlife hunting rifle bullets causes contamination of the target with lead. The community of scavenger species which feed on carcasses or viscera discarded by hunters are regularly exposed to these lead fragments and may die by acute or chronic lead intoxication, as demonstrated for numerous species such as white-tailed eagles (Haliaeetus albicilla) where it is among the most important sources of mortality. Not only does hunting with conventional ammunition deposit lead in considerable quantities in the environment, it also significantly delays or threatens the recovery of endangered raptor populations. Although lead-free bullets might be considered a suitable alternative that addresses the source of these problems, serious reservations have been expressed as to their ability to quickly and effectively kill a hunted animal. To assess the suitability of lead-free projectiles for hunting practice, the wounding potential of conventional bullets was compared with lead-free bullets under real life hunting conditions. Wound dimensions were regarded as good markers of the projectiles' killing potential. Wound channels in 34 killed wild ungulates were evaluated using computed tomography and post-mortem macroscopical examination. Wound diameters caused by conventional bullets did not differ significantly to those created by lead-free bullets. Similarly, the size of the maximum cross-sectional area of the wound was similar for both bullet types. Injury patterns suggested that all animals died by exsanguination. This study demonstrates that lead-free bullets are equal to conventional hunting bullets in terms of killing effectiveness and thus equally meet the welfare requirements of killing wildlife as painlessly as possible. The widespread introduction and use of lead-free bullets should be encouraged as it prevents environmental contamination with a seriously toxic pollutant and contributes to the conservation of a wide

Are lead-free hunting rifle bullets as effective at killing wildlife as conventional lead bullets? A comparison based on wound size and morphology

International Nuclear Information System (INIS)

Trinogga, Anna; Fritsch, Guido; Hofer, Heribert; Krone, Oliver

2013-01-01

Fragmentation of the lead core of conventional wildlife hunting rifle bullets causes contamination of the target with lead. The community of scavenger species which feed on carcasses or viscera discarded by hunters are regularly exposed to these lead fragments and may die by acute or chronic lead intoxication, as demonstrated for numerous species such as white-tailed eagles (Haliaeetus albicilla) where it is among the most important sources of mortality. Not only does hunting with conventional ammunition deposit lead in considerable quantities in the environment, it also significantly delays or threatens the recovery of endangered raptor populations. Although lead-free bullets might be considered a suitable alternative that addresses the source of these problems, serious reservations have been expressed as to their ability to quickly and effectively kill a hunted animal. To assess the suitability of lead-free projectiles for hunting practice, the wounding potential of conventional bullets was compared with lead-free bullets under real life hunting conditions. Wound dimensions were regarded as good markers of the projectiles' killing potential. Wound channels in 34 killed wild ungulates were evaluated using computed tomography and post-mortem macroscopical examination. Wound diameters caused by conventional bullets did not differ significantly to those created by lead-free bullets. Similarly, the size of the maximum cross-sectional area of the wound was similar for both bullet types. Injury patterns suggested that all animals died by exsanguination. This study demonstrates that lead-free bullets are equal to conventional hunting bullets in terms of killing effectiveness and thus equally meet the welfare requirements of killing wildlife as painlessly as possible. The widespread introduction and use of lead-free bullets should be encouraged as it prevents environmental contamination with a seriously toxic pollutant and contributes to the conservation of a wide variety

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility.

Science.gov (United States)

Iribarren, Carlos; Round, Alfred D; Lu, Meng; Okin, Peter M; McNulty, Edward J

2017-10-05

ECG left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH ("ECG LVH trajectories") across the adult lifespan in both sexes and across ethnicities. We examined: (1) correlates of ECG LVH trajectories; (2) the association of ECG LVH trajectories with incident coronary heart disease, transient ischemic attack, ischemic stroke, hemorrhagic stroke, and heart failure; and (3) reclassification of cardiovascular disease risk using ECG LVH trajectories. We performed a cohort study among 75 412 men and 107 954 women in the Northern California Kaiser Permanente Medical Care Program who had available longitudinal exposures of ECG LVH and covariates, followed for a median of 4.8 (range ECG LVH was measured by Cornell voltage-duration product. Adverse trajectories of ECG LVH (persistent, new development, or variable pattern) were more common among blacks and Native American men and were independently related to incident cardiovascular disease with hazard ratios ranging from 1.2 for ECG LVH variable pattern and transient ischemic attack in women to 2.8 for persistent ECG LVH and heart failure in men. ECG LVH trajectories reclassified 4% and 7% of men and women with intermediate coronary heart disease risk, respectively. ECG LVH trajectories were significant indicators of coronary heart disease, stroke, and heart failure risk, independently of level and change in cardiovascular disease risk factors, and may have clinical utility. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Noise Maps for Quantitative and Clinical Severity Towards Long-Term ECG Monitoring.

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Everss-Villalba, Estrella; Melgarejo-Meseguer, Francisco Manuel; Blanco-Velasco, Manuel; Gimeno-Blanes, Francisco Javier; Sala-Pla, Salvador; Rojo-Álvarez, José Luis; García-Alberola, Arcadi

2017-10-25

Noise and artifacts are inherent contaminating components and are particularly present in Holter electrocardiogram (ECG) monitoring. The presence of noise is even more significant in long-term monitoring (LTM) recordings, as these are collected for several days in patients following their daily activities; hence, strong artifact components can temporarily impair the clinical measurements from the LTM recordings. Traditionally, the noise presence has been dealt with as a problem of non-desirable component removal by means of several quantitative signal metrics such as the signal-to-noise ratio (SNR), but current systems do not provide any information about the true impact of noise on the ECG clinical evaluation. As a first step towards an alternative to classical approaches, this work assesses the ECG quality under the assumption that an ECG has good quality when it is clinically interpretable. Therefore, our hypotheses are that it is possible (a) to create a clinical severity score for the effect of the noise on the ECG, (b) to characterize its consistency in terms of its temporal and statistical distribution, and (c) to use it for signal quality evaluation in LTM scenarios. For this purpose, a database of external event recorder (EER) signals is assembled and labeled from a clinical point of view for its use as the gold standard of noise severity categorization. These devices are assumed to capture those signal segments more prone to be corrupted with noise during long-term periods. Then, the ECG noise is characterized through the comparison of these clinical severity criteria with conventional quantitative metrics taken from traditional noise-removal approaches, and noise maps are proposed as a novel representation tool to achieve this comparison. Our results showed that neither of the benchmarked quantitative noise measurement criteria represent an accurate enough estimation of the clinical severity of the noise. A case study of long-term ECG is reported

High-pitch dual-source CT angiography of the whole aorta without ECG synchronisation: Initial experience

International Nuclear Information System (INIS)

Beeres, Martin; Schell, Boris; Mastragelopoulos, Aristidis; Kerl, Josef Matthias; Gruber-Rouh, Tatjana; Lee, Clara; Siebenhandl, Petra; Bodelle, Boris; Zangos, Stephan; Vogl, Thomas J.; Jacobi, Volkmar; Bauer, Ralf W.; Herrmann, Eva

2012-01-01

To investigate the feasibility, image quality and radiation dose for high-pitch dual-source CT angiography (CTA) of the whole aorta without ECG synchronisation. Each group of 40 patients underwent CTA either on a 16-slice (group 1) or dual-source CT device with conventional single-source (group 2) or high-pitch mode with a pitch of 3.0 (group 3). The presence of motion or stair-step artefacts of the thoracic aorta was independently assessed by two readers. Subjective and objective scoring of motion and artefacts were significantly reduced in the high-pitch examination protocol (p < 0.05). The imaging length was not significantly different, but the imaging time was significantly (p < 0.001) shorter in the high-pitch group (12.2 vs. 7.4 vs. 1.7 s for groups 1, 2 and 3). The ascending aorta and the coronary ostia were reliably evaluable in all patients of group 3 without motion artefacts as well. High-pitch dual-source CT angiography of the whole aorta is feasible in unselected patients. As a significant advantage over regular pitch protocols, motion-free imaging of the aorta is possible without ECG synchronisation. Thus, this CT mode bears potential to become a standard CT protocol before trans-catheter aortic valve implantation (TAVI). (orig.)

An integrated on-line system for the evaluation of ECG patterns with a small process computer

International Nuclear Information System (INIS)

Schoffa, G.; Eggenberger, O.; Krueger, G.; Karlsruhe Univ.

1975-01-01

This paper describes an on-line system for ECG processing with a small computer (8K memory) and a magnetic tape cassette for mass storage capable to evaluate 30 ECG patterns in a twelfe lead system per day. The use of a small computer was possible by a compact and easy-to-handle operating system and space-saving programs. The system described was specifically intended for use in smaller hospitals with a low number of ECG's per day which do not allow an economic operation of greater DP installations. The economy calculations, based on the 'Break-even-point method' with special regard to the installations, mainennance and personnel costs already grant an economic operation of a small computer at a rate of 5 ECG's per day. (orig.) [de

Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG.

Science.gov (United States)

Fudge, Jessie; Harmon, Kimberly G; Owens, David S; Prutkin, Jordan M; Salerno, Jack C; Asif, Irfan M; Haruta, Alison; Pelto, Hank; Rao, Ashwin L; Toresdahl, Brett G; Drezner, Jonathan A

2014-08-01

This study compares the accuracy of cardiovascular screening in active adolescents and young adults using a standardised history, physical examination and resting 12-lead ECG. Participants were prospectively screened using a standardised questionnaire based on the Pre-participation Physical Evaluation Monograph 4th Edition (PPE-4), physical examination and ECG interpreted using modern standards. Participants with abnormal findings had focused echocardiography and further evaluation. Primary outcomes included disorders associated with sudden cardiac arrest (SCA). From September 2010 to July 2011, 1339 participants underwent screening: age 13-24 (mean 16) years, 49% male, 68% Caucasian, 17% African-American and 1071 (80%) participating in organised sports. Abnormal history responses were reported on 916 (68%) questionnaires. After physician review, 495/916 (54%) participants with positive questionnaires were thought to have non-cardiac symptoms and/or a benign family history and did not warrant additional evaluation. Physical examination was abnormal in 124 (9.3%) participants, and 72 (5.4%) had ECG abnormalities. Echocardiograms were performed in 586 (44%) participants for abnormal history (31%), physical examination (8%) or ECG (5%). Five participants (0.4%) were identified with a disorder associated with SCA, all with ECG-detected Wolff-Parkinson-White. The false-positive rates for history, physical examination and ECG were 31.3%, 9.3% and 5%, respectively. A standardised history and physical examination using the PPE-4 yields a high false-positive rate in a young active population with limited sensitivity to identify those at risk for SCA. ECG screening has a low false-positive rate using modern interpretation standards and improves detection of primary electrical disease at risk of SCA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

ECG acquisition and automated remote processing

CERN Document Server

Gupta, Rajarshi; Bera, Jitendranath

2014-01-01

The book is focused on the area of remote processing of ECG in the context of telecardiology, an emerging area in the field of Biomedical Engineering Application. Considering the poor infrastructure and inadequate numbers of physicians in rural healthcare clinics in India and other developing nations, telemedicine services assume special importance. Telecardiology, a specialized area of telemedicine, is taken up in this book considering the importance of cardiac diseases, which is prevalent in the population under discussion. The main focus of this book is to discuss different aspects of ECG acquisition, its remote transmission and computerized ECG signal analysis for feature extraction. It also discusses ECG compression and application of standalone embedded systems, to develop a cost effective solution of a telecardiology system.

Radiotherapy-induced Early ECG Changes and Their Comparison with Echocardiography in Patients with Early-stage Breast Cancer.

Science.gov (United States)

Tuohinen, Suvi Sirkku; Keski-Pukkila, Konsta; Skyttä, Tanja; Huhtala, Heini; Virtanen, Vesa; Kellokumpu-Lehtinen, Pirkko-Liisa; Raatikainen, Pekka; Nikus, Kjell

2018-04-01

Early electrocardiogram (ECG) changes after breast cancer radiotherapy (RT) have been reported, but their characteristics and associated factors are largely unknown. This study aimed to explore early RT-induced ECG changes and to compare them with echocardiography changes. Sixty eligible patients with chemotherapy-naïve left-sided and 20 with right-sided breast cancer were evaluated with echocardiography, blood samples and ECG before and after RT. RT-induced ECG changes in the anterior leads. T-Wave changes were most frequent. T-Wave decline was associated independently with patient age (β=-0.245, p=0.005), mean heart radiation dose (β=1.252, p=0.001) and global systolic strain rate change (β=7.943, p=0.002). T-Wave inversion was associated independently with mean heart radiation dose (β=0.143, pECG changes were prevalent and associated with functional and structural changes in echocardiography. ECG could be used for post-RT cardiac screening. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Accuracy of localization of acute myocardial infarction by 12 lead electrocardiography

International Nuclear Information System (INIS)

Yasuda, T.; Ribeiro, L.G.; Holman, B.L.; Alpert, J.S.; Maroko, P.R.

1982-01-01

Until recently, ECG accuracy in localizing acute myocardial infarction (AMI) could be assessed only by comparing the ECGs with autopsy findings. This approach, however, preselected patients, including only those who died. It is possible that this postmortem group of patients would be different from the whole population of patients with AMI. Myocardial imaging with 99 mTc-pyrophosphate offers the advantage of directly localizing the region of injured myocardium in the acute phase of AMI. In 34 patients with confirmed AMI and focal uptake of 99 mTc-pyrophosphate, serial ECGs were obtained and interpreted by two independent observers. The sensitivity and specificity of serial ECGs in determining the location of AMI in the five left ventricular (LV) wall segments were determined: (1) in the anterior wall sensitivity was 86.7% and specificity was 89.5%; (2) in the lateral wall sensitivity was 73.7% and specificity was 80.0%; (3) in the high lateral wall sensitivity was 80.0% and specificity was 87.5%; (4) in the inferior wall sensitivity was 87.5% and specificity was 100%; (5) in the true posterior wall sensitivity was 83.3% and specificity was 86.4%. Overall, in the 170 LV wall segments (five per patient) examined, scans localized with a sensitivity of 81.9% and a specificity of 88.8%. After four patients with LBBB were excluded, sensitivity increased to 87.1%. Overall, localization of AMI by serial ECG was accurate in 85.9% of the 34 patients included in the study

Noninvasive coronary artery imaging by multislice spiral computed tomography. A novel approach for a retrospectively ECG-gated reconstruction technique

International Nuclear Information System (INIS)

Sato, Yuichi; Kanmatsuse, Katsuo; Inoue Fumio

2003-01-01

Although the excellent spatial resolution of multislice spiral computed tomography (MSCT) enables the coronary arteries to be visualized, its limited temporal resolution results in poor image reproducibility because of cardiac motion artifact (CMA) and hence limits its widespread clinical use. A novel retrospectively electrocardiogram (ECG)-gated reconstruction method has been developed to minimize CMA. In 88 consecutive patients, the scan data were reconstructed using 2 retrospectively ECG-gated reconstruction methods. Method 1: the end of the reconstruction window (250 ms) was positioned at the peak of the P wave on ECG, which corresponded to the end of the slow filling phase during diastole immediately before atrial contraction. Method 2 (conventional method): relative retrospective gating with 50% referred to the R-R interval was performed so that the beginning of the reconstruction window (250 ms) was positioned at the halfway point between the R-R intervals of the heart cycle. The quality of the coronary artery images was evaluated according to the presence or absence of CMA. The assessment was applied to the left main coronary artery (LMCA), the left anterior descending artery (LAD, segments no.6, no.7, and no.8), the left circumflex artery (LCx, segments no.11 and no.13) and the right coronary artery (RCA, segments no.1, no.2 and no.3). The first diagonal artery (no.9-1), the obtuse marginal artery (no.12-1), the posterior descending artery (no.4-PD), the atrioventricular node branch (no.4-AV) and the first right ventricular branch (RV) were also evaluated. Of the 88 patients, 85 were eligible for image evaluation. Method 1 allowed visualization of the major coronary arteries without CMA in the majority of patients. The left coronary artery (LCA) system (segments no.5-7, no.11 and no.13) and the proximal portion of the RCA were visualized in more than 94% of patients. Artifact-free visualization of the distal portion of the LAD (segment no.8) and RCA (no.4

Biosignal integrated circuit with simultaneous acquisition of ECG and PPG for wearable healthcare applications.

Science.gov (United States)

Kim, Hyungseup; Park, Yunjong; Ko, Youngwoon; Mun, Yeongjin; Lee, Sangmin; Ko, Hyoungho

2018-01-01

Wearable healthcare systems require measurements from electrocardiograms (ECGs) and photoplethysmograms (PPGs), and the blood pressure of the user. The pulse transit time (PTT) can be calculated by measuring the ECG and PPG simultaneously. Continuous-time blood pressure without using an air cuff can be estimated by using the PTT. This paper presents a biosignal acquisition integrated circuit (IC) that can simultaneously measure the ECG and PPG for wearable healthcare applications. Included in this biosignal acquisition circuit are a voltage mode instrumentation amplifier (IA) for ECG acquisition and a current mode transimpedance amplifier for PPG acquisition. The analog outputs from the ECG and PPG channels are muxed and converted to digital signals using 12-bit successive approximation register (SAR) analog-to-digital converter (ADC). The proposed IC is fabricated by using a standard 0.18 μm CMOS process with an active area of 14.44 mm2. The total current consumption for the multichannel IC is 327 μA with a 3.3 V supply. The measured input referred noise of ECG readout channel is 1.3 μVRMS with a bandwidth of 0.5 Hz to 100 Hz. And the measured input referred current noise of the PPG readout channel is 0.122 nA/√Hz with a bandwidth of 0.5 Hz to 100 Hz. The proposed IC, which is implemented using various circuit techniques, can measure ECG and PPG signals simultaneously to calculate the PTT for wearable healthcare applications.

The evaluation of an open source online training system for teaching 12 lead electrocardiographic interpretation.

Science.gov (United States)

Breen, Cathal; Zhu, Tingting; Bond, Raymond; Finlay, Dewar; Clifford, Gari

2016-01-01

The aim of this study is to present and evaluate the integration of a low resource JavaScript based ECG training interface (CrowdLabel) and a standardised curriculum for self-guided tuition in ECG interpretation. Participants practiced interpreting ECGs weekly using the CrowdLabel interface to assist with the learning of the traditional didactic taught course material during a 6 week training period. To determine competency students were tested during week 7. A total of 245 unique ECG cases were submitted by each student. Accuracy scores during the training period ranged from 0-59.5% (median = 33.3%). Conversely accuracy scores during the test ranged from 30 - 70% (median = 37.5%) (p < 0.05). There was no correlation between students who interpreted high numbers of ECGs during the training period and their marks obtained. CrowdLabel is shown to be a readily accessible dedicated learning platform to support ECG interpretation competency. Copyright © 2016 Elsevier Inc. All rights reserved.

E-Bra system for women ECG measurement with GPRS communication, Nanosensor, and motion artifact remove algorithm

Science.gov (United States)

Kwon, Hyeokjun; Oh, Sechang; Kumar, Prashanth S.; Varadan, Vijay K.

2012-10-01

CardioVascular Disease(CVD)s lead the sudden cardiac death due to irregular phenomenon of the cardiac signal by the abnormal case of blood vessel and cardiac structure. For last two decades, cardiac disease research for man is under active discussion. As a result, the death rate by cardiac disease in men has been falling gradually compared with relatively increasing the women death rate due to CVD[2]. The main reason of this phenomenon causes the lack a sense of the seriousness to female CVD and different symptom of female CVD compared with the symptoms of male CVD. Usually, because the women CVD accompanies with ordinary symptoms unrecognizing the heart abnormality signal such as unusual fatigue, sleep disturbances, shortness of breath, anxiety, chest discomfort, and indigestion dyspepsia, most women CVD patients do not realize that these symptoms are related to the CVD symptoms. Therefore, periodic ECG signal observation is required for women cardiac disease patients. ElectroCardioGram(ECG) detection, treadmill test/exercise ECG, nuclear scan, coronary angiography, and intracoronary ultrasound are used to diagnose abnormality of heart. Among the medical checkup methods for CVDs checkup, it is very effective method for the diagnosis of cardiac disease and the early detection of heart abnormality to monitor ECG periodically. This paper suggests the effective ECG monitoring system for woman by attaching the system on woman's brassiere by using augmented chest lead attachment method. The suggested system in this paper consists of ECG signal transmission system and a server program to display and analyze the transmitted ECG. The ECG signal transmission system consists of three parts such as ECG physical signal detection part with two electrodes made by gold nanowire structure, data acquisition with AD converter, and data transmission part with GPRS(General Packet Radio Service) communication. Usually, to detect human bio signal, Ag/AgCl or gold cup electrodes are used

Variable threshold method for ECG R-peak detection.

Science.gov (United States)

Kew, Hsein-Ping; Jeong, Do-Un

2011-10-01

In this paper, a wearable belt-type ECG electrode worn around the chest by measuring the real-time ECG is produced in order to minimize the inconvenient in wearing. ECG signal is detected using a potential instrument system. The measured ECG signal is transmits via an ultra low power consumption wireless data communications unit to personal computer using Zigbee-compatible wireless sensor node. ECG signals carry a lot of clinical information for a cardiologist especially the R-peak detection in ECG. R-peak detection generally uses the threshold value which is fixed. There will be errors in peak detection when the baseline changes due to motion artifacts and signal size changes. Preprocessing process which includes differentiation process and Hilbert transform is used as signal preprocessing algorithm. Thereafter, variable threshold method is used to detect the R-peak which is more accurate and efficient than fixed threshold value method. R-peak detection using MIT-BIH databases and Long Term Real-Time ECG is performed in this research in order to evaluate the performance analysis.

Spectral analysis of 87-lead body surface signal-averaged ECGs in patients with previous anterior myocardial infarction as a marker of ventricular tachycardia.

Science.gov (United States)

Hosoya, Y; Kubota, I; Shibata, T; Yamaki, M; Ikeda, K; Tomoike, H

1992-06-01

There were few studies on the relation between the body surface distribution of high- and low-frequency components within the QRS complex and ventricular tachycardia (VT). Eighty-seven signal-averaged ECGs were obtained from 30 normal subjects (N group) and 30 patients with previous anterior myocardial infarction (MI) with VT (MI-VT[+] group, n = 10) or without VT (MI-VT[-] group, n = 20). The onset and offset of the QRS complex were determined from 87-lead root mean square values computed from the averaged (but not filtered) ECG waveforms. Fast Fourier transform analysis was performed on signal-averaged ECG. The resulting Fourier coefficients were attenuated by use of the transfer function, and then inverse transform was done with five frequency ranges (0-25, 25-40, 40-80, 80-150, and 150-250 Hz). From the QRS onset to the QRS offset, the time integration of the absolute value of reconstructed waveforms was calculated for each of the five frequency ranges. The body surface distributions of these areas were expressed as QRS area maps. The maximal values of QRS area maps were compared among the three groups. In the frequency ranges of 0-25 and 150-250 Hz, there were no significant differences in the maximal values among these three groups. Both MI groups had significantly smaller maximal values of QRS area maps in the frequency ranges of 25-40 and 40-80 Hz compared with the N group. The MI-VT(+) group had significantly smaller maximal values in the frequency ranges of 40-80 and 80-150 Hz than the MI-VT(-) group. These three groups were clearly differentiated by the maximal values of the 40-80-Hz QRS area map. It was suggested that the maximal value of the 40-80-Hz QRS area map was a new marker for VT after anterior MI.

A wavelet-based ECG delineation algorithm for 32-bit integer online processing.

Science.gov (United States)

Di Marco, Luigi Y; Chiari, Lorenzo

2011-04-03

Since the first well-known electrocardiogram (ECG) delineator based on Wavelet Transform (WT) presented by Li et al. in 1995, a significant research effort has been devoted to the exploitation of this promising method. Its ability to reliably delineate the major waveform components (mono- or bi-phasic P wave, QRS, and mono- or bi-phasic T wave) would make it a suitable candidate for efficient online processing of ambulatory ECG signals. Unfortunately, previous implementations of this method adopt non-linear operators such as root mean square (RMS) or floating point algebra, which are computationally demanding. This paper presents a 32-bit integer, linear algebra advanced approach to online QRS detection and P-QRS-T waves delineation of a single lead ECG signal, based on WT. The QRS detector performance was validated on the MIT-BIH Arrhythmia Database (sensitivity Se = 99.77%, positive predictive value P+ = 99.86%, on 109010 annotated beats) and on the European ST-T Database (Se = 99.81%, P+ = 99.56%, on 788050 annotated beats). The ECG delineator was validated on the QT Database, showing a mean error between manual and automatic annotation below 1.5 samples for all fiducial points: P-onset, P-peak, P-offset, QRS-onset, QRS-offset, T-peak, T-offset, and a mean standard deviation comparable to other established methods. The proposed algorithm exhibits reliable QRS detection as well as accurate ECG delineation, in spite of a simple structure built on integer linear algebra.

ECG-gating in non-cardiac digital subtraction angiography

International Nuclear Information System (INIS)

Gattoni, F.; Baldini, V.; Cairo, F.

1987-01-01

This paper reports the results of the ECG-gating in non-cardiac digital subtraction angiography (DSA). One hundred and fifteen patients underwent DSA (126 examinations); ECG-gating was applied in 66/126 examinations: images recorded at 70% of R wave were subtracted. Artifacts produced by vascular movements were evaluated in all patients: only 40 examinations, carried out whithout ECG-gating, showed vascular artifacts. The major advantage of the ECG-gated DSA is the more efficent subtraction because of the better images superimposition: therefore, ECG-gating can be clinically helpful. On the contrary, it could be a problem in arrhytmic or bradycardic patients. ECG-gating is helpful in DSA imaging of the thoracic and abdominal aorta and of the cervical and renal arteries. In the examinations of peripheral vessels of the limbs it is not so efficent as in the trunk or in the neck

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

Science.gov (United States)

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

Systematic analysis of ECG predictors of sinus rhythm maintenance after electrical cardioversion for persistent atrial fibrillation.

Science.gov (United States)

Lankveld, Theo; de Vos, Cees B; Limantoro, Ione; Zeemering, Stef; Dudink, Elton; Crijns, Harry J; Schotten, Ulrich

2016-05-01

Electrical cardioversion (ECV) is one of the rhythm control strategies in patients with persistent atrial fibrillation (AF). Unfortunately, recurrences of AF are common after ECV, which significantly limits the practical benefit of this treatment in patients with AF. The objectives of this study were to identify noninvasive complexity or frequency parameters obtained from the surface electrocardiogram (ECG) to predict sinus rhythm (SR) maintenance after ECV and to compare these ECG parameters with clinical predictors. We studied a wide variety of ECG-derived time- and frequency-domain AF complexity parameters in a prospective cohort of 502 patients with persistent AF referred for ECV. During 1-year follow-up, 161 patients (32%) maintained SR. The best clinical predictor of SR maintenance was antiarrhythmic drug (AAD) treatment. A model including clinical parameters predicted SR maintenance with a mean cross-validated area under the receiver operating characteristic curve (AUC) of 0.62 ± 0.05. The best single ECG parameter was the dominant frequency (DF) on lead V6. Combining several ECG parameters predicted SR maintenance with a mean AUC of 0.64 ± 0.06. Combining clinical and ECG parameters improved prediction to a mean AUC of 0.67 ± 0.05. Although the DF was affected by AAD treatment, excluding patients taking AADs did not significantly lower the predictive performance captured by the ECG. ECG-derived parameters predict SR maintenance during 1-year follow-up after ECV at least as good as known clinical predictors of rhythm outcome. The DF proved to be the most powerful ECG-derived predictor. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Robust electrocardiogram (ECG) beat classification using discrete wavelet transform

International Nuclear Information System (INIS)

Minhas, Fayyaz-ul-Amir Afsar; Arif, Muhammad

2008-01-01

This paper presents a robust technique for the classification of six types of heartbeats through an electrocardiogram (ECG). Features extracted from the QRS complex of the ECG using a wavelet transform along with the instantaneous RR-interval are used for beat classification. The wavelet transform utilized for feature extraction in this paper can also be employed for QRS delineation, leading to reduction in overall system complexity as no separate feature extraction stage would be required in the practical implementation of the system. Only 11 features are used for beat classification with the classification accuracy of ∼99.5% through a KNN classifier. Another main advantage of this method is its robustness to noise, which is illustrated in this paper through experimental results. Furthermore, principal component analysis (PCA) has been used for feature reduction, which reduces the number of features from 11 to 6 while retaining the high beat classification accuracy. Due to reduction in computational complexity (using six features, the time required is ∼4 ms per beat), a simple classifier and noise robustness (at 10 dB signal-to-noise ratio, accuracy is 95%), this method offers substantial advantages over previous techniques for implementation in a practical ECG analyzer

Flexible Graphene Electrodes for Prolonged Dynamic ECG Monitoring

Directory of Open Access Journals (Sweden)

Cunguang Lou

2016-11-01

Full Text Available This paper describes the development of a graphene-based dry flexible electrocardiography (ECG electrode and a portable wireless ECG measurement system. First, graphene films on polyethylene terephthalate (PET substrates and graphene paper were used to construct the ECG electrode. Then, a graphene textile was synthesized for the fabrication of a wearable ECG monitoring system. The structure and the electrical properties of the graphene electrodes were evaluated using Raman spectroscopy, scanning electron microscopy (SEM, and alternating current impedance spectroscopy. ECG signals were then collected from healthy subjects using the developed graphene electrode and portable measurement system. The results show that the graphene electrode was able to acquire the typical characteristics and features of human ECG signals with a high signal-to-noise (SNR ratio in different states of motion. A week-long continuous wearability test showed no degradation in the ECG signal quality over time. The graphene-based flexible electrode demonstrates comfortability, good biocompatibility, and high electrophysiological detection sensitivity. The graphene electrode also combines the potential for use in long-term wearable dynamic cardiac activity monitoring systems with convenience and comfort for use in home health care of elderly and high-risk adults.

21 CFR 892.1970 - Radiographic ECG/respirator synchronizer.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiographic ECG/respirator synchronizer. 892.1970... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1970 Radiographic ECG/respirator synchronizer. (a) Identification. A radiographic ECG/respirator synchronizer is a device intended to be used to...

Expert knowledge for computerized ECG interpretation

NARCIS (Netherlands)

J.A. Kors (Jan)

1992-01-01

textabstractIn this study, two main questions are addressed: (1) Can the time consuming and cumbersome development and refinement of (heuristic) ECG classifiers be alleviated, and (2) Is it possible to increase diagnostic performance of ECG computer programs by combining knowledge from multiple

ECG authentication in post-exercise situation.

Science.gov (United States)

Dongsuk Sung; Jeehoon Kim; Myungjun Koh; Kwangsuk Park

2017-07-01

Human authentication based on electrocardiogram (ECG) has been a remarkable issue for recent ten years. This paper proposed an authentication technology with the ECG data recorded after the harsh exercise. 55 subjects voluntarily attended to this experiment. A stepper was used as an exercise equipment. The subjects are asked to do stepper for 5 minutes and their ECG signals are acquired before and after the exercise in rest, sitting posture. Linear discriminant analysis (LDA) was used for both feature extraction and classification. Even though, within the first 1 minute recording, the subject recognition accuracy was 59.64%, which is too low to utilize, after one minute the accuracy was higher than 90% and it increased up to 96.22% within 5 minutes, which is plausible to use in authentication circumstances. Therefore, we have concluded that ECG authentication techniques will be able to be used after 1 minute of catching breath.

Spatiotemporal Characteristics of QRS Complexes Enable the Diagnosis of Brugada Syndrome Regardless of the Appearance of a Type 1 ECG.

Science.gov (United States)

Guillem, Maria S; Climent, Andreu M; Millet, José; Berne, Paola; Ramos, Rafael; Brugada, Josep; Brugada, Ramon

2016-05-01

The diagnosis of Brugada syndrome based on the ECG is hampered by the dynamic nature of its ECG manifestations. Brugada syndrome patients are only 25% likely to present a type 1 ECG. The objective of this study is to provide an ECG diagnostic criterion for Brugada syndrome patients that can be applied consistently even in the absence of a type 1 ECG. We recorded 67-lead body surface potential maps from 94 Brugada syndrome patients and 82 controls (including right bundle branch block patients and healthy individuals). The spatial propagation direction during the last r' wave and the slope at the end of the QRS complex were measured and compared between patients groups. Receiver-operating characteristic curves were constructed for half of the database to identify optimal cutoff values; sensitivity and specificity for these cutoff values were measured in the other half of the database. A spontaneous type 1 ECG was present in only 30% of BrS patients. An orientation in the sagittal plane ECG recordings can enable a robust identification of BrS even without the presence of a type 1 ECG. © 2016 Wiley Periodicals, Inc.

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Directory of Open Access Journals (Sweden)

Marcin Waligóra

2018-01-01

Full Text Available Introduction. Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH, but the role of electrocardiography (ECG in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods. Consecutive patients with pulmonary arterial hypertension (PAH or chronic thromboembolic pulmonary hypertension (CTEPH were eligible to be included if they had had performed two consecutive right heart catheterization (RHC procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results. We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6±10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL-SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84, PII (AUC: 0.67, 95% CI: 0.56–0.77, and max⁡RV1,2+max⁡SI,aVL-SV1 (0.73; 95% CI: 0.63–0.82. In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24. Conclusion. Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2+max⁡SI,aVL-SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better

Wearable Textile Electrodes for ECG Measurement

Directory of Open Access Journals (Sweden)

Lukas Vojtech

2013-01-01

Full Text Available The electrocardiogram (ECG is one of the most important parameters for monitoring of the physiological state of a person. Currently available systems for ECG monitoring are both stationary and wearable, but the comfort of the monitored person is not at a satisfactory level because these systems are not part of standard clothing. This article is therefore devoted to the development and measurement of wearable textile electrodes for ECG measurement device with high comfort for the user. The electrode material is made of electrically conductive textile. This creates a textile composite that guarantees high comfort for the user while ensuring good quality of ECG measurements. The composite is implemented by a carrier (a T-shirt with flame retardant and sensing electrodes embroidered with yarn based on a mixture of polyester coated with silver nanoparticles and cotton. The electrodes not only provide great comfort but are also antibacterial and antiallergic due to silver nanoparticles.

The Basel Convention: effect on the Asian secondary lead industry

Science.gov (United States)

Elmer, J. W.

The Basel Convention has had a dramatic effect on the world trade in scrap materials. The scope of implementation is broader than was originally intended. This is due mainly to uncertainties created by a failure to distinguish between waste for disposal and waste destined for recycling. Spent lead/acid batteries and other lead scrap flows from OECD to non-OECD countries have been restricted to the point where secondary lead production is being affected. Export-import flows between OECD members have also changed as recycling is being contained within those countries. The economics of recycling in OECD countries may result in a smaller percentage of scrap being recycled. The established lead/acid battery industry in the Asian region, which relies heavily on imported scrap, will now be forced to import more finished metal, to maintain output. With strong economic growth forecast for the region, and no substitute for the lead-based battery, the supply situation is unlikely to ease.

Automatic ECG quality scoring methodology: mimicking human annotators

International Nuclear Information System (INIS)

Johannesen, Lars; Galeotti, Loriano

2012-01-01

An algorithm to determine the quality of electrocardiograms (ECGs) can enable inexperienced nurses and paramedics to record ECGs of sufficient diagnostic quality. Previously, we proposed an algorithm for determining if ECG recordings are of acceptable quality, which was entered in the PhysioNet Challenge 2011. In the present work, we propose an improved two-step algorithm, which first rejects ECGs with macroscopic errors (signal absent, large voltage shifts or saturation) and subsequently quantifies the noise (baseline, powerline or muscular noise) on a continuous scale. The performance of the improved algorithm was evaluated using the PhysioNet Challenge database (1500 ECGs rated by humans for signal quality). We achieved a classification accuracy of 92.3% on the training set and 90.0% on the test set. The improved algorithm is capable of detecting ECGs with macroscopic errors and giving the user a score of the overall quality. This allows the user to assess the degree of noise and decide if it is acceptable depending on the purpose of the recording. (paper)

Basic principles of the ECG. The normal ECG

African Journals Online (AJOL)

Angel_D

Southern Sudan Medical Journal vol 3. no 2. 26. How to read an ... Reduce some of the anxiety juniors often experience when faced with an ECG. ... This overall direction of travel of the electrical .... Anne Lancey, Education Centre, St Mary's Hospital, Isle of Wight, UK. .... 'method' section explains how the literature search.

Are ECG abnormalities in Noonan syndrome characteristic for the syndrome?

Science.gov (United States)

Raaijmakers, R; Noordam, C; Noonan, J A; Croonen, E A; van der Burgt, C J A M; Draaisma, J M T

2008-12-01

Of all patients with Noonan syndrome, 50-90% have one or more congenital heart defects. The most frequent occurring are pulmonary stenosis (PS) and hypertrophic cardiomyopathy. The electrocardiogram (ECG) of a patient with Noonan syndrome often shows a characteristic pattern, with a left axis deviation, abnormal R/S ratio over the left precordium, and an abnormal Q wave. The objective of this study was to determine if these ECG characteristics are an independent feature of the Noonan syndrome or if they are related to the congenital heart defect. A cohort study was performed with 118 patients from two university hospitals in the United States and in The Netherlands. All patients were diagnosed with definite Noonan syndrome and had had an ECG and echocardiography. Sixty-nine patients (58%) had characteristic abnormalities of the ECG. In the patient group without a cardiac defect (n = 21), ten patients had a characteristic ECG abnormality. There was no statistical relationship between the presence of a characteristic ECG abnormality and the presence of a cardiac defect (p = 0.33). Patients with hypertrophic cardiomyopathy had more ECG abnormalities in total (p = 0.05), without correlation with a specific ECG abnormality. We conclude that the ECG features in patients with Noonan syndrome are characteristic for the syndrome and are not related to a specific cardiac defect. An ECG is very useful in the diagnosis of Noonan syndrome; every child with a Noonan phenotype should have an ECG and echocardiogram for evaluation.

Freeware eLearning Flash-ECG for learning electrocardiography.

Science.gov (United States)

Romanov, Kalle; Kuusi, Timo

2009-06-01

Electrocardiographic (ECG) analysis can be taught in eLearning programmes with suitable software that permits the effective use of basic tools such as a ruler and a magnifier, required for measurements. The Flash-ECG (Research & Development Unit for Medical Education, University of Helsinki, Finland) was developed to enable teachers and students to use scanned and archived ECGs on computer screens and classroom projectors. The software requires only a standard web browser with a Flash plug-in and can be integrated with learning environments (Blackboard/WebCT, Moodle). The Flash-ECG is freeware and is available to medical teachers worldwide.

A model-based Bayesian framework for ECG beat segmentation

International Nuclear Information System (INIS)

Sayadi, O; Shamsollahi, M B

2009-01-01

The study of electrocardiogram (ECG) waveform amplitudes, timings and patterns has been the subject of intense research, for it provides a deep insight into the diagnostic features of the heart's functionality. In some recent works, a Bayesian filtering paradigm has been proposed for denoising and compression of ECG signals. In this paper, it is shown that this framework may be effectively used for ECG beat segmentation and extraction of fiducial points. Analytic expressions for the determination of points and intervals are derived and evaluated on various real ECG signals. Simulation results show that the method can contribute to and enhance the clinical ECG beat segmentation performance

ECG telemetry in conscious guinea pigs.

Science.gov (United States)

Ruppert, Sabine; Vormberge, Thomas; Igl, Bernd-Wolfgang; Hoffmann, Michael

2016-01-01

During preclinical drug development, monitoring of the electrocardiogram (ECG) is an important part of cardiac safety assessment. To detect potential pro-arrhythmic liabilities of a drug candidate and for internal decision-making during early stage drug development an in vivo model in small animals with translatability to human cardiac function is required. Over the last years, modifications/improvements regarding animal housing, ECG electrode placement, and data evaluation have been introduced into an established model for ECG recordings using telemetry in conscious, freely moving guinea pigs. Pharmacological validation using selected reference compounds affecting different mechanisms relevant for cardiac electrophysiology (quinidine, flecainide, atenolol, dl-sotalol, dofetilide, nifedipine, moxifloxacin) was conducted and findings were compared with results obtained in telemetered Beagle dogs. Under standardized conditions, reliable ECG data with low variability allowing largely automated evaluation were obtained from the telemetered guinea pig model. The model is sensitive to compounds blocking cardiac sodium channels, hERG K(+) channels and calcium channels, and appears to be even more sensitive to β-blockers as observed in dogs at rest. QT interval correction according to Bazett and Sarma appears to be appropriate methods in conscious guinea pigs. Overall, the telemetered guinea pig is a suitable model for the conduct of early stage preclinical ECG assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

Prolonged corrected QT interval is predictive of future stroke events even in subjects without ECG-diagnosed left ventricular hypertrophy.

Science.gov (United States)

Ishikawa, Joji; Ishikawa, Shizukiyo; Kario, Kazuomi

2015-03-01

We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (≥440 ms in men and ≥460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, ≥244 mV×ms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7±28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population. © 2014 American Heart Association, Inc.

Usefulness of ST elevation score by using vector-projected virtual 187-channel ECG for risk stratification in patients with Brugada-type ECG pattern

Directory of Open Access Journals (Sweden)

Shoko Ishikawa

2012-08-01

Conclusion: The ST elevation score in VP-ECG objectively documented the degree of ST elevation in surface ECG in Brugada-type ECG patterns. The ST-elevation score might be useful for risk stratification in patients with asymptomatic Brugada syndrome.

Empirical mode decomposition of the ECG signal for noise removal

Science.gov (United States)

Khan, Jesmin; Bhuiyan, Sharif; Murphy, Gregory; Alam, Mohammad

2011-04-01

Electrocardiography is a diagnostic procedure for the detection and diagnosis of heart abnormalities. The electrocardiogram (ECG) signal contains important information that is utilized by physicians for the diagnosis and analysis of heart diseases. So good quality ECG signal plays a vital role for the interpretation and identification of pathological, anatomical and physiological aspects of the whole cardiac muscle. However, the ECG signals are corrupted by noise which severely limit the utility of the recorded ECG signal for medical evaluation. The most common noise presents in the ECG signal is the high frequency noise caused by the forces acting on the electrodes. In this paper, we propose a new ECG denoising method based on the empirical mode decomposition (EMD). The proposed method is able to enhance the ECG signal upon removing the noise with minimum signal distortion. Simulation is done on the MIT-BIH database to verify the efficacy of the proposed algorithm. Experiments show that the presented method offers very good results to remove noise from the ECG signal.

Biometric and Emotion Identification: An ECG Compression Based Method.

Science.gov (United States)

Brás, Susana; Ferreira, Jacqueline H T; Soares, Sandra C; Pinho, Armando J

2018-01-01

We present an innovative and robust solution to both biometric and emotion identification using the electrocardiogram (ECG). The ECG represents the electrical signal that comes from the contraction of the heart muscles, indirectly representing the flow of blood inside the heart, it is known to convey a key that allows biometric identification. Moreover, due to its relationship with the nervous system, it also varies as a function of the emotional state. The use of information-theoretic data models, associated with data compression algorithms, allowed to effectively compare ECG records and infer the person identity, as well as emotional state at the time of data collection. The proposed method does not require ECG wave delineation or alignment, which reduces preprocessing error. The method is divided into three steps: (1) conversion of the real-valued ECG record into a symbolic time-series, using a quantization process; (2) conditional compression of the symbolic representation of the ECG, using the symbolic ECG records stored in the database as reference; (3) identification of the ECG record class, using a 1-NN (nearest neighbor) classifier. We obtained over 98% of accuracy in biometric identification, whereas in emotion recognition we attained over 90%. Therefore, the method adequately identify the person, and his/her emotion. Also, the proposed method is flexible and may be adapted to different problems, by the alteration of the templates for training the model.

EP-based wavelet coefficient quantization for linear distortion ECG data compression.

Science.gov (United States)

Hung, King-Chu; Wu, Tsung-Ching; Lee, Hsieh-Wei; Liu, Tung-Kuan

2014-07-01

Reconstruction quality maintenance is of the essence for ECG data compression due to the desire for diagnosis use. Quantization schemes with non-linear distortion characteristics usually result in time-consuming quality control that blocks real-time application. In this paper, a new wavelet coefficient quantization scheme based on an evolution program (EP) is proposed for wavelet-based ECG data compression. The EP search can create a stationary relationship among the quantization scales of multi-resolution levels. The stationary property implies that multi-level quantization scales can be controlled with a single variable. This hypothesis can lead to a simple design of linear distortion control with 3-D curve fitting technology. In addition, a competitive strategy is applied for alleviating data dependency effect. By using the ECG signals saved in MIT and PTB databases, many experiments were undertaken for the evaluation of compression performance, quality control efficiency, data dependency influence. The experimental results show that the new EP-based quantization scheme can obtain high compression performance and keep linear distortion behavior efficiency. This characteristic guarantees fast quality control even for the prediction model mismatching practical distortion curve. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Prospective and retrospective ECG-gating for CT coronary angiography perform similarly accurate at low heart rates

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Stolzmann, Paul, E-mail: paul.stolzmann@usz.ch [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Goetti, Robert; Baumueller, Stephan [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Plass, Andre; Falk, Volkmar [Clinic for Cardiovascular Surgery, University Hospital Zurich (Switzerland); Scheffel, Hans; Feuchtner, Gudrun; Marincek, Borut [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Alkadhi, Hatem [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Leschka, Sebastian [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

2011-07-15

Objective: To compare, in patients with suspicion of coronary artery disease (CAD) and low heart rates, image quality, diagnostic performance, and radiation dose values of prospectively and retrospectively electrocardiography (ECG)-gated dual-source computed tomography coronary angiography (CTCA) for the diagnosis of significant coronary stenoses. Materials and methods: Two-hundred consecutive patients with heart rates {<=}70 bpm were retrospectively enrolled; 100 patients undergoing prospectively ECG-gated CTCA (group 1) and 100 patients undergoing retrospectively-gated CTCA (group 2). Coronary artery segments were assessed for image quality and significant luminal diameter narrowing. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy of both CTCA groups were determined using conventional catheter angiography (CCA) as reference standard. Radiation dose values were calculated. Results: Both groups were comparable regarding gender, body weight, cardiovascular risk profile, severity of CAD, mean heart rate, heart rate variability, and Agatston score (all p > 0.05). There was no significant difference in the rate of non-assessable coronary segments between group 1 (1.6%, 24/1404) and group 2 (1.4%, 19/1385; p = 0.77); non-diagnostic image quality was significantly (p < 0.001) more often attributed to stair step artifacts in group 1. Segment-based sensitivity, specificity, PPV, NPV, and accuracy were 98%, 98%, 88%, 100%, and 100% among group 1; 96%, 99%, 90%, 100%, and 98% among group 2, respectively. Parameters of diagnostic performance were similar (all p > 0.05). Mean effective radiation dose of prospectively ECG-gated CTCA (2.2 {+-} 0.4 mSv) was significantly (p < 0.0001) smaller than that of retrospectively ECG-gated CTCA (8.1 {+-} 0.6 mSv). Conclusion: Prospectively ECG-gated CTCA yields similar image quality, performs as accurately as retrospectively ECG-gated CTCA in patients having heart rates {<=}70 bpm

Ability of a 5-minute electrocardiography (ECG) for predicting arrhythmias in Doberman Pinschers with cardiomyopathy in comparison with a 24-hour ambulatory ECG.

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Wess, G; Schulze, A; Geraghty, N; Hartmann, K

2010-01-01

Ventricular premature contractions (VPCs) are common in the occult stage of cardiomyopathy in Doberman Pinschers. Although the gold standard for detecting arrhythmia is the 24-hour ambulatory electrocardiography (ECG) (Holter), this method is more expensive, time-consuming and often not as readily available as common ECG. Comparison of 5-minute ECGs with Holter examinations. Eight hundred and seventy-five 5-minute ECGs and Holter examinations of 431 Doberman Pinschers. Each examination included a 5-minute ECG and Holter examination. A cut-off value of > 100 VPCs/24 hours using Holter was considered diagnostic for the presence of cardiomyopathy. Statistical evaluation included calculation of sensitivity, specificity, positive predictive value, and negative predictive value. Holter examinations revealed > 100 VPCs/24 hours in 204/875 examinations. At least 1 VPC during a 5-minute ECG was detected in 131 (64.2%) of these 204 examinations. No VPCs were found in the 5-minute ECG in 73 (35.8%) examinations of affected Doberman Pinschers. A 5-minute ECG with at least 1 VPC as cut-off had a sensitivity of 64.2%, a specificity of 96.7%, a positive predictive value of 85.6% and a negative predictive value of 89.9% for the presence of > 100 VPCs/24 hours. A 5-minute ECG is a rather insensitive method for detecting arrhythmias in Doberman Pinschers. However, the occurrence of at least 1 VPC in 5 minutes strongly warrants further examination of the dog, because specificity (96.7%) and positive predictive value (85.6%) are high and could suggest occult cardiomyopathy.

[ECG for non-competitive sports in childhood: strengths and disputes].

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Poggi, Elena; Giannattasio, Alessandro; Bolloli, Sara; Beccaria, Andrea; Mezzano, Paola; Rocca, Paola; Del Vecchio, Cecilia

2016-11-01

Sport is very important for health promotion and conservation. Active lifestyle and regular exercise reduce cardiovascular disease incidence. The Italian Ministry of Health issued the Law Decree no. 243 (10/18/2014) concerning "guidelines for certification about non-competitive sports" to promote safety in sports. This regulation defines the activities for which a certificate is required, the professional actors involved and the clinical exams to be performed according to the patient's health status. In particular, the Law Decree recommends to perform an electrocardiogram (ECG) "at least once in a lifetime", introducing much greater news into pediatric practice. We proposed a survey evaluating frequency of ECG implementation for non-competitive sports and cardiovascular diseases incidence was administered to 7 Ligurian pediatricians. The number of ECG/year for pediatrician increased from 10 ECG/year to 50 ECG/year with an indication of suitability to non-competitive sports. One case of QT prolongation and 2 cases of type 1 Brugada ECG pattern were diagnosed. In addition, 3 patients had an atrial septal defect and 3 children had a ventricular septal defect. Forty-three percent of the pediatricians considered useful performing the ECG. ECG in children has enhanced the positive effects on the community health. However, it remains to be defined in agreement with scientific societies the age at which to perform ECG, the sports for which ECG is required and the cost-benefit ratio for the National Health System and families.

Female False Positive Exercise Stress ECG Testing - Fact Verses Fiction.

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Fitzgerald, Benjamin T; Scalia, William M; Scalia, Gregory M

2018-03-07

Exercise stress testing is a well validated cardiovascular investigation. Accuracy for treadmill stress electrocardiograph (ECG) testing has been documented at 60%. False positive stress ECGs (exercise ECG changes with non-obstructive disease on anatomical testing) are common, especially in women, limiting the effectiveness of the test. This study investigates the incidence and predictors of false positive stress ECG findings, referenced against stress echocardiography (SE) as a standard. Stress echocardiography was performed using the Bruce treadmill protocol. False positive stress ECG tests were defined as greater than 1mm of ST depression on ECG during exertion, without pain, with a normal SE. Potential causes for false positive tests were recorded before the test. Three thousand consecutive negative stress echocardiograms (1036 females, 34.5%) were analysed (age 59+/-14 years. False positive (F+) stress ECGs were documented in 565/3000 tests (18.8%). F+ stress ECGs were equally prevalent in females (194/1036, 18.7%) and males (371/1964, 18.9%, p=0.85 for the difference). Potential causes (hypertension, left ventricular hypertrophy, known coronary disease, arrhythmia, diabetes mellitus, valvular heart disease) were recorded in 36/194 (18.6%) of the female F+ ECG tests and 249/371 (68.2%) of the male F+ ECG tests (preinforce the value of stress imaging, particularly in women. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

The PLR-DTW method for ECG based biometric identification.

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Shen, Jun; Bao, Shu-Di; Yang, Li-Cai; Li, Ye

2011-01-01

There has been a surge of research on electrocardiogram (ECG) signal based biometric for person identification. Though most of the existing studies claimed that ECG signal is unique to an individual and can be a viable biometric, one of the main difficulties for real-world applications of ECG biometric is the accuracy performance. To address this problem, this study proposes a PLR-DTW method for ECG biometric, where the Piecewise Linear Representation (PLR) is used to keep important information of an ECG signal segment while reduce the data dimension at the same time if necessary, and the Dynamic Time Warping (DTW) is used for similarity measures between two signal segments. The performance evaluation was carried out on three ECG databases, and the existing method using wavelet coefficients, which was proved to have good accuracy performance, was selected for comparison. The analysis results show that the PLR-DTW method achieves an accuracy rate of 100% for identification, while the one using wavelet coefficients achieved only around 93%.

PIC microcontroller-based RF wireless ECG monitoring system.

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Oweis, R J; Barhoum, A

2007-01-01

This paper presents a radio-telemetry system that provides the possibility of ECG signal transmission from a patient detection circuit via an RF data link. A PC then receives the signal through the National Instrument data acquisition card (NIDAQ). The PC is equipped with software allowing the received ECG signals to be saved, analysed, and sent by email to another part of the world. The proposed telemetry system consists of a patient unit and a PC unit. The amplified and filtered ECG signal is sampled 360 times per second, and the A/D conversion is performed by a PIC16f877 microcontroller. The major contribution of the final proposed system is that it detects, processes and sends patients ECG data over a wireless RF link to a maximum distance of 200 m. Transmitted ECG data with different numbers of samples were received, decoded by means of another PIC microcontroller, and displayed using MATLAB program. The designed software is presented in a graphical user interface utility.

Biometric and Emotion Identification: An ECG Compression Based Method

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Susana Brás

2018-04-01

Full Text Available We present an innovative and robust solution to both biometric and emotion identification using the electrocardiogram (ECG. The ECG represents the electrical signal that comes from the contraction of the heart muscles, indirectly representing the flow of blood inside the heart, it is known to convey a key that allows biometric identification. Moreover, due to its relationship with the nervous system, it also varies as a function of the emotional state. The use of information-theoretic data models, associated with data compression algorithms, allowed to effectively compare ECG records and infer the person identity, as well as emotional state at the time of data collection. The proposed method does not require ECG wave delineation or alignment, which reduces preprocessing error. The method is divided into three steps: (1 conversion of the real-valued ECG record into a symbolic time-series, using a quantization process; (2 conditional compression of the symbolic representation of the ECG, using the symbolic ECG records stored in the database as reference; (3 identification of the ECG record class, using a 1-NN (nearest neighbor classifier. We obtained over 98% of accuracy in biometric identification, whereas in emotion recognition we attained over 90%. Therefore, the method adequately identify the person, and his/her emotion. Also, the proposed method is flexible and may be adapted to different problems, by the alteration of the templates for training the model.

Biometric and Emotion Identification: An ECG Compression Based Method

Science.gov (United States)

Brás, Susana; Ferreira, Jacqueline H. T.; Soares, Sandra C.; Pinho, Armando J.

2018-01-01

We present an innovative and robust solution to both biometric and emotion identification using the electrocardiogram (ECG). The ECG represents the electrical signal that comes from the contraction of the heart muscles, indirectly representing the flow of blood inside the heart, it is known to convey a key that allows biometric identification. Moreover, due to its relationship with the nervous system, it also varies as a function of the emotional state. The use of information-theoretic data models, associated with data compression algorithms, allowed to effectively compare ECG records and infer the person identity, as well as emotional state at the time of data collection. The proposed method does not require ECG wave delineation or alignment, which reduces preprocessing error. The method is divided into three steps: (1) conversion of the real-valued ECG record into a symbolic time-series, using a quantization process; (2) conditional compression of the symbolic representation of the ECG, using the symbolic ECG records stored in the database as reference; (3) identification of the ECG record class, using a 1-NN (nearest neighbor) classifier. We obtained over 98% of accuracy in biometric identification, whereas in emotion recognition we attained over 90%. Therefore, the method adequately identify the person, and his/her emotion. Also, the proposed method is flexible and may be adapted to different problems, by the alteration of the templates for training the model. PMID:29670564

The Development of a Portable ECG Monitor Based on DSP

Science.gov (United States)

Nan, CHI Jian; Tao, YAN Yan; Meng Chen, LIU; Li, YANG

With the advent of global information, researches of Smart Home system are in the ascendant, the ECG real-time detection, and wireless transmission of ECG become more useful. In order to achieve the purpose we developed a portable ECG monitor which achieves the purpose of cardiac disease remote monitoring, and will be used in the physical and psychological disease surveillance in smart home system, we developed this portable ECG Monitor, based on the analysis of existing ECG Monitor, using TMS320F2812 as the core controller, which complete the signal collection, storage, processing, waveform display and transmission.

Triagem pré-participação com ECG em recrutas militares

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Alon Grossman

2013-03-01

investigações adicionais baseado nos achados do ECG de 12 derivações deve ser criterioso.

An ECG simulator for generating maternal-foetal activity mixtures on abdominal ECG recordings

International Nuclear Information System (INIS)

Behar, Joachim; Andreotti, Fernando; Li, Qiao; Oster, Julien; Clifford, Gari D; Zaunseder, Sebastian

2014-01-01

Accurate foetal electrocardiogram (FECG) morphology extraction from non-invasive sensors remains an open problem. This is partly due to the paucity of available public databases. Even when gold standard information (i.e derived from the scalp electrode) is present, the collection of FECG can be problematic, particularly during stressful or clinically important events. In order to address this problem we have introduced an FECG simulator based on earlier work on foetal and adult ECG modelling. The open source foetal ECG synthetic simulator, fecgsyn, is able to generate maternal-foetal ECG mixtures with realistic amplitudes, morphology, beat-to-beat variability, heart rate changes and noise. Positional (rotation and translation-related) movements in the foetal and maternal heart due to respiration, foetal activity and uterine contractions were also added to the simulator. The simulator was used to generate some of the signals that were part of the 2013 PhysioNet Computing in Cardiology Challenge dataset and has been posted on Physionet.org (together with scripts to generate realistic scenarios) under an open source license. The toolbox enables further research in the field and provides part of a standard for industry and regulatory testing of rare pathological scenarios. (paper)

Usefulness of exercise ECG test with nitroglycerin and exercise cardiac scintigraphy in patients with false positive exercise ECG test

International Nuclear Information System (INIS)

Moritani, Kohshiro

1984-01-01

The purpose of this study is to evaluate the clinical usefulness of exercise (Ex) ECG test with sublingual nitroglycerin (NTG) and Ex cardiac scintigraphy in differentiating false positive responses from true positive responses of Ex ECG test. We examined 7 pts (age : 46+-7 years) with true positive Ex ECG test (TP) and 8 pts (age : 55+-10 years) with false positive Ex ECG test (FP). TP had significant coronary artery disease and FP did not. Ex test was done by multistage ergometer test. In 5 pts of TP and all pts of FP, Ex cardiac scintigraphy was performed. In TP, Ex cardiac scintigraphy revealed reversible perfusion deficit, but not in FP. NTG was administered 3 minutes before Ex test was started. Ex test with NTG was terminated at the same load as Ex test without NTG. Pressure-rate products at the end point of Ex test did not show significant difference between Ex test without NTG and that with NTG (TP: 203x10 2 , 213x10 2 , FP: 196x10 2 , 206x10 2 , respectively). In 7 pts of FP, ST depression in Ex test without NTG was not improved in Ex test with NTG. On the other hand, in all pts of TP, ST depression seen in Ex test without NTG, was not observed in Ex test with NTG. It may be concluded that Ex cardiac scintigraphy is diagnostic for differentiation of false positive responses from true positive responses of Ex ECG test, as well as Ex ECG test with NTG is. (author)

Enhancement of Twins Fetal ECG Signal Extraction Based on Hybrid Blind Extraction Techniques

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Ahmed Kareem Abdullah

2017-07-01

Full Text Available ECG machines are noninvasive system used to measure the heartbeat signal. It’s very important to monitor the fetus ECG signals during pregnancy to check the heat activity and to detect any problem early before born, therefore the monitoring of ECG signals have clinical significance and importance. For multi-fetal pregnancy case the classical filtering algorithms are not sufficient to separate the ECG signals between mother and fetal. In this paper the mixture consists of mixing from three ECG signals, the first signal is the mother ECG (M-ECG signal, second signal the Fetal-1 ECG (F1-ECG, and third signal is the Fetal-2 ECG (F2-ECG, these signals are extracted based on modified blind source extraction (BSE techniques. The proposed work based on hybridization between two BSE techniques to ensure that the extracted signals separated well. The results demonstrate that the proposed work very efficiently to extract the useful ECG signals

On the Design of an Efficient Cardiac Health Monitoring System Through Combined Analysis of ECG and SCG Signals.

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Sahoo, Prasan Kumar; Thakkar, Hiren Kumar; Lin, Wen-Yen; Chang, Po-Cheng; Lee, Ming-Yih

2018-01-28

Cardiovascular disease (CVD) is a major public concern and socioeconomic problem across the globe. The popular high-end cardiac health monitoring systems such as magnetic resonance imaging (MRI), computerized tomography scan (CT scan), and echocardiography (Echo) are highly expensive and do not support long-term continuous monitoring of patients without disrupting their activities of daily living (ADL). In this paper, the continuous and non-invasive cardiac health monitoring using unobtrusive sensors is explored aiming to provide a feasible and low-cost alternative to foresee possible cardiac anomalies in an early stage. It is learned that cardiac health monitoring based on sole usage of electrocardiogram (ECG) signals may not provide powerful insights as ECG provides shallow information on various cardiac activities in the form of electrical impulses only. Hence, a novel low-cost, non-invasive seismocardiogram (SCG) signal along with ECG signals are jointly investigated for the robust cardiac health monitoring. For this purpose, the in-laboratory data collection model is designed for simultaneous acquisition of ECG and SCG signals followed by mechanisms for the automatic delineation of relevant feature points in acquired ECG and SCG signals. In addition, separate feature points based novel approach is adopted to distinguish between normal and abnormal morphology in each ECG and SCG cardiac cycle. Finally, a combined analysis of ECG and SCG is carried out by designing a Naïve Bayes conditional probability model. Experiments on Institutional Review Board (IRB) approved licensed ECG/SCG signals acquired from real subjects containing 12,000 cardiac cycles show that the proposed feature point delineation mechanisms and abnormal morphology detection methods consistently perform well and give promising results. In addition, experimental results show that the combined analysis of ECG and SCG signals provide more reliable cardiac health monitoring compared to the

On the Design of an Efficient Cardiac Health Monitoring System Through Combined Analysis of ECG and SCG Signals

Directory of Open Access Journals (Sweden)

Prasan Kumar Sahoo

2018-01-01

Full Text Available Cardiovascular disease (CVD is a major public concern and socioeconomic problem across the globe. The popular high-end cardiac health monitoring systems such as magnetic resonance imaging (MRI, computerized tomography scan (CT scan, and echocardiography (Echo are highly expensive and do not support long-term continuous monitoring of patients without disrupting their activities of daily living (ADL. In this paper, the continuous and non-invasive cardiac health monitoring using unobtrusive sensors is explored aiming to provide a feasible and low-cost alternative to foresee possible cardiac anomalies in an early stage. It is learned that cardiac health monitoring based on sole usage of electrocardiogram (ECG signals may not provide powerful insights as ECG provides shallow information on various cardiac activities in the form of electrical impulses only. Hence, a novel low-cost, non-invasive seismocardiogram (SCG signal along with ECG signals are jointly investigated for the robust cardiac health monitoring. For this purpose, the in-laboratory data collection model is designed for simultaneous acquisition of ECG and SCG signals followed by mechanisms for the automatic delineation of relevant feature points in acquired ECG and SCG signals. In addition, separate feature points based novel approach is adopted to distinguish between normal and abnormal morphology in each ECG and SCG cardiac cycle. Finally, a combined analysis of ECG and SCG is carried out by designing a Naïve Bayes conditional probability model. Experiments on Institutional Review Board (IRB approved licensed ECG/SCG signals acquired from real subjects containing 12,000 cardiac cycles show that the proposed feature point delineation mechanisms and abnormal morphology detection methods consistently perform well and give promising results. In addition, experimental results show that the combined analysis of ECG and SCG signals provide more reliable cardiac health monitoring compared to

Evaluation of Digital Compressed Sensing for Real-Time Wireless ECG System with Bluetooth low Energy.

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Wang, Yishan; Doleschel, Sammy; Wunderlich, Ralf; Heinen, Stefan

2016-07-01

In this paper, a wearable and wireless ECG system is firstly designed with Bluetooth Low Energy (BLE). It can detect 3-lead ECG signals and is completely wireless. Secondly the digital Compressed Sensing (CS) is implemented to increase the energy efficiency of wireless ECG sensor. Different sparsifying basis, various compression ratio (CR) and several reconstruction algorithms are simulated and discussed. Finally the reconstruction is done by the android application (App) on smartphone to display the signal in real time. The power efficiency is measured and compared with the system without CS. The optimum satisfying basis built by 3-level decomposed db4 wavelet coefficients, 1-bit Bernoulli random matrix and the most suitable reconstruction algorithm are selected by the simulations and applied on the sensor node and App. The signal is successfully reconstructed and displayed on the App of smartphone. Battery life of sensor node is extended from 55 h to 67 h. The presented wireless ECG system with CS can significantly extend the battery life by 22 %. With the compact characteristic and long term working time, the system provides a feasible solution for the long term homecare utilization.

Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents.

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Pourmand, Ali; Tanski, Mary; Davis, Steven; Shokoohi, Hamid; Lucas, Raymond; Zaver, Fareen

2015-01-01

Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI). We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation. 148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001). An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.

Bivariate empirical mode decomposition for ECG-based biometric identification with emotional data.

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Ferdinando, Hany; Seppanen, Tapio; Alasaarela, Esko

2017-07-01

Emotions modulate ECG signals such that they might affect ECG-based biometric identification in real life application. It motivated in finding good feature extraction methods where the emotional state of the subjects has minimum impacts. This paper evaluates feature extraction based on bivariate empirical mode decomposition (BEMD) for biometric identification when emotion is considered. Using the ECG signal from the Mahnob-HCI database for affect recognition, the features were statistical distributions of dominant frequency after applying BEMD analysis to ECG signals. The achieved accuracy was 99.5% with high consistency using kNN classifier in 10-fold cross validation to identify 26 subjects when the emotional states of the subjects were ignored. When the emotional states of the subject were considered, the proposed method also delivered high accuracy, around 99.4%. We concluded that the proposed method offers emotion-independent features for ECG-based biometric identification. The proposed method needs more evaluation related to testing with other classifier and variation in ECG signals, e.g. normal ECG vs. ECG with arrhythmias, ECG from various ages, and ECG from other affective databases.

Predictable and reliable ECG monitoring over IEEE 802.11 WLANs within a hospital.

Science.gov (United States)

Park, Juyoung; Kang, Kyungtae

2014-09-01

Telecardiology provides mobility for patients who require constant electrocardiogram (ECG) monitoring. However, its safety is dependent on the predictability and robustness of data delivery, which must overcome errors in the wireless channel through which the ECG data are transmitted. We report here a framework that can be used to gauge the applicability of IEEE 802.11 wireless local area network (WLAN) technology to ECG monitoring systems in terms of delay constraints and transmission reliability. For this purpose, a medical-grade WLAN architecture achieved predictable delay through the combination of a medium access control mechanism based on the point coordination function provided by IEEE 802.11 and an error control scheme based on Reed-Solomon coding and block interleaving. The size of the jitter buffer needed was determined by this architecture to avoid service dropout caused by buffer underrun, through analysis of variations in transmission delay. Finally, we assessed this architecture in terms of service latency and reliability by modeling the transmission of uncompressed two-lead electrocardiogram data from the MIT-BIH Arrhythmia Database and highlight the applicability of this wireless technology to telecardiology.

A method of ECG template extraction for biometrics applications.

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Zhou, Xiang; Lu, Yang; Chen, Meng; Bao, Shu-Di; Miao, Fen

2014-01-01

ECG has attracted widespread attention as one of the most important non-invasive physiological signals in healthcare-system related biometrics for its characteristics like ease-of-monitoring, individual uniqueness as well as important clinical value. This study proposes a method of dynamic threshold setting to extract the most stable ECG waveform as the template for the consequent ECG identification process. With the proposed method, the accuracy of ECG biometrics using the dynamic time wraping for difference measures has been significantly improved. Analysis results with the self-built electrocardiogram database show that the deployment of the proposed method was able to reduce the half total error rate of the ECG biometric system from 3.35% to 1.45%. Its average running time on the platform of android mobile terminal was around 0.06 seconds, and thus demonstrates acceptable real-time performance.

Noninvasive Recording of True-to-Form Fetal ECG during the Third Trimester of Pregnancy

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Istvan Peterfi

2014-01-01

Full Text Available Objective. The aim of the study was to develop a complex electrophysiological measurement system (hardware and software which uses the methods of electrophysiology and provides significant information about the intrauterine status of the fetus, intending to obtain true-to-form, morphologically evaluated fetal ECG from transabdominal maternal lead. Results. The present method contains many novel ideas that allow creating true-to-form noninvasive fetal ECG in the third trimester of the pregnancy in 80% of the cases. Such ideas are the telemetric data collection, the “cleanse” of the real time recording from the maternal ECG, and the use of the cardiotocograph (CTG that allows identifying the fetal heart events. The advantage of this developed system is that it does not require any qualified staff, because both the extraction of the information from the abdominal recording and the processing of the data are automatic. Discussion. Although the idea of a noninvasive fetal electrocardiography is more than 100 years old still there is no simple, effective, and cheap method available that would enable an extensive use. This developed system can be used in the third trimester of the pregnancy efficiently. It can produce true-to-form fetal ECGs with amplitude less than 10 µV.

Wireless ECG and PCG Portable Telemedicine Kit for Rural Areas of Colombia

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Miguel Jimeno

2014-07-01

Full Text Available Telemedicine is always a popular topic thanks to the constants advancements of technology. The focus on development of new devices has been mainly on decreasing size to increase portability. Our research focused on improving functionality but not giving up on portability and cost. In this paper we are presenting the first prototype device that measures 4-leads electrocardiogram (ECG and phonocardiogram (PCG signals with low cost, high portability and wireless connectivity features in mind. We designed and developed a prototype that measures ECG using a standard ECG cable; we designed and developed a digital stethoscope prototype and also the necessary hardware for both medical signals to be transmitted through Bluetooth to a computer. We present here the hardware design, a new communication protocol for transmission of both signals from the device to the computer, and the software system to enable remote consultations. We designed the prototype with the main purpose of using low cost parts without sacrificing functionality, with the purpose of using it in remote zones of the Caribbean coast of Colombia. We show open issues and prepare a field implementation of the kit in the target zone.

FastICA peel-off for ECG interference removal from surface EMG.

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Chen, Maoqi; Zhang, Xu; Chen, Xiang; Zhu, Mingxing; Li, Guanglin; Zhou, Ping

2016-06-13

Multi-channel recording of surface electromyographyic (EMG) signals is very likely to be contaminated by electrocardiographic (ECG) interference, specifically when the surface electrode is placed on muscles close to the heart. A novel fast independent component analysis (FastICA) based peel-off method is presented to remove ECG interference contaminating multi-channel surface EMG signals. Although demonstrating spatial variability in waveform shape, the ECG interference in different channels shares the same firing instants. Utilizing the firing information estimated from FastICA, ECG interference can be separated from surface EMG by a "peel off" processing. The performance of the method was quantified with synthetic signals by combining a series of experimentally recorded "clean" surface EMG and "pure" ECG interference. It was demonstrated that the new method can remove ECG interference efficiently with little distortion to surface EMG amplitude and frequency. The proposed method was also validated using experimental surface EMG signals contaminated by ECG interference. The proposed FastICA peel-off method can be used as a new and practical solution to eliminating ECG interference from multichannel EMG recordings.

[Study for portable dynamic ECG monitor and recorder].

Science.gov (United States)

Yang, Pengcheng; Li, Yongqin; Chen, Bihua

2012-09-01

This Paper presents a portable dynamic ECG monitor system based on MSP430F149 microcontroller. The electrocardiogram detecting system consists of ECG detecting circuit, man-machine interaction module, MSP430F149 and upper computer software. The ECG detecting circuit including a preamplifier, second-order Butterworth low-pass filter, high-pass filter, and 50Hz trap circuit to detects electrocardiogram and depresses various kinds of interference effectively. A microcontroller is used to collect three channel analog signals which can be displayed on TFT LCD. A SD card is used to record real-time data continuously and implement the FTA16 file system. In the end, a host computer system interface is also designed to analyze the ECG signal and the analysis results can provide diagnosis references to clinical doctors.

Extraction of ECG signal with adaptive filter for hearth abnormalities detection

Science.gov (United States)

Turnip, Mardi; Saragih, Rijois. I. E.; Dharma, Abdi; Esti Kusumandari, Dwi; Turnip, Arjon; Sitanggang, Delima; Aisyah, Siti

2018-04-01

This paper demonstrates an adaptive filter method for extraction ofelectrocardiogram (ECG) feature in hearth abnormalities detection. In particular, electrocardiogram (ECG) is a recording of the heart's electrical activity by capturing a tracingof cardiac electrical impulse as it moves from the atrium to the ventricles. The applied algorithm is to evaluate and analyze ECG signals for abnormalities detection based on P, Q, R and S peaks. In the first phase, the real-time ECG data is acquired and pre-processed. In the second phase, the procured ECG signal is subjected to feature extraction process. The extracted features detect abnormal peaks present in the waveform. Thus the normal and abnormal ECG signal could be differentiated based on the features extracted.

Near Field Communication-based telemonitoring with integrated ECG recordings.

Science.gov (United States)

Morak, J; Kumpusch, H; Hayn, D; Leitner, M; Scherr, D; Fruhwald, F M; Schreier, G

2011-01-01

Telemonitoring of vital signs is an established option in treatment of patients with chronic heart failure (CHF). In order to allow for early detection of atrial fibrillation (AF) which is highly prevalent in the CHF population telemonitoring programs should include electrocardiogram (ECG) signals. It was therefore the aim to extend our current home monitoring system based on mobile phones and Near Field Communication technology (NFC) to enable patients acquiring their ECG signals autonomously in an easy-to-use way. We prototypically developed a sensing device for the concurrent acquisition of blood pressure and ECG signals. The design of the device equipped with NFC technology and Bluetooth allowed for intuitive interaction with a mobile phone based patient terminal. This ECG monitoring system was evaluated in the course of a clinical pilot trial to assess the system's technical feasibility, usability and patient's adherence to twice daily usage. 21 patients (4f, 54 ± 14 years) suffering from CHF were included in the study and were asked to transmit two ECG recordings per day via the telemonitoring system autonomously over a monitoring period of seven days. One patient dropped out from the study. 211 data sets were transmitted over a cumulative monitoring period of 140 days (overall adherence rate 82.2%). 55% and 8% of the transmitted ECG signals were sufficient for ventricular and atrial rhythm assessment, respectively. Although ECG signal quality has to be improved for better AF detection the developed communication design of joining Bluetooth and NFC technology in our telemonitoring system allows for ambulatory ECG acquisition with high adherence rates and system usability in heart failure patients.

[Implementation of ECG Monitoring System Based on Internet of Things].

Science.gov (United States)

Lu, Liangliang; Chen, Minya

2015-11-01

In order to expand the capabilities of hospital's traditional ECG device and enhance medical staff's work efficiency, an ECG monitoring system based on internet of things is introduced. The system can monitor ECG signals in real time and analyze data using ECG sensor, PDA, Web servers, which embeds C language, Android systems, .NET, wireless network and other technologies. After experiments, it can be showed that the system has high reliability and stability and can bring the convenience to medical staffs.

ECG fiducial point extraction using switching Kalman filter.

Science.gov (United States)

Akhbari, Mahsa; Ghahjaverestan, Nasim Montazeri; Shamsollahi, Mohammad B; Jutten, Christian

2018-04-01

In this paper, we propose a novel method for extracting fiducial points (FPs) of the beats in electrocardiogram (ECG) signals using switching Kalman filter (SKF). In this method, according to McSharry's model, ECG waveforms (P-wave, QRS complex and T-wave) are modeled with Gaussian functions and ECG baselines are modeled with first order auto regressive models. In the proposed method, a discrete state variable called "switch" is considered that affects only the observation equations. We denote a mode as a specific observation equation and switch changes between 7 modes and corresponds to different segments of an ECG beat. At each time instant, the probability of each mode is calculated and compared among two consecutive modes and a path is estimated, which shows the relation of each part of the ECG signal to the mode with the maximum probability. ECG FPs are found from the estimated path. For performance evaluation, the Physionet QT database is used and the proposed method is compared with methods based on wavelet transform, partially collapsed Gibbs sampler (PCGS) and extended Kalman filter. For our proposed method, the mean error and the root mean square error across all FPs are 2 ms (i.e. less than one sample) and 14 ms, respectively. These errors are significantly smaller than those obtained using other methods. The proposed method achieves lesser RMSE and smaller variability with respect to others. Copyright © 2018 Elsevier B.V. All rights reserved.

Data fusion for QRS complex detection in multi-lead electrocardiogram recordings

Science.gov (United States)

Ledezma, Carlos A.; Perpiñan, Gilberto; Severeyn, Erika; Altuve, Miguel

2015-12-01

Heart diseases are the main cause of death worldwide. The first step in the diagnose of these diseases is the analysis of the electrocardiographic (ECG) signal. In turn, the ECG analysis begins with the detection of the QRS complex, which is the one with the most energy in the cardiac cycle. Numerous methods have been proposed in the bibliography for QRS complex detection, but few authors have analyzed the possibility of taking advantage of the information redundancy present in multiple ECG leads (simultaneously acquired) to produce accurate QRS detection. In our previous work we presented such an approach, proposing various data fusion techniques to combine the detections made by an algorithm on multiple ECG leads. In this paper we present further studies that show the advantages of this multi-lead detection approach, analyzing how many leads are necessary in order to observe an improvement in the detection performance. A well known QRS detection algorithm was used to test the fusion techniques on the St. Petersburg Institute of Cardiological Technics database. Results show improvement in the detection performance with as little as three leads, but the reliability of these results becomes interesting only after using seven or more leads. Results were evaluated using the detection error rate (DER). The multi-lead detection approach allows an improvement from DER = 3:04% to DER = 1:88%. Further works are to be made in order to improve the detection performance by implementing further fusion steps.

Designing ECG-based physical unclonable function for security of wearable devices.

Science.gov (United States)

Shihui Yin; Chisung Bae; Sang Joon Kim; Jae-Sun Seo

2017-07-01

As a plethora of wearable devices are being introduced, significant concerns exist on the privacy and security of personal data stored on these devices. Expanding on recent works of using electrocardiogram (ECG) as a modality for biometric authentication, in this work, we investigate the possibility of using personal ECG signals as the individually unique source for physical unclonable function (PUF), which eventually can be used as the key for encryption and decryption engines. We present new signal processing and machine learning algorithms that learn and extract maximally different ECG features for different individuals and minimally different ECG features for the same individual over time. Experimental results with a large 741-subject in-house ECG database show that the distributions of the intra-subject (same person) Hamming distance of extracted ECG features and the inter-subject Hamming distance have minimal overlap. 256-b random numbers generated from the ECG features of 648 (out of 741) subjects pass the NIST randomness tests.

ECG changes after a session of regional intraarterial hyperglycemia

International Nuclear Information System (INIS)

Korobchenko, Z.A.; Livshits, L.I.

1988-01-01

ECG changes after a session of regional intraarterial hyperglycemia (RIH) in 13 patients (the mean age of 49 years) with locally advanced cancer of the tongue, oral mucosa and oropharynx were presented. Taking into account the mean age of patients and the negative ECG time course after a RIH session, the necessity of patients' examination (including ECG after a RIH session and, when indicated, a consultation by a cardiologist) was emphasized

Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Bastarrika, Gorka [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Cardiac Imaging Unit, Clinica Univ. de Navarra, Pamplona (Spain)], e-mail: bastarrika@unav.es

2012-06-15

Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 {+-} 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 {+-} 58.3 mL) with respect to ECG-gated CT (142.7 {+-} 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 {+-} 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.

Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

International Nuclear Information System (INIS)

Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria; Bastarrika, Gorka

2012-01-01

Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 ± 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 ± 58.3 mL) with respect to ECG-gated CT (142.7 ± 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 ± 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols

Artifact reduction in maternal abdominal ECG recordings for fetal ECG estimation.

NARCIS (Netherlands)

Vullings, R.; Peters, C.H.L.; Mischi, M.; Sluijter, R.J.; Oei, S.G.; Bergmans, J.W.M.

2010-01-01

Monitoring the fetal electrocardiogram (1ECG) is currently one of the most promising methods to assess fetal health. However, the main problem associated with this method is that the signals recorded from the maternal abdomen are affected by noise and interferences: the maternal electrocardiogram

The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document.

Science.gov (United States)

Birnbaum, Yochai; Nikus, Kjell; Kligfield, Paul; Fiol, Miguel; Barrabés, Jose Antonio; Sionis, Alessandro; Pahlm, Olle; Niebla, J Garcia; de Luna, Antonio Bayès

2014-09-01

The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients. © 2014 Wiley Periodicals, Inc.

The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study.

Science.gov (United States)

Rossetti, Francesca; Pittiruti, Mauro; Lamperti, Massimo; Graziano, Ugo; Celentano, Davide; Capozzoli, Giuseppe

2015-01-01

The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients. We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices (VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina. There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%. We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.

Low-power analog integrated circuits for wireless ECG acquisition systems.

Science.gov (United States)

Tsai, Tsung-Heng; Hong, Jia-Hua; Wang, Liang-Hung; Lee, Shuenn-Yuh

2012-09-01

This paper presents low-power analog ICs for wireless ECG acquisition systems. Considering the power-efficient communication in the body sensor network, the required low-power analog ICs are developed for a healthcare system through miniaturization and system integration. To acquire the ECG signal, a low-power analog front-end system, including an ECG signal acquisition board, an on-chip low-pass filter, and an on-chip successive-approximation analog-to-digital converter for portable ECG detection devices is presented. A quadrature CMOS voltage-controlled oscillator and a 2.4 GHz direct-conversion transmitter with a power amplifier and upconversion mixer are also developed to transmit the ECG signal through wireless communication. In the receiver, a 2.4 GHz fully integrated CMOS RF front end with a low-noise amplifier, differential power splitter, and quadrature mixer based on current-reused folded architecture is proposed. The circuits have been implemented to meet the specifications of the IEEE 802.15.4 2.4 GHz standard. The low-power ICs of the wireless ECG acquisition systems have been fabricated using a 0.18 μm Taiwan Semiconductor Manufacturing Company (TSMC) CMOS standard process. The measured results on the human body reveal that ECG signals can be acquired effectively by the proposed low-power analog front-end ICs.

Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy

International Nuclear Information System (INIS)

Sun Zhonghua; Ng, Kwan-Hoong

2012-01-01

Purpose: To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and methods: A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies. Results: 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p < 0.001). The mean dose length product was 225 mGy cm (95% CI: 188, 262 mGy cm) and 822 mGy cm (95% CI: 630, 1013 mGy cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p < 0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p = 0.047). Conclusion: Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value.

Diagnostic Role of ECG Recording Simultaneously With EEG Testing.

Science.gov (United States)

Kendirli, Mustafa Tansel; Aparci, Mustafa; Kendirli, Nurten; Tekeli, Hakan; Karaoglan, Mustafa; Senol, Mehmet Guney; Togrol, Erdem

2015-07-01

Arrhythmia is not uncommon in the etiology of syncope which mimics epilepsy. Data about the epilepsy induced vagal tonus abnormalities have being increasingly reported. So we aimed to evaluate what a neurologist may gain by a simultaneous electrocardiogram (ECG) and electroencephalogram (EEG) recording in the patients who underwent EEG testing due to prediagnosis of epilepsy. We retrospectively evaluated and detected ECG abnormalities in 68 (18%) of 376 patients who underwent EEG testing. A minimum of 20 of minutes artifact-free recording were required for each patient. Standard 1-channel ECG was simultaneously recorded in conjunction with the EEG. In all, 28% of females and 14% of males had ECG abnormalities. Females (mean age 49 years, range 18-88 years) were older compared with the male group (mean age 28 years, range 16-83 years). Atrial fibrillation was more frequent in female group whereas bradycardia and respiratory sinus arrhythmia was higher in male group. One case had been detected a critical asystole indicating sick sinus syndrome in the female group and treated with a pacemaker implantation in the following period. Simultaneous ECG recording in conjunction with EEG testing is a clinical prerequisite to detect and to clarify the coexisting ECG and EEG abnormalities and their clinical relevance. Potentially rare lethal causes of syncope that mimic seizure or those that could cause resistance to antiepileptic therapy could effectively be distinguished by detecting ECG abnormalities coinciding with the signs and abnormalities during EEG recording. © EEG and Clinical Neuroscience Society (ECNS) 2014.

Hybrid ECG-gated versus non-gated 512-slice CT angiography of the aorta and coronary artery: image quality and effect of a motion correction algorithm.

Science.gov (United States)

Lee, Ji Won; Kim, Chang Won; Lee, Geewon; Lee, Han Cheol; Kim, Sang-Pil; Choi, Bum Sung; Jeong, Yeon Joo

2018-02-01

Background Using the hybrid electrocardiogram (ECG)-gated computed tomography (CT) technique, assessment of entire aorta, coronary arteries, and aortic valve can be possible using single-bolus contrast administration within a single acquisition. Purpose To compare the image quality of hybrid ECG-gated and non-gated CT angiography of the aorta and evaluate the effect of a motion correction algorithm (MCA) on coronary artery image quality in a hybrid ECG-gated aorta CT group. Material and Methods In total, 104 patients (76 men; mean age = 65.8 years) prospectively randomized into two groups (Group 1 = hybrid ECG-gated CT; Group 2 = non-gated CT) underwent wide-detector array aorta CT. Image quality, assessed using a four-point scale, was compared between the groups. Coronary artery image quality was compared between the conventional reconstruction and motion correction reconstruction subgroups in Group 1. Results Group 1 showed significant advantages over Group 2 in aortic wall, cardiac chamber, aortic valve, coronary ostia, and main coronary arteries image quality (all P ECG-gated CT significantly improved the heart and aortic wall image quality and the MCA can further improve the image quality and interpretability of coronary arteries.

Assessment of the stability of morphological ECG features and their potential for person verification/identification

Directory of Open Access Journals (Sweden)

Matveev Mikhail

2017-01-01

Full Text Available This study investigates the potential of a set of ECG morphological features for person verification/identification. The measurements are done over 145 pairs of ECG recordings from healthy subjects, acquired 5 years apart (T1, T2 = T1+5 years. Time, amplitude, area and slope descriptors of the QRS-T pattern are analysed in 4 ECG leads, forming quasi-orthogonal lead system (II&III, V1, V5. The correspondence between feature values in T1 and T2 is verified via factor analysis by principal components extraction method; correlation analysis applied over the measurements in T1 and T2; synthesis of regression equations for prediction of features’ values in T2 based on T1 measurements; and cluster analysis for assessment of the correspondence between measured and predicted feature values. Thus, 11 amplitude descriptors of the QRS complex are highlighted as stable, i.e. keeping their strong correlation (≥0.7 within a certain factor, weak correlation (<0.3 with the features from the remaining factors and presenting high correlation in the two measurement periods that is a sign for their person verification/identification potential. The observed coincidence between feature values measured in T2 and predicted via the designed regression models (r=0.93 suggests about the confidence of person identification via the proposed morphological features.

Global Ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction

DEFF Research Database (Denmark)

Stengaard, Carsten; Sørensen, Jacob Thorsted; Andersen, M.P.

2011-01-01

.J. Terkelsen2, 1Aarhus University Hospital, Aarhus, Department of medicine and Cardiology A - Aarhus - Denmark, 2Aarhus University Hospital, Skejby, Department of Cardiology - Aarhus - Denmark, 3Aalborg University, Department of Health Science and Technology - Aalborg - Denmark, 4Tampere University Hospital...... ischemia ECG pattern (GIP) has been proposed for diagnosis of acute left main stem (LM) occlusion. The GIP is defined by ST-elevation of 1mm in lead aVR and ST-depression of 0.5mm in seven or more ECG leads. Previous studies focus on the sensitivity of GIP in patients with confirmed LM occlusion. We...

Assessment of hypertrophic cardiomyopathy by ECG gated cardiac computed tomography

International Nuclear Information System (INIS)

Takeuchi, Kazuhide; Tanaka, Chujiro; Oku, Hisao

1981-01-01

The applicability of ECG gated cardiac computed tomography (CT) in 12 patients with hypertrophic cardiomyopathy was examined. Six of the 12 patients had hypertrophic obstructive cardiomyopathy, including one patient with mid-ventricular obstruction. Three of the 12 patients had hypertrophic non-obstructive cardiomyopathy, and three had apical hypertrophic cardiomyopathy. The diagnosis of hypertrophic cardiomyopathy was confirmed by the angiocardiogram in all patients. Cardiac CT was performed after intravenous administration of contrast media usually given as a bolus injection. The gantry was set with positive 20 0 tilt angle. In all patients with hypertrophic obstructive cardiomyopathy except for mid-ventricular obstruction, the hypertrophied interventricular septum in the basal and mid portions was observed, and the left ventricular cavity was narrowed in systole. In a patient with mid-ventricular obstruction, the marked hypertrophied interventricular septum and antero-lateral papillary muscle were observed. In diastole, the left ventricular cavity was narrow and divided into two parts. The apical cavity was completely disappeared in systole. In all patients with hypertrophic non-obstructive cardiomyopathy, the diffuse hypertrophied interventricular septum was observed in diastole. In systole, the apical portion of the left ventricular cavity was markedly narrow and antero-lateral papillary muscle was hypertrophic. In all patients with apical hypertrophic cardiomyopathy, the marked apical hypertrophy of the left ventricular wall was observed in diastole. It is concluded that ECG gated cardiac CT could estimate myocardial wall motion and thickness and differentiate the types of hypertrophic cardiomyopathy each other. (author)

Advanced Electrocardiography Can Identify Occult Cardiomyopathy in Doberman Pinschers

Science.gov (United States)

Spiljak, M.; Petric, A. Domanjko; Wilberg, M.; Olsen, L. H.; Stepancic, A.; Schlegel, T. T.; Starc, V.

2011-01-01

Recently, multiple advanced resting electrocardiographic (A-ECG) techniques have improved the diagnostic value of short-duration ECG in detection of dilated cardiomyopathy (DCM) in humans. This study investigated whether 12-lead A-ECG recordings could accurately identify the occult phase of DCM in dogs. Short-duration (3-5 min) high-fidelity 12-lead ECG recordings were obtained from 31 privately-owned, clinically healthy Doberman Pinschers (5.4 +/- 1.7 years, 11/20 males/females). Dogs were divided into 2 groups: 1) 19 healthy dogs with normal echocardiographic M-mode measurements: left ventricular internal diameter in diastole (LVIDd . 47mm) and in systole (LVIDs . 38mm) and normal 24-hour ECG recordings (100 VPCs/24h; 1/12 dogs had only abnormal 24-hour ECG recordings (>100 VPCs/24h). ECG recordings were evaluated via custom software programs to calculate multiple parameters of high-frequency (HF) QRS ECG, heart rate variability, QT variability, waveform complexity and 3-D ECG. Student's t-tests determined 19 ECG parameters that were significantly different (P canine DCM as five selected ECG parameters can with reasonable accuracy identify occult DCM in Doberman Pinschers. Future extensive clinical studies need to clarify if 12-lead A-ECG could be useful as an additional screening test for canine DCM.

Dose reduction in multi-slice CT of the heart by use of ECG-controlled tube current modulation (''ECG pulsing''): phantom measurements

International Nuclear Information System (INIS)

Poll, L.W.; Cohnen, M.; Brachten, S.; Moedder, U.; Ewen, K.

2002-01-01

To evaluate the effect of ECG-controlled tube current modulation on radiation exposure in retrospectively-ECG-gated multislice CT (MSCT) of the heart. Material and methods: Three different cardiac MSCT protocols with different slice collimation (4 x 1, and 4 x 2.5 mm), and a pitch-factor of 1.5 and 1.8 were investigated at a multi-slice CT scanner Somatom Volume Zoom, Siemens. An anthropomorphic Alderson-Rando phantom was equipped with LiF-Thermoluminescence dosimeters at several organ sites, and effective doses were calculated using ICRP-weighting factors. Scan protocols were performed with ECG-controlled tube current modulation ('ECG pulsing') at two different heart rates (60 and 80 bpm). These data were compared to previous data from MSCT of the heart without use of 'ECG pulsing'. Results: Radiation exposure with (60 bpm) and without tube current modulation using a 2.5 mm collimation was 1.8 mSv and 2.9 mSv for females, and 1.5 mSv and 2.4 mSv for males, respectively. For protocols using a 1 mm collimation with a pitch-factor of 1.5 (1.8), radiation exposure with and without tube current modulation was 5.6 (6.3) mSv and 9.5 (11.2) mSv for females, and 4.6 (5.2) mSv and 7.7 (9.2) mSv for males, respectively. At higher heart rates (80 bpm) radiation exposure is increased from 1.5-1.8 mSv to 1.8-2.1 mSv, using the 2.5 mm collimation, and from 4.6-5.6 mSv to 5.9-7.2 mSv, for protocols using 1 mm collimation. Conclusions: The ECG-controlled tube current modulation allows a dose reduction of 37% to 44% when retrospectively ECG-gated MSCT of the heart is performed. The tube current - as a function over time - and therefore the radiation exposure is dependent on the heart rate. (orig.) [de

Multistage principal component analysis based method for abdominal ECG decomposition

International Nuclear Information System (INIS)

Petrolis, Robertas; Krisciukaitis, Algimantas; Gintautas, Vladas

2015-01-01

Reflection of fetal heart electrical activity is present in registered abdominal ECG signals. However this signal component has noticeably less energy than concurrent signals, especially maternal ECG. Therefore traditionally recommended independent component analysis, fails to separate these two ECG signals. Multistage principal component analysis (PCA) is proposed for step-by-step extraction of abdominal ECG signal components. Truncated representation and subsequent subtraction of cardio cycles of maternal ECG are the first steps. The energy of fetal ECG component then becomes comparable or even exceeds energy of other components in the remaining signal. Second stage PCA concentrates energy of the sought signal in one principal component assuring its maximal amplitude regardless to the orientation of the fetus in multilead recordings. Third stage PCA is performed on signal excerpts representing detected fetal heart beats in aim to perform their truncated representation reconstructing their shape for further analysis. The algorithm was tested with PhysioNet Challenge 2013 signals and signals recorded in the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences. Results of our method in PhysioNet Challenge 2013 on open data set were: average score: 341.503 bpm 2 and 32.81 ms. (paper)

ECG denoising and fiducial point extraction using an extended Kalman filtering framework with linear and nonlinear phase observations.

Science.gov (United States)

Akhbari, Mahsa; Shamsollahi, Mohammad B; Jutten, Christian; Armoundas, Antonis A; Sayadi, Omid

2016-02-01

In this paper we propose an efficient method for denoising and extracting fiducial point (FP) of ECG signals. The method is based on a nonlinear dynamic model which uses Gaussian functions to model ECG waveforms. For estimating the model parameters, we use an extended Kalman filter (EKF). In this framework called EKF25, all the parameters of Gaussian functions as well as the ECG waveforms (P-wave, QRS complex and T-wave) in the ECG dynamical model, are considered as state variables. In this paper, the dynamic time warping method is used to estimate the nonlinear ECG phase observation. We compare this new approach with linear phase observation models. Using linear and nonlinear EKF25 for ECG denoising and nonlinear EKF25 for fiducial point extraction and ECG interval analysis are the main contributions of this paper. Performance comparison with other EKF-based techniques shows that the proposed method results in higher output SNR with an average SNR improvement of 12 dB for an input SNR of -8 dB. To evaluate the FP extraction performance, we compare the proposed method with a method based on partially collapsed Gibbs sampler and an established EKF-based method. The mean absolute error and the root mean square error of all FPs, across all databases are 14 ms and 22 ms, respectively, for our proposed method, with an advantage when using a nonlinear phase observation. These errors are significantly smaller than errors obtained with other methods. For ECG interval analysis, with an absolute mean error and a root mean square error of about 22 ms and 29 ms, the proposed method achieves better accuracy and smaller variability with respect to other methods.

One-Dimensional Signal Extraction Of Paper-Written ECG Image And Its Archiving

Science.gov (United States)

Zhang, Zhi-ni; Zhang, Hong; Zhuang, Tian-ge

1987-10-01

A method for converting paper-written electrocardiograms to one dimensional (1-D) signals for archival storage on floppy disk is presented here. Appropriate image processing techniques were employed to remove the back-ground noise inherent to ECG recorder charts and to reconstruct the ECG waveform. The entire process consists of (1) digitization of paper-written ECGs with an image processing system via a TV camera; (2) image preprocessing, including histogram filtering and binary image generation; (3) ECG feature extraction and ECG wave tracing, and (4) transmission of the processed ECG data to IBM-PC compatible floppy disks for storage and retrieval. The algorithms employed here may also be used in the recognition of paper-written EEG or EMG and may be useful in robotic vision.

ECG-triggered MDR-CT for the detection of pulmonary metastases

International Nuclear Information System (INIS)

Pauls, S.; Wahl, J.; Aschoff, A.J.; Brambs, H.J.; Fleiter, T.R.

2003-01-01

Purpose: Comparison of multidetector-row CT (MDR-CT) of the chest with and without ECG triggering for the detection of pulmonary metastases. Materials and Methods: Fifty patients with malignant tumors underwent CT of the chest. The unenhanced phase was performed with ECG-triggered MDR-CT and the contrast-enhanced phase with helical MDR-CT. The ECG-triggered and standard helical scans were interpreted in separate sessions, with the analysis determining the number and demarcation of the intrapulmonary nodules and the delineation of the mediastinal structure (rated 1 = excellent to 5 = poor). Results: ECG-MDR-CT images detected 38% more pulmonary nodules than MDR-CT. The detection rate for tumors [de

ECG Identification System Using Neural Network with Global and Local Features

Science.gov (United States)

Tseng, Kuo-Kun; Lee, Dachao; Chen, Charles

2016-01-01

This paper proposes a human identification system via extracted electrocardiogram (ECG) signals. Two hierarchical classification structures based on global shape feature and local statistical feature is used to extract ECG signals. Global shape feature represents the outline information of ECG signals and local statistical feature extracts the…

Heart rhythm analysis using ECG recorded with a novel sternum based patch technology

DEFF Research Database (Denmark)

Saadi, Dorthe Bodholt; Fauerskov, Inge; Osmanagic, Armin

2013-01-01

, reliable long-term ECG recordings. The device is designed for high compliance and low patient burden. This novel patch technology is CE approved for ambulatory ECG recording of two ECG channels on the sternum. This paper describes a clinical pilot study regarding the usefulness of these ECG signals...... for heart rhythm analysis. A clinical technician with experience in ECG interpretation selected 200 noise-free 7 seconds ECG segments from 25 different patients. These 200 ECG segments were evaluated by two medical doctors according to their usefulness for heart rhythm analysis. The first doctor considered...... 98.5% of the segments useful for rhythm analysis, whereas the second doctor considered 99.5% of the segments useful for rhythm analysis. The conclusion of this pilot study indicates that two channel ECG recorded on the sternum is useful for rhythm analysis and could be used as input to diagnosis...

Low-cost compact ECG with graphic LCD and phonocardiogram system design.

Science.gov (United States)

Kara, Sadik; Kemaloğlu, Semra; Kirbaş, Samil

2006-06-01

Till today, many different ECG devices are made in developing countries. In this study, low cost, small size, portable LCD screen ECG device, and phonocardiograph were designed. With designed system, heart sounds that take synchronously with ECG signal are heard as sensitive. Improved system consist three units; Unit 1, ECG circuit, filter and amplifier structure. Unit 2, heart sound acquisition circuit. Unit 3, microcontroller, graphic LCD and ECG signal sending unit to computer. Our system can be used easily in different departments of the hospital, health institution and clinics, village clinic and also in houses because of its small size structure and other benefits. In this way, it is possible that to see ECG signal and hear heart sounds as synchronously and sensitively. In conclusion, heart sounds are heard on the part of both doctor and patient because sounds are given to environment with a tiny speaker. Thus, the patient knows and hears heart sounds him/herself and is acquainted by doctor about healthy condition.

Dynamic segmentation and linear prediction for maternal ECG removal in antenatal abdominal recordings

International Nuclear Information System (INIS)

Vullings, R; Sluijter, R J; Mischi, M; Bergmans, J W M; Peters, C H L; Oei, S G

2009-01-01

Monitoring the fetal heart rate (fHR) and fetal electrocardiogram (fECG) during pregnancy is important to support medical decision making. Before labor, the fHR is usually monitored using Doppler ultrasound. This method is inaccurate and therefore of limited clinical value. During labor, the fHR can be monitored more accurately using an invasive electrode; this method also enables monitoring of the fECG. Antenatally, the fECG and fHR can also be monitored using electrodes on the maternal abdomen. The signal-to-noise ratio of these recordings is, however, low, the maternal electrocardiogram (mECG) being the main interference. Existing techniques to remove the mECG from these non-invasive recordings are insufficiently accurate or do not provide all spatial information of the fECG. In this paper a new technique for mECG removal in antenatal abdominal recordings is presented. This technique operates by the linear prediction of each separate wave in the mECG. Its performance in mECG removal and fHR detection is evaluated by comparison with spatial filtering, adaptive filtering, template subtraction and independent component analysis techniques. The new technique outperforms the other techniques in both mECG removal and fHR detection (by more than 3%)

Long-Term Non-Invasive ECG-Based Risk Stratification of Sudden Cardiac Death: Extended 5-Year Results

Directory of Open Access Journals (Sweden)

Elena Okisheva

2017-01-01

Evaluation of HRT, DC and mTWA during 24-hour ECG monitoring may define the high risk of cardiovascular mortality and SCD in post-MI patients especially during the first 12 months after the baseline examination.

Limitations of Dower's inverse transform for the study of atrial loops during atrial fibrillation.

Science.gov (United States)

Guillem, María S; Climent, Andreu M; Bollmann, Andreas; Husser, Daniela; Millet, José; Castells, Francisco

2009-08-01

Spatial characteristics of atrial fibrillatory waves have been extracted by using a vectorcardiogram (VCG) during atrial fibrillation (AF). However, the VCG is usually not recorded in clinical practice and atrial loops are derived from the 12-lead electrocardiogram (ECG). We evaluated the suitability of the reconstruction of orthogonal leads from the 12-lead ECG for fibrillatory waves in AF. We used the Physikalisch-Technische Bundesanstalt diagnostic ECG database, which contains 15 simultaneously recorded signals (12-lead ECG and three Frank orthogonal leads) of 13 patients during AF. Frank leads were derived from the 12-lead ECG by using Dower's inverse transform. Derived leads were then compared to true Frank leads in terms of the relative error achieved. We calculated the orientation of AF loops of both recorded orthogonal leads and derived leads and measured the difference in estimated orientation. Also, we investigated the relationship of errors in derivation with fibrillatory wave amplitude, frequency, wave residuum, and fit to a plane of the AF loops. Errors in derivation of AF loops were 68 +/- 31% and errors in the estimation of orientation were 35.85 +/- 20.43 degrees . We did not find any correlation among these errors and amplitude, frequency, or other parameters. In conclusion, Dower's inverse transform should not be used for the derivation of orthogonal leads from the 12-lead ECG for the analysis of fibrillatory wave loops in AF. Spatial parameters obtained after this derivation may differ from those obtained from recorded orthogonal leads.

New approach to ECG's features recognition involving neural network

International Nuclear Information System (INIS)

Babloyantz, A.; Ivanov, V.V.; Zrelov, P.V.

2001-01-01

A new approach for the detection of slight changes in the form of the ECG signal is proposed. It is based on the approximation of raw ECG data inside each RR-interval by the expansion in polynomials of special type and on the classification of samples represented by sets of expansion coefficients using a layered feed-forward neural network. The transformation applied provides significantly simpler data structure, stability to noise and to other accidental factors. A by-product of the method is the compression of ECG data with factor 5

Arrhythmia Classification Based on Multi-Domain Feature Extraction for an ECG Recognition System

Directory of Open Access Journals (Sweden)

Hongqiang Li

2016-10-01

Full Text Available Automatic recognition of arrhythmias is particularly important in the diagnosis of heart diseases. This study presents an electrocardiogram (ECG recognition system based on multi-domain feature extraction to classify ECG beats. An improved wavelet threshold method for ECG signal pre-processing is applied to remove noise interference. A novel multi-domain feature extraction method is proposed; this method employs kernel-independent component analysis in nonlinear feature extraction and uses discrete wavelet transform to extract frequency domain features. The proposed system utilises a support vector machine classifier optimized with a genetic algorithm to recognize different types of heartbeats. An ECG acquisition experimental platform, in which ECG beats are collected as ECG data for classification, is constructed to demonstrate the effectiveness of the system in ECG beat classification. The presented system, when applied to the MIT-BIH arrhythmia database, achieves a high classification accuracy of 98.8%. Experimental results based on the ECG acquisition experimental platform show that the system obtains a satisfactory classification accuracy of 97.3% and is able to classify ECG beats efficiently for the automatic identification of cardiac arrhythmias.

Disease Classification and Biomarker Discovery Using ECG Data

Directory of Open Access Journals (Sweden)

Rong Huang

2015-01-01

Full Text Available In the recent decade, disease classification and biomarker discovery have become increasingly important in modern biological and medical research. ECGs are comparatively low-cost and noninvasive in screening and diagnosing heart diseases. With the development of personal ECG monitors, large amounts of ECGs are recorded and stored; therefore, fast and efficient algorithms are called for to analyze the data and make diagnosis. In this paper, an efficient and easy-to-interpret procedure of cardiac disease classification is developed through novel feature extraction methods and comparison of classifiers. Motivated by the observation that the distributions of various measures on ECGs of the diseased group are often skewed, heavy-tailed, or multimodal, we characterize the distributions by sample quantiles which outperform sample means. Three classifiers are compared in application both to all features and to dimension-reduced features by PCA: stepwise discriminant analysis (SDA, SVM, and LASSO logistic regression. It is found that SDA applied to dimension-reduced features by PCA is the most stable and effective procedure, with sensitivity, specificity, and accuracy being 89.68%, 84.62%, and 88.52%, respectively.

Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies.

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Bourque, Jamieson M; Beller, George A

2015-11-01

Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. In addition to exercise-induced ischemic ST-segment depression, such markers as ST-segment elevation in lead aVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 metabolic equivalents on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher-risk populations (e.g., poor functional capacity, diabetes, or chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A novel wavelet sequence based on deep bidirectional LSTM network model for ECG signal classification.

Science.gov (United States)

Yildirim, Özal

2018-05-01

Long-short term memory networks (LSTMs), which have recently emerged in sequential data analysis, are the most widely used type of recurrent neural networks (RNNs) architecture. Progress on the topic of deep learning includes successful adaptations of deep versions of these architectures. In this study, a new model for deep bidirectional LSTM network-based wavelet sequences called DBLSTM-WS was proposed for classifying electrocardiogram (ECG) signals. For this purpose, a new wavelet-based layer is implemented to generate ECG signal sequences. The ECG signals were decomposed into frequency sub-bands at different scales in this layer. These sub-bands are used as sequences for the input of LSTM networks. New network models that include unidirectional (ULSTM) and bidirectional (BLSTM) structures are designed for performance comparisons. Experimental studies have been performed for five different types of heartbeats obtained from the MIT-BIH arrhythmia database. These five types are Normal Sinus Rhythm (NSR), Ventricular Premature Contraction (VPC), Paced Beat (PB), Left Bundle Branch Block (LBBB), and Right Bundle Branch Block (RBBB). The results show that the DBLSTM-WS model gives a high recognition performance of 99.39%. It has been observed that the wavelet-based layer proposed in the study significantly improves the recognition performance of conventional networks. This proposed network structure is an important approach that can be applied to similar signal processing problems. Copyright © 2018 Elsevier Ltd. All rights reserved.

ECG-Based Measurements of Drug-induced Repolarization Changes

DEFF Research Database (Denmark)

Bhuiyan, Tanveer Ahmed

The purpose of this thesis is to investigate the abnormal repolarization both in the cellular and the surface ECG along with their relationship. It has been identified that the certain morphological changes of the monophasic action potential are predictor of TdP arrhythmia. Therefore the proporti......The purpose of this thesis is to investigate the abnormal repolarization both in the cellular and the surface ECG along with their relationship. It has been identified that the certain morphological changes of the monophasic action potential are predictor of TdP arrhythmia. Therefore...... the proportional changes of the surface ECG which corresponds to the arrhythmia-triggering MAP morphology is warranted to increase the confidence of determining cardiotoxicity of drugs....

ECG changes in gamma-therapy of esophagus cancer

International Nuclear Information System (INIS)

Khajrushev, Zh.A.; Abdrakhmanov, Zh.N.

1978-01-01

Effect of ionizing radiation dose distribution with time in gamma therapy of esophagus cancer has been studied on the basis of the results obtained with electrocardiography. 700 persons were examined before treatment and after completing the full course of irradiation, 426 persons were examined repeatedly. Radiation treatment methods used are given. In most cases ECG changes result in the quickened systole rhythm and diffuse changes in the myocardium due to intoxication. ECG changes associated with the irradiation for patients with esophagus cancer amounted to 16%. Frequency of postirradiation ECG changes depends on the position of esophagus area under irradiation. Different variants of mean dose fractionation were the most sparing with respect to the heart

Microprocessor-based simulator of surface ECG signals

International Nuclear Information System (INIS)

MartInez, A E; Rossi, E; Siri, L Nicola

2007-01-01

In this work, a simulator of surface electrocardiogram recorded signals (ECG) is presented. The device, based on a microcontroller and commanded by a personal computer, produces an analog signal resembling actual ECGs, not only in time course and voltage levels, but also in source impedance. The simulator is a useful tool for electrocardiograph calibration and monitoring, to incorporate as well in educational tasks and in clinical environments for early detection of faulty behaviour

Ecg changes after dipyridamole infusion in patients undergoing myocardial perfusion imaging

International Nuclear Information System (INIS)

Taherpour, M.; Zakavi, R.; Ariana, K.

2002-01-01

Dipyridamole is used as the main pharmacological stress agent in patient referred for myocardial perfusion imaging. This vasodilator agent makes difference between normal and abnormal coronary perfusion. Some authors believe that post-Dipyridamole Ecg changes have low sensitivity and relatively high specificity for ischemic detection. This study tries to evaluate this issue. All patients who referred to nuclear medicine department for Myocardial Perfusion Imaging and were not suitable for treadmill E T T, and had no L BBB pattern in basal Ecg were included in the study. Basal and post Dipyridamole Ecg were interpreted with a cardiologist after infusion of 142 u g/kg/min of Dipyridamole and all changes as well as basal Ecg abnormalities were recorded. Also Q Tc were calculated in all Ecg records: M P Is were interpreted by a nuclear medicine specialist and summed stress and rest scores were determined. Two hundred patients including 89 female (44.5%) and 111 male (55.5%) with a mean age of 55.2 years and age range of 30-85 years were studied. Mean basal and post Dipyridamole heart rates were 72.2/min and 84.8/min and mean basal and post Dipyridamole Qt Cs were 419.6 msec and 435.7 msec respectively. New Ecg changes were noted in 22.5% of cases and consisted of 1% T-wave flattening, 1% T-wave inversion, 16.5% St depression and 4% Pseudo normalization. Horizontal pattern was the main type of St segment depression (83.%) among new S T changes. Mean St depression severity was 0.8 mm with a range of 0.5-2 mm. New St depression was noted in lateral leads (Excluding high lateral) in 62.5% of new S T changes. M P I was interpreted normal in 4% of cases and showed some degrees of ischemia in 42% of the cases. The mean post Dipyridamole heart rate increment, was 11.2/ min patients with abnormal scintigraphy (infarct and/or ischemia) compared to 14.5/ min in normal cases. (P=0.009). Also Qt c increment in patients with ischemia was significantly more than patients with simple

Clinical evaluation of the Tl-201 ECG-gated myocardial SPECT

International Nuclear Information System (INIS)

Mochizuki, Teruhito

1989-01-01

In order to evaluate the clinical usefulness of the Tl-201 ECG-gated myocardial single photon emission computed tomography (SPECT), we compared the wall motion and the grade of the Tl-201 uptake of the ECG-gated myocardial SPECT with the wall motion of the ECG-gated blood pool SPECT. Materials were 87 patients of 50 old myocardial infarctions (OMIs), 19 hypertrophic cardiomyopathies (HCMs), 2 dilated cardiomyopathies (DCMs) and 16 others. After intravenous injection of 111-185 MBq (3-5 mCi) of Tl-201 at rest, the projection data were acquired using a rotating gamma-camera through 180deg, from RAO 45deg in 24 directions, each of which consisted of 80-100 beats. For the reconstruction of ED, ES and non-gated images, R-R interval was divided into about 20 (18-22) fractions. In 348 regions of interest (anterior, septal, lateral and inferior wall) in 87 cases, wall motion and the Tl-201 uptake were evaluated to three grades (normal, hypokinesis and akinesis; normal, low and defect, respectively), which were compared with the wall motion of the ECG-gated blood pool SPECT. The wall motion and the grade of the Tl-201 uptake of the ECG-gated myocardial SPECT correlated well with the wall motion of the ECG-gated blood pool SPECT (96.6% and 87.9%, respectively). In conclusion, the ECG-gated myocardial SPECT can provide clear perfusion images and is a very useful diagnostic strategy to evaluate the regional wall motion and perfusion simultaneously. (author)

Alexander fractional differential window filter for ECG denoising.

Science.gov (United States)

Verma, Atul Kumar; Saini, Indu; Saini, Barjinder Singh

2018-06-01

The electrocardiogram (ECG) non-invasively monitors the electrical activities of the heart. During the process of recording and transmission, ECG signals are often corrupted by various types of noises. Minimizations of these noises facilitate accurate detection of various anomalies. In the present paper, Alexander fractional differential window (AFDW) filter is proposed for ECG signal denoising. The designed filter is based on the concept of generalized Alexander polynomial and the R-L differential equation of fractional calculus. This concept is utilized to formulate a window that acts as a forward filter. Thereafter, the backward filter is constructed by reversing the coefficients of the forward filter. The proposed AFDW filter is then obtained by averaging of the forward and backward filter coefficients. The performance of the designed AFDW filter is validated by adding the various type of noise to the original ECG signal obtained from MIT-BIH arrhythmia database. The two non-diagnostic measure, i.e., SNR, MSE, and one diagnostic measure, i.e., wavelet energy based diagnostic distortion (WEDD) have been employed for the quantitative evaluation of the designed filter. Extensive experimentations on all the 48-records of MIT-BIH arrhythmia database resulted in average SNR of 22.014 ± 3.806365, 14.703 ± 3.790275, 13.3183 ± 3.748230; average MSE of 0.001458 ± 0.00028, 0.0078 ± 0.000319, 0.01061 ± 0.000472; and average WEDD value of 0.020169 ± 0.01306, 0.1207 ± 0.061272, 0.1432 ± 0.073588, for ECG signal contaminated by the power line, random, and the white Gaussian noise respectively. A new metric named as morphological power preservation measure (MPPM) is also proposed that account for the power preservance (as indicated by PSD plots) and the QRS morphology. The proposed AFDW filter retained much of the original (clean) signal power without any significant morphological distortion as validated by MPPM measure that were 0

Efficient algorithm for baseline wander and powerline noise removal from ECG signals based on discrete Fourier series.

Science.gov (United States)

Bahaz, Mohamed; Benzid, Redha

2018-03-01

Electrocardiogram (ECG) signals are often contaminated with artefacts and noises which can lead to incorrect diagnosis when they are visually inspected by cardiologists. In this paper, the well-known discrete Fourier series (DFS) is re-explored and an efficient DFS-based method is proposed to reduce contribution of both baseline wander (BW) and powerline interference (PLI) noises in ECG records. In the first step, the determination of the exact number of low frequency harmonics contributing in BW is achieved. Next, the baseline drift is estimated by the sum of all associated Fourier sinusoids components. Then, the baseline shift is discarded efficiently by a subtraction of its approximated version from the original biased ECG signal. Concerning the PLI, the subtraction of the contributing harmonics calculated in the same manner reduces efficiently such type of noise. In addition of visual quality results, the proposed algorithm shows superior performance in terms of higher signal-to-noise ratio and smaller mean square error when faced to the DCT-based algorithm.

A protocol for a prospective observational study using chest and thumb ECG: transient ECG assessment in stroke evaluation (TEASE) in Sweden.

Science.gov (United States)

Magnusson, Peter; Koyi, Hirsh; Mattsson, Gustav

2018-04-03

Atrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke. Secondary objectives are to assess health-related quality of life (HRQoL) using short-form health survey (SF-36) and the feasibility of the Coala Heart Monitor in patients who had a stroke. Stroke survivors in Region Gävleborg, Sweden, will be eligible for the study from October 2017. Patients with a history of ischaemic stroke without documented AF before or during ECG evaluation in the stroke unit will be evaluated by the chest and thumb ECG system Coala Heart Monitor. The monitoring system is connected to a smartphone application which allows for remote monitoring and prompt advice on clinical management. Over a period of 28 days, patients will be monitored two times a day and may activate the ECG recording at symptoms. On completion, the system is returned by mail. This system offers a possibility to evaluate the presence of AF poststroke, but the feasibility of this system in patients who recently suffered from a stroke is unknown. In addition, HRQoL using SF-36 in comparison to Swedish population norms will be assessed. The feasibility of the Coala Heart Monitor will be assessed by a self-developed questionnaire. The study was approved by The Regional Ethical Committee in Uppsala (2017/321). The database will be closed after the last follow-up, followed by statistical analyses, interpretation of results and dissemination to a scientific journal. NCT03301662; Pre-results. © Article author

Value of the 12-lead electrocardiogram to define the level of obstruction in acute anterior wall myocardial infarction: correlation to coronary angiography and clinical outcome in the DANAMI-2 trial

DEFF Research Database (Denmark)

Eskola, Markku J; Nikus, Kjell C; Holmvang, Lene

2008-01-01

was studied. RESULTS: In 146 patients without confounding factors on the ECG, either ST-elevation>or=0.5 mm in lead aVL or any ST-elevation in lead aVR in association with precordial ST-segment elevation in at least two contiguous leads (including V2, V3 or V4) had a sensitivity of 94%, specificity of 49...

Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocardiogram.

Science.gov (United States)

Khelassi, Abdeldjalil; Yelles-Chaouche, Sarra-Nassira; Benais, Faiza

2017-05-01

The computer-aided detection of cardiac arrhythmias stills a crucial application in medical technologies. The rule based systems RBS ensure a high level of transparency and interpretability of the obtained results. To facilitate the diagnosis of the cardiologists and to reduce the uncertainty made in this diagnosis. In this research article, we have realized a classification and automatic recognition of cardiac arrhythmias, by using XML rules that represent the cardiologist knowledge. Thirteen experiments with different knowledge bases were realized for improving the performance of the used method in the detection of 13 cardiac arrhythmias. In the first 12 experiments, we have designed a specialized knowledge base for each cardiac arrhythmia, which contains just one arrhythmia detection rule. In the last experiment, we applied the knowledge base which contains rules of 12 arrhythmias. We used, for the experiments, an international data set with 279 features and 452 records characterizing 12 leads of ECG signal and social information of patients. The data sets were constructed and published at Bilkent University of Ankara, Turkey. In addition, the second version of the self-developed software "XMLRULE" was used; the software can infer more than one class and facilitate the interpretability of the obtained results. The 12 first experiments give 82.80% of correct detection as the mean of all experiments, the results were between 19% and 100% with a low rate in just one experiment. The last experiment in which all arrhythmias are considered, the results of correct detection was 38.33% with 90.55% of sensibility and 46.24% of specificity. It was clearly show that in these results the good choice of the classification model is very beneficial in terms of performance. The obtained results were better than the published results with other computational methods for the mono class detection, but it was less in multi-class detection. The RBS is the most transparent method for

Beat-to-beat ECG restitution: A review and proposal for a new biomarker to assess cardiac stress and ventricular tachyarrhythmia vulnerability.

Science.gov (United States)

Fossa, Anthony A

2017-09-01

Cardiac restitution is the ability of the heart to recover from one beat to the next. Ventricular arrhythmia vulnerability can occur when the heart does not properly adjust to sudden changes in rate or in hemodynamics leading to excessive temporal and/or spatial heterogeneity in conduction or repolarization. Restitution has historically been used to study, by invasive means, the dynamics of the relationship between action potential duration (APD) and diastolic interval (DI) in sedated subjects using various pacing protocols. Even though the analogous measures of APD and DI can be obtained using the surface ECG to acquire the respective QT and TQ intervals for ECG restitution, this methodology has not been widely adopted for a number of reasons. Recent development of more advanced software algorithms enables ECG intervals to be measured accurately, on a continuous beat-to-beat basis, in an automated manner, and under highly dynamic conditions (i.e., ambulatory or exercise) providing information beyond that available in the typical resting state. Current breakthroughs in ECG technology will allow ECG restitution measures to become a practical approach for providing quantitative measures of the risks for ventricular arrhythmias as well as cardiac stress in general. In addition to a review of the underlying principles and caveats of ECG restitution, a new approach toward an advancement of more integrated restitution biomarkers is proposed. © 2017 Wiley Periodicals, Inc.

A Wearable Healthcare System With a 13.7 μA Noise Tolerant ECG Processor.

Science.gov (United States)

Izumi, Shintaro; Yamashita, Ken; Nakano, Masanao; Kawaguchi, Hiroshi; Kimura, Hiromitsu; Marumoto, Kyoji; Fuchikami, Takaaki; Fujimori, Yoshikazu; Nakajima, Hiroshi; Shiga, Toshikazu; Yoshimoto, Masahiko

2015-10-01

To prevent lifestyle diseases, wearable bio-signal monitoring systems for daily life monitoring have attracted attention. Wearable systems have strict size and weight constraints, which impose significant limitations of the battery capacity and the signal-to-noise ratio of bio-signals. This report describes an electrocardiograph (ECG) processor for use with a wearable healthcare system. It comprises an analog front end, a 12-bit ADC, a robust Instantaneous Heart Rate (IHR) monitor, a 32-bit Cortex-M0 core, and 64 Kbyte Ferroelectric Random Access Memory (FeRAM). The IHR monitor uses a short-term autocorrelation (STAC) algorithm to improve the heart-rate detection accuracy despite its use in noisy conditions. The ECG processor chip consumes 13.7 μA for heart rate logging application.

[An Algorithm to Eliminate Power Frequency Interference in ECG Using Template].

Science.gov (United States)

Shi, Guohua; Li, Jiang; Xu, Yan; Feng, Liang

2017-01-01

Researching an algorithm to eliminate power frequency interference in ECG. The algorithm first creates power frequency interference template, then, subtracts the template from the original ECG signals, final y, the algorithm gets the ECG signals without interference. Experiment shows the algorithm can eliminate interference effectively and has none side effect to normal signal. It’s efficient and suitable for practice.

ECG biometric identification: A compression based approach.

Science.gov (United States)

Bras, Susana; Pinho, Armando J

2015-08-01

Using the electrocardiogram signal (ECG) to identify and/or authenticate persons are problems still lacking satisfactory solutions. Yet, ECG possesses characteristics that are unique or difficult to get from other signals used in biometrics: (1) it requires contact and liveliness for acquisition (2) it changes under stress, rendering it potentially useless if acquired under threatening. Our main objective is to present an innovative and robust solution to the above-mentioned problem. To successfully conduct this goal, we rely on information-theoretic data models for data compression and on similarity metrics related to the approximation of the Kolmogorov complexity. The proposed measure allows the comparison of two (or more) ECG segments, without having to follow traditional approaches that require heartbeat segmentation (described as highly influenced by external or internal interferences). As a first approach, the method was able to cluster the data in three groups: identical record, same participant, different participant, by the stratification of the proposed measure with values near 0 for the same participant and closer to 1 for different participants. A leave-one-out strategy was implemented in order to identify the participant in the database based on his/her ECG. A 1NN classifier was implemented, using as distance measure the method proposed in this work. The classifier was able to identify correctly almost all participants, with an accuracy of 99% in the database used.

Real-Time ECG Simulation for Hybrid Mock Circulatory Loops.

Science.gov (United States)

Korn, Leonie; Rüschen, Daniel; Zander, Niklas; Leonhardt, Steffen; Walter, Marian

2018-02-01

Classically, mock circulatory loops only simulate mechanical properties of the circulation. To connect the hydraulic world with electrophysiology, we present a real-time electrical activity model of the heart and show how to integrate this model into a real-time mock loop simulation. The model incorporates a predefined conduction pathway and a simplified volume conductor to solve the bidomain equations and the forward problem of electrocardiography, resulting in a physiological simulation of the electrocardiogram (ECG) at arbitrary electrode positions. A complete physiological simulation of the heart's excitation would be too CPU intensive. Thus, in our model, complexity was reduced to allow real-time simulation of ECG-triggered medical systems in vitro; this decreases time and cost in the development process. Conversely, the presented model can still be adapted to various pathologies by locally changing the properties of the heart's conduction pathway. To simulate the ECG, the heart is divided into suitable areas, which are innervated by the hierarchically structured conduction system. To distinguish different cardiac regions, a segmentation of the heart was performed. In these regions, Prim's algorithm was applied to identify the directed minimal spanning trees for conduction orientation. Each node of the tree was assigned to a cardiac action potential generated by its hybrid automaton to represent the heart's conduction system by the spatial distribution of action potentials. To generate the ECG output, the bidomain equations were implemented and a simple model of the volume conductor of the body was used to solve the forward problem of electrocardiography. As a result, the model simulates potentials at arbitrary electrode positions in real-time. To verify the developed real-time ECG model, measurements were made within a hybrid mock circulatory loop, including a simple ECG-triggered ventricular assist device control. The model's potential value is to simulate

Using Intracardiac Vectorcardiographic Loop for Surface ECG Synthesis

Directory of Open Access Journals (Sweden)

G. Carrault

2008-09-01

Full Text Available Current cardiac implantable devices offer improved processing power and recording capabilities. Some of these devices already provide basic telemonitoring features that may help to reduce health care expenditure. A challenge is posed in particular for the telemonitoring of the patient's cardiac electrical activity. Indeed, only intracardiac electrograms (EGMs are acquired by the implanted device and these signals are difficult to analyze directly by clinicians. In this paper, we propose a patient-specific method to synthesize the surface electrocardiogram (ECG from a set of EGM signals, based on a 3D representation of the cardiac electrical activity and principal component analysis (PCA. The results, in the case of sinus rhythm, show a correlation coefficient between the real ECG and the synthesized ECG of about 0.85. Moreover, the application of the proposed method to the patients who present an abnormal heart rhythm exhibits promising results, especially for characterizing the bundle branch blocs. Finally, in order to evaluate the behavior of our procedure in some practical situations, the quality of the ECG reconstruction is studied as a function of the number of EGM electrodes provided by the CIDs.

Using Intracardiac Vectorcardiographic Loop for Surface ECG Synthesis

Science.gov (United States)

Kachenoura, A.; Porée, F.; Hernández, A. I.; Carrault, G.

2008-12-01

Current cardiac implantable devices offer improved processing power and recording capabilities. Some of these devices already provide basic telemonitoring features that may help to reduce health care expenditure. A challenge is posed in particular for the telemonitoring of the patient's cardiac electrical activity. Indeed, only intracardiac electrograms (EGMs) are acquired by the implanted device and these signals are difficult to analyze directly by clinicians. In this paper, we propose a patient-specific method to synthesize the surface electrocardiogram (ECG) from a set of EGM signals, based on a 3D representation of the cardiac electrical activity and principal component analysis (PCA). The results, in the case of sinus rhythm, show a correlation coefficient between the real ECG and the synthesized ECG of about 0.85. Moreover, the application of the proposed method to the patients who present an abnormal heart rhythm exhibits promising results, especially for characterizing the bundle branch blocs. Finally, in order to evaluate the behavior of our procedure in some practical situations, the quality of the ECG reconstruction is studied as a function of the number of EGM electrodes provided by the CIDs.

ECG-cryptography and authentication in body area networks.

Science.gov (United States)

Zhang, Zhaoyang; Wang, Honggang; Vasilakos, Athanasios V; Fang, Hua

2012-11-01

Wireless body area networks (BANs) have drawn much attention from research community and industry in recent years. Multimedia healthcare services provided by BANs can be available to anyone, anywhere, and anytime seamlessly. A critical issue in BANs is how to preserve the integrity and privacy of a person's medical data over wireless environments in a resource efficient manner. This paper presents a novel key agreement scheme that allows neighboring nodes in BANs to share a common key generated by electrocardiogram (ECG) signals. The improved Jules Sudan (IJS) algorithm is proposed to set up the key agreement for the message authentication. The proposed ECG-IJS key agreement can secure data communications over BANs in a plug-n-play manner without any key distribution overheads. Both the simulation and experimental results are presented, which demonstrate that the proposed ECG-IJS scheme can achieve better security performance in terms of serval performance metrics such as false acceptance rate (FAR) and false rejection rate (FRR) than other existing approaches. In addition, the power consumption analysis also shows that the proposed ECG-IJS scheme can achieve energy efficiency for BANs.

Low-complexity R-peak detection in ECG signals: a preliminary step towards ambulatory fetal monitoring.

Science.gov (United States)

Rooijakkers, Michiel; Rabotti, Chiara; Bennebroek, Martijn; van Meerbergen, Jef; Mischi, Massimo

2011-01-01

Non-invasive fetal health monitoring during pregnancy has become increasingly important. Recent advances in signal processing technology have enabled fetal monitoring during pregnancy, using abdominal ECG recordings. Ubiquitous ambulatory monitoring for continuous fetal health measurement is however still unfeasible due to the computational complexity of noise robust solutions. In this paper an ECG R-peak detection algorithm for ambulatory R-peak detection is proposed, as part of a fetal ECG detection algorithm. The proposed algorithm is optimized to reduce computational complexity, while increasing the R-peak detection quality compared to existing R-peak detection schemes. Validation of the algorithm is performed on two manually annotated datasets, the MIT/BIH Arrhythmia database and an in-house abdominal database. Both R-peak detection quality and computational complexity are compared to state-of-the-art algorithms as described in the literature. With a detection error rate of 0.22% and 0.12% on the MIT/BIH Arrhythmia and in-house databases, respectively, the quality of the proposed algorithm is comparable to the best state-of-the-art algorithms, at a reduced computational complexity.

Integrated processing of ECG's in a hospital information system

NARCIS (Netherlands)

Helder, J.C.; Schram, P.H.; Verwey, H.; Meijler, F.L.; Robles de Medina, E.O.

The ECG handling in the University Hospital of Utrecht is composed by a system consisting of acquisition and storage of ECG signals, computer analysis, data management, and storage of readings in a patient data base. The last two modules are part of a Hospital Information System (HIS). The modular

ECG denoising with adaptive bionic wavelet transform.

Science.gov (United States)

Sayadi, Omid; Shamsollahi, Mohammad Bagher

2006-01-01

In this paper a new ECG denoising scheme is proposed using a novel adaptive wavelet transform, named bionic wavelet transform (BWT), which had been first developed based on a model of the active auditory system. There has been some outstanding features with the BWT such as nonlinearity, high sensitivity and frequency selectivity, concentrated energy distribution and its ability to reconstruct signal via inverse transform but the most distinguishing characteristic of BWT is that its resolution in the time-frequency domain can be adaptively adjusted not only by the signal frequency but also by the signal instantaneous amplitude and its first-order differential. Besides by optimizing the BWT parameters parallel to modifying a new threshold value, one can handle ECG denoising with results comparing to those of wavelet transform (WT). Preliminary tests of BWT application to ECG denoising were constructed on the signals of MIT-BIH database which showed high performance of noise reduction.

A wearable wireless ECG monitoring system with dynamic transmission power control for long-term homecare.

Science.gov (United States)

Wang, Yishan; Doleschel, Sammy; Wunderlich, Ralf; Heinen, Stefan

2015-03-01

This paper presents a wearable wireless ECG monitoring system based on novel 3-Lead electrode placements for long-term homecare. The experiment for novel 3-Lead electrode placements is carried out, and the results show that the distance between limb electrodes can be significantly reduced. Based on the new electrode position, a small size sensor node, which is powered by a rechargeable battery, is designed to detect, amplify, filter and transmit the ECG signals. The coordinator receives the data and sends it to PC. Finally the signals are displayed on the GUI. In order to control the power consumption of sensor node, a dynamic power adjustment method is applied to automatically adjust the transmission power of the sensor node according to the received signal strength indicator (RSSI), which is related to the distance and obstacle between sensor node and coordinator. The system is evaluated when the user, who wears the sensor, is walking and running. A promising performance is achieved even under body motion. The power consumption can be significantly reduced with this dynamic power adjustment method.

A Deep Learning Approach to Examine Ischemic ST Changes in Ambulatory ECG Recordings.

Science.gov (United States)

Xiao, Ran; Xu, Yuan; Pelter, Michele M; Mortara, David W; Hu, Xiao

2018-01-01

Patients with suspected acute coronary syndrome (ACS) are at risk of transient myocardial ischemia (TMI), which could lead to serious morbidity or even mortality. Early detection of myocardial ischemia can reduce damage to heart tissues and improve patient condition. Significant ST change in the electrocardiogram (ECG) is an important marker for detecting myocardial ischemia during the rule-out phase of potential ACS. However, current ECG monitoring software is vastly underused due to excessive false alarms. The present study aims to tackle this problem by combining a novel image-based approach with deep learning techniques to improve the detection accuracy of significant ST depression change. The obtained convolutional neural network (CNN) model yields an average area under the curve (AUC) at 89.6% from an independent testing set. At selected optimal cutoff thresholds, the proposed model yields a mean sensitivity at 84.4% while maintaining specificity at 84.9%.

Statistical performance evaluation of ECG transmission using wireless networks.

Science.gov (United States)

Shakhatreh, Walid; Gharaibeh, Khaled; Al-Zaben, Awad

2013-07-01

This paper presents simulation of the transmission of biomedical signals (using ECG signal as an example) over wireless networks. Investigation of the effect of channel impairments including SNR, pathloss exponent, path delay and network impairments such as packet loss probability; on the diagnosability of the received ECG signal are presented. The ECG signal is transmitted through a wireless network system composed of two communication protocols; an 802.15.4- ZigBee protocol and an 802.11b protocol. The performance of the transmission is evaluated using higher order statistics parameters such as kurtosis and Negative Entropy in addition to the common techniques such as the PRD, RMS and Cross Correlation.

Fetal electrocardiogram (ECG) for fetal monitoring during labour.

Science.gov (United States)

Neilson, James P

2015-12-21

Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electronic fetal heart rate monitoring with the aim of improving fetal outcome and minimising unnecessary obstetric interference. To compare the effects of analysis of fetal ECG waveforms during labour with alternative methods of fetal monitoring. The Cochrane Pregnancy and Childbirth Group's Trials Register (latest search 23 September 2015) and reference lists of retrieved studies. Randomised trials comparing fetal ECG waveform analysis with alternative methods of fetal monitoring during labour. One review author independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. One review author assessed the quality of the evidence using the GRADE approach. Seven trials (27,403 women) were included: six trials of ST waveform analysis (26,446 women) and one trial of PR interval analysis (957 women). The trials were generally at low risk of bias for most domains and the quality of evidence for ST waveform analysis trials was graded moderate to high. In comparison to continuous electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis made no obvious difference to primary outcomes: births by caesarean section (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.96 to 1.08; six trials, 26,446 women; high quality evidence); the number of babies with severe metabolic acidosis at birth (cord arterial pH less than 7.05 and base deficit greater than 12 mmol/L) (average RR 0.72, 95% CI 0.43 to 1.20; six trials, 25,682 babies; moderate quality evidence); or babies with neonatal encephalopathy (RR 0.61, 95% CI 0.30 to 1.22; six trials, 26,410 babies; high quality evidence). There were, however, on average

Mobile application development for Tele-ECG

International Nuclear Information System (INIS)

Srivastava, Shikha; Bharade, Sandeep; Sinha, Vineet; Sarade, Bhagyashree; Jindal, G.D.; Ananthakrishnan, T.S.; Pithawa, C.K.

2010-01-01

Mobile computing has caught the attention of research community for quite some time. The constant improvement of hardware and software related to mobile computing (e.g. better computing power, larger wireless network bandwidth) clearly enhance capabilities of mobile devices. The acceptance of mobile technology by the population at large would suggest that this could be the basis of a system for the communication of medical data from patients to remote physician and vice versa. This paper presents a mobile solution, which makes use of a Tele-ECG unit with a mobile phone to collect, store and forward ECG data to a cardiologist for diagnosis and recommendation. (author)

Decomposition of ECG by linear filtering.

Science.gov (United States)

Murthy, I S; Niranjan, U C

1992-01-01

A simple method is developed for the delineation of a given electrocardiogram (ECG) signal into its component waves. The properties of discrete cosine transform (DCT) are exploited for the purpose. The transformed signal is convolved with appropriate filters and the component waves are obtained by computing the inverse transform (IDCT) of the filtered signals. The filters are derived from the time signal itself. Analysis of continuous strips of ECG signals with various arrhythmias showed that the performance of the method is satisfactory both qualitatively and quantitatively. The small amplitude P wave usually had a high percentage rms difference (PRD) compared to the other large component waves.

[Experience in the use of equipment for ECG system analysis in municipal polyclinics].

Science.gov (United States)

Bondarenko, A A

2006-01-01

Two electrocardiographs, an analog-digital electrocardiograph with preliminary analog filtering of signal and a smart cardiograph implemented as a PC-compatible device without preliminary analog filtering, are considered. Advantages and disadvantages of ECG systems based on artificial intelligence are discussed. ECG interpretation modes provided by the two electrocardiographs are considered. The reliability of automatic ECG interpretation is assessed. Problems of rational use of automated ECG processing systems are discussed.

A Hygroscopic Sensor Electrode for Fast Stabilized Non-Contact ECG Signal Acquisition.

Science.gov (United States)

Fong, Ee-May; Chung, Wan-Young

2015-08-05

A capacitive electrocardiography (cECG) technique using a non-invasive ECG measuring technology that does not require direct contact between the sensor and the skin has attracted much interest. The system encounters several challenges when the sensor electrode and subject's skin are weakly coupled. Because there is no direct physical contact between the subject and any grounding point, there is no discharge path for the built-up electrostatic charge. Subsequently, the electrostatic charge build-up can temporarily contaminate the ECG signal from being clearly visible; a stabilization period (3-15 min) is required for the measurement of a clean, stable ECG signal at low humidity levels (below 55% relative humidity). Therefore, to obtain a clear ECG signal without noise and to reduce the ECG signal stabilization time to within 2 min in a dry ambient environment, we have developed a fabric electrode with embedded polymer (FEEP). The designed hygroscopic FEEP has an embedded superabsorbent polymer layer. The principle of FEEP as a conductive electrode is to provide humidity to the capacitive coupling to ensure strong coupling and to allow for the measurement of a stable, clear biomedical signal. The evaluation results show that hygroscopic FEEP is capable of rapidly measuring high-accuracy ECG signals with a higher SNR ratio.

An IoT-cloud Based Wearable ECG Monitoring System for Smart Healthcare.

Science.gov (United States)

Yang, Zhe; Zhou, Qihao; Lei, Lei; Zheng, Kan; Xiang, Wei

2016-12-01

Public healthcare has been paid an increasing attention given the exponential growth human population and medical expenses. It is well known that an effective health monitoring system can detect abnormalities of health conditions in time and make diagnoses according to the gleaned data. As a vital approach to diagnose heart diseases, ECG monitoring is widely studied and applied. However, nearly all existing portable ECG monitoring systems cannot work without a mobile application, which is responsible for data collection and display. In this paper, we propose a new method for ECG monitoring based on Internet-of-Things (IoT) techniques. ECG data are gathered using a wearable monitoring node and are transmitted directly to the IoT cloud using Wi-Fi. Both the HTTP and MQTT protocols are employed in the IoT cloud in order to provide visual and timely ECG data to users. Nearly all smart terminals with a web browser can acquire ECG data conveniently, which has greatly alleviated the cross-platform issue. Experiments are carried out on healthy volunteers in order to verify the reliability of the entire system. Experimental results reveal that the proposed system is reliable in collecting and displaying real-time ECG data, which can aid in the primary diagnosis of certain heart diseases.

Improving Remote Health Monitoring: A Low-Complexity ECG Compression Approach.

Science.gov (United States)

Elgendi, Mohamed; Al-Ali, Abdulla; Mohamed, Amr; Ward, Rabab

2018-01-16

Recent advances in mobile technology have created a shift towards using battery-driven devices in remote monitoring settings and smart homes. Clinicians are carrying out diagnostic and screening procedures based on the electrocardiogram (ECG) signals collected remotely for outpatients who need continuous monitoring. High-speed transmission and analysis of large recorded ECG signals are essential, especially with the increased use of battery-powered devices. Exploring low-power alternative compression methodologies that have high efficiency and that enable ECG signal collection, transmission, and analysis in a smart home or remote location is required. Compression algorithms based on adaptive linear predictors and decimation by a factor B / K are evaluated based on compression ratio (CR), percentage root-mean-square difference (PRD), and heartbeat detection accuracy of the reconstructed ECG signal. With two databases (153 subjects), the new algorithm demonstrates the highest compression performance ( CR = 6 and PRD = 1.88 ) and overall detection accuracy (99.90% sensitivity, 99.56% positive predictivity) over both databases. The proposed algorithm presents an advantage for the real-time transmission of ECG signals using a faster and more efficient method, which meets the growing demand for more efficient remote health monitoring.

Improving Remote Health Monitoring: A Low-Complexity ECG Compression Approach

Directory of Open Access Journals (Sweden)

Mohamed Elgendi

2018-01-01

Full Text Available Recent advances in mobile technology have created a shift towards using battery-driven devices in remote monitoring settings and smart homes. Clinicians are carrying out diagnostic and screening procedures based on the electrocardiogram (ECG signals collected remotely for outpatients who need continuous monitoring. High-speed transmission and analysis of large recorded ECG signals are essential, especially with the increased use of battery-powered devices. Exploring low-power alternative compression methodologies that have high efficiency and that enable ECG signal collection, transmission, and analysis in a smart home or remote location is required. Compression algorithms based on adaptive linear predictors and decimation by a factor B / K are evaluated based on compression ratio (CR, percentage root-mean-square difference (PRD, and heartbeat detection accuracy of the reconstructed ECG signal. With two databases (153 subjects, the new algorithm demonstrates the highest compression performance ( CR = 6 and PRD = 1.88 and overall detection accuracy (99.90% sensitivity, 99.56% positive predictivity over both databases. The proposed algorithm presents an advantage for the real-time transmission of ECG signals using a faster and more efficient method, which meets the growing demand for more efficient remote health monitoring.

An Adaptive and Time-Efficient ECG R-Peak Detection Algorithm.

Science.gov (United States)

Qin, Qin; Li, Jianqing; Yue, Yinggao; Liu, Chengyu

2017-01-01

R-peak detection is crucial in electrocardiogram (ECG) signal analysis. This study proposed an adaptive and time-efficient R-peak detection algorithm for ECG processing. First, wavelet multiresolution analysis was applied to enhance the ECG signal representation. Then, ECG was mirrored to convert large negative R-peaks to positive ones. After that, local maximums were calculated by the first-order forward differential approach and were truncated by the amplitude and time interval thresholds to locate the R-peaks. The algorithm performances, including detection accuracy and time consumption, were tested on the MIT-BIH arrhythmia database and the QT database. Experimental results showed that the proposed algorithm achieved mean sensitivity of 99.39%, positive predictivity of 99.49%, and accuracy of 98.89% on the MIT-BIH arrhythmia database and 99.83%, 99.90%, and 99.73%, respectively, on the QT database. By processing one ECG record, the mean time consumptions were 0.872 s and 0.763 s for the MIT-BIH arrhythmia database and QT database, respectively, yielding 30.6% and 32.9% of time reduction compared to the traditional Pan-Tompkins method.

Alterations of the ECG after frationated radiotherapy of the mediastine

International Nuclear Information System (INIS)

Alheit, C.; Alheit, H.D.; Herrmann, T.

1986-01-01

In 72 patients with irradiation of the mediastine the ECGs were examined before, immediately after, and 3-6 months after termination of radiotherapy. In comparison with starting findings 41.7% ECG alterations were found at the end of irradiation and 40.1% in control examinations. Mainly it was the question of alterations in ST-lines, in type of position, in P-waves, and an increase of the heart rate. However, in result of uni- and multivariant variance analyses it could be shown, that extracardiac factors and general reactions of the irradiated organism resulted in ECG alterations too. Considering the correlation of ECG alterations to the heart dose however, a direct influence of the capillary system of the heart has also to be discussed and an adequate after-care of patients with irradiation of the mediastine must be recommended. (author)

Performance of human body communication-based wearable ECG with capacitive coupling electrodes.

Science.gov (United States)

Sakuma, Jun; Anzai, Daisuke; Wang, Jianqing

2016-09-01

Wearable electrocardiogram (ECG) is attracting much attention in daily healthcare applications, and human body communication (HBC) technology provides an evident advantage in making the sensing electrodes of ECG also working for transmission through the human body. In view of actual usage in daily life, however, non-contact electrodes to the human body are desirable. In this Letter, the authors discussed the ECG circuit structure in the HBC-based wearable ECG for removing the common mode noise when employing non-contact capacitive coupling electrodes. Through the comparison of experimental results, they have shown that the authors' proposed circuit structure with the third electrode directly connected to signal ground can provide an effect on common mode noise reduction similar to the usual drive-right-leg circuit, and a sufficiently good acquisition performance of ECG signals.

Performance evaluation of carbon black based electrodes for underwater ECG monitoring.

Science.gov (United States)

Reyes, Bersain A; Posada-Quintero, Hugo F; Bales, Justin R; Chon, Ki H

2014-01-01

Underwater electrocardiogram (ECG) monitoring currently uses Ag/AgCl electrodes and requires sealing of the electrodes to avoid water intrusion, but this procedure is time consuming and often results in severe irritations or even tearing of the skin. To alleviate these problems, our research team developed hydrophobic electrodes comprised of a mixture of carbon black powder (CB) and polydimethylsiloxane (PDMS) that provide all morphological waveforms without distortion of an ECG signal for dry and water-immersed conditions. Performance comparison of CB/PDMS electrodes to adhesive Ag/AgCl hydrogel electrodes was carried out in three different scenarios which included recordings from a dry surface, water immersion, and post-water immersion conditions. CB/PDMS electrodes were able to acquire ECG signals highly correlated with those from adhesive Ag/AgCl electrodes during all conditions. Statistical reduction in ECG amplitude (pelectrodes when compared to Ag/AgCl electrodes sealed with their waterproof adhesive tape. Besides this reduction readability of the recordings was not obscured and all morphological waveforms of the ECG signal were discernible. The advantages of our CB/PDMS electrodes are that they are reusable, can be fabricated economically, and most importantly, high-fidelity underwater ECG signals can be acquired without relying on the heavy use of waterproof sealing.

Effects of eCG and progesterone on superovulation and embryo production in wood bison (Bison bison athabascae).

Science.gov (United States)

Palomino, J Manuel; Cervantes, Miriam P; Woodbury, Murray R; Mapletoft, Reuben J; Adams, Gregg P

2017-06-01

Experiments were done to determine if inclusion of eCG and progesterone in the superstimulation protocol will increase the ovarian response and embryo production in wood bison, and to provide preliminary information regarding the effect of season. In Experiment 1 (anovulatory season), bison (n=26) were synchronized by follicular ablation (Day -1) and given FSH on Days 0 and 2, and assigned to 3 groups: Progesterone (Days 0-4), eCG (Day 3), or progesterone+eCG. On Day 5, bison were given hCG and inseminated 12 and 24h later. Ova/embryos were collected 8days after hCG. In Experiment 2 (ovulatory season), bison (n=24) were synchronized and assigned randomly to two groups in which superstimulation was induced with FSH, either with or without eCG, as in Experiment 1. No differences among groups were found in ovarian response or embryo production in either experiment. The follicular count at wave emergence was positively correlated with the number of large follicles at the end of superstimulation in all groups. A significantly greater number of follicles present at wave emergence in the anovulatory vs. ovulatory season was associated with a greater number of CL at the time of embryo collection, but only half the number of freezable embryos. In conclusion, the number of transferable embryos collected (1-2/bison) was higher than in any previous report, but was not attributable to the inclusion of eCG or progesterone in the superovulatory protocol. The apparent effect of season on oocyte competence, and not superovulatory response, is worthy of further investigation. Copyright © 2017 Elsevier B.V. All rights reserved.

SUPPRESSION OF POWERLINE INTERFERENCE IN ECG USING ADAPTIVE DIGITAL FILTER BY

OpenAIRE

Mbachu C.B; Onoh G. N; Idigo V.E; Oguejiofor O.S

2011-01-01

Artifacts in electrocardiogram (ECG) records are caused by various factors, such as powerline interference, electroencephalogram (EEG), electromyogram (EMG) and baseline wander. These noise sources increase the difficulty in analyzing the ECG and to obtaining clinical information. For that reason, it is necessary to designspecific filters to decrease such artifacts in ECG records. In this paper, FIR adaptive filter based on a least mean square (LMS) algorithm for eliminating 50Hz powerline in...

Brugada-like Precordial ST Elevation on ECG by Anterior Mediastinal Infective Mass Lesion

Directory of Open Access Journals (Sweden)

Yuji Nakazato

2003-07-01

Full Text Available Several causes are known to induce the right precordial ST elevation mimicking Brugada syndrome. Right ventricular outflow area is assumed to be responsible for such ECG changes. We experienced a case of anterior mediastinal infective mass lesion with a Brugada-like ECG. A 52-year-old female, who has pulmonary stenosis and recurrent episodes of right ventricular heart failure, complained of high fever, abdominal discomfort, and edema. On physical examination, jugular vein dilation, hepatomegaly, and facial and leg edema were noted. Leucocytosis was also noted on blood examination. An ECG showed right ventricular hypertrophy, incomplete right bundle branch block pattern and marked ST elevation on precordial leads mimicking Brugada syndrome. Magnetic resonance imaging revealed an abnormal mass shadow located on the anterior mediastinum and compressing the right ventricle (Figure 1A. Trans-thoracic echocardiography also showed the high echogenic mass lesion at the anterior side of right ventricle and the vicinity of pulmonary valve. After treatment with antibiotics, the mass lesion gradually shrunk. Concomitantly, the ST elevation disappeared with improvement of inflammatory markers (Figure 1B. The symptoms suggesting right ventricular failure were also ameliorated. The mechanism of Brugada-like ST elevation in this patient was considered to be compression, by the abnormal infective mass, of the right ventricular outflow tract with/without focal pericardial inflammation.

A new feature detection mechanism and its application in secured ECG transmission with noise masking.

Science.gov (United States)

Sufi, Fahim; Khalil, Ibrahim

2009-04-01

With cardiovascular disease as the number one killer of modern era, Electrocardiogram (ECG) is collected, stored and transmitted in greater frequency than ever before. However, in reality, ECG is rarely transmitted and stored in a secured manner. Recent research shows that eavesdropper can reveal the identity and cardiovascular condition from an intercepted ECG. Therefore, ECG data must be anonymized before transmission over the network and also stored as such in medical repositories. To achieve this, first of all, this paper presents a new ECG feature detection mechanism, which was compared against existing cross correlation (CC) based template matching algorithms. Two types of CC methods were used for comparison. Compared to the CC based approaches, which had 40% and 53% misclassification rates, the proposed detection algorithm did not perform any single misclassification. Secondly, a new ECG obfuscation method was designed and implemented on 15 subjects using added noises corresponding to each of the ECG features. This obfuscated ECG can be freely distributed over the internet without the necessity of encryption, since the original features needed to identify personal information of the patient remain concealed. Only authorized personnel possessing a secret key will be able to reconstruct the original ECG from the obfuscated ECG. Distribution of the would appear as regular ECG without encryption. Therefore, traditional decryption techniques including powerful brute force attack are useless against this obfuscation.

ECG Signal Processing, Classification and Interpretation A Comprehensive Framework of Computational Intelligence

CERN Document Server

Pedrycz, Witold

2012-01-01

Electrocardiogram (ECG) signals are among the most important sources of diagnostic information in healthcare so improvements in their analysis may also have telling consequences. Both the underlying signal technology and a burgeoning variety of algorithms and systems developments have proved successful targets for recent rapid advances in research. ECG Signal Processing, Classification and Interpretation shows how the various paradigms of Computational Intelligence, employed either singly or in combination, can produce an effective structure for obtaining often vital information from ECG signals. Neural networks do well at capturing the nonlinear nature of the signals, information granules realized as fuzzy sets help to confer interpretability on the data and evolutionary optimization may be critical in supporting the structural development of ECG classifiers and models of ECG signals. The contributors address concepts, methodology, algorithms, and case studies and applications exploiting the paradigm of Comp...

Energy-efficient ECG compression on wireless biosensors via minimal coherence sensing and weighted ℓ₁ minimization reconstruction.

Science.gov (United States)

Zhang, Jun; Gu, Zhenghui; Yu, Zhu Liang; Li, Yuanqing

2015-03-01

Low energy consumption is crucial for body area networks (BANs). In BAN-enabled ECG monitoring, the continuous monitoring entails the need of the sensor nodes to transmit a huge data to the sink node, which leads to excessive energy consumption. To reduce airtime over energy-hungry wireless links, this paper presents an energy-efficient compressed sensing (CS)-based approach for on-node ECG compression. At first, an algorithm called minimal mutual coherence pursuit is proposed to construct sparse binary measurement matrices, which can be used to encode the ECG signals with superior performance and extremely low complexity. Second, in order to minimize the data rate required for faithful reconstruction, a weighted ℓ1 minimization model is derived by exploring the multisource prior knowledge in wavelet domain. Experimental results on MIT-BIH arrhythmia database reveals that the proposed approach can obtain higher compression ratio than the state-of-the-art CS-based methods. Together with its low encoding complexity, our approach can achieve significant energy saving in both encoding process and wireless transmission.

Performance Analysis of Ten Common QRS Detectors on Different ECG Application Cases

Directory of Open Access Journals (Sweden)

Feifei Liu

2018-01-01

Full Text Available A systematical evaluation work was performed on ten widely used and high-efficient QRS detection algorithms in this study, aiming at verifying their performances and usefulness in different application situations. Four experiments were carried on six internationally recognized databases. Firstly, in the test of high-quality ECG database versus low-quality ECG database, for high signal quality database, all ten QRS detection algorithms had very high detection accuracy (F1 >99%, whereas the F1 results decrease significantly for the poor signal-quality ECG signals (all 95% except RS slope algorithm with 94.24% on normal ECG database and 94.44% on arrhythmia database. Thirdly, for the paced rhythm ECG database, all ten algorithms were immune to the paced beats (>94% except the RS slope method, which only output a low F1 result of 78.99%. At last, the detection accuracies had obvious decreases when dealing with the dynamic telehealth ECG signals (all <80% except OKB algorithm with 80.43%. Furthermore, the time costs from analyzing a 10 s ECG segment were given as the quantitative index of the computational complexity. All ten algorithms had high numerical efficiency (all <4 ms except RS slope (94.07 ms and sixth power algorithms (8.25 ms. And OKB algorithm had the highest numerical efficiency (1.54 ms.

Imaging of pulmonary vein anatomy using low-dose prospective ECG-triggered dual-source computed tomography

Energy Technology Data Exchange (ETDEWEB)

Blanke, Philipp; Baumann, Tobias; Langer, Mathias; Pache, Gregor [University Hospital Freiburg, Department of Diagnostic Radiology, Freiburg (Germany)

2010-08-15

To prospectively investigate the feasibility, image quality and radiation dose estimates for computed tomography angiography (CTA) of the pulmonary veins and left atrium using prospective electrocardiography (ECG)-triggered sequential dual-source (DS) data acquisition at end-systole in patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation. Thirty-five patients (mean age 66.2 {+-} 12.6 years) with paroxysmal atrial fibrillation underwent prospective ECG-triggered sequential DS-CTA with tube current (250 mAs/rotation) centred 250 ms past the R-peak. Tube voltage was adjusted to the BMI (<25 kg/m{sup 2}: 100 kV, >25 kg/m{sup 2}: 120 kV). Presence of motion or stair-step artefacts was assessed. Effective radiation dose was calculated from the dose-length product. All data sets could be integrated into the electroanatomical mapping system. Twenty-two patients (63%) were in sinus rhythm (mean heart rate 69.2 {+-} 11.1 bpm, variability 1.0 {+-} 1.7 bpm) and 13 (37%) showed an ECG pattern of atrial fibrillation (mean heart rate 84.8 {+-} 16.6 bpm, variability 17.9 {+-} 7.5 bpm). Minor step artefacts were observed in three patients (23%) with atrial fibrillation. Mean estimated effective dose was 1.1 {+-} 0.3 and 3.0 {+-} 0.5 mSv for 100 and 120 kV respectively. Imaging of pulmonary vein anatomy is feasible using prospective ECG-triggered sequential data acquisition at end-systole regardless of heart rate or rhythm at the benefit of low radiation dose. (orig.)

Efficacy and safety of dextrose-insulin in unmasking non-diagnostic Brugada ECG patterns.

Science.gov (United States)

Velázquez-Rodríguez, Enrique; Rodríguez-Piña, Horacio; Pacheco-Bouthillier, Alex; Jiménez-Cruz, Marcelo Paz

Typical diagnostic, coved-type 1, Brugada ECG patterns fluctuate spontaneously over time with a high proportion of non-diagnostic ECG patterns. Insulin modulates ion transport mechanisms and causes hyperpolarization of the resting potential. We report our experience with unmasking J-ST changes in response to a dextrose-insulin test. Nine patients, mean age 40.5±19.4years (range: 15-65years), presented initially with a non-diagnostic ECG pattern, which was suggestive of Brugada syndrome (group I). They were compared with 10 patients with normal ECG patterns (group II). Participants received an infusion of 50g of 50% dextrose, followed by 10IU of intravenous regular insulin. Positive changes were defined by conversion to a diagnostic ECG pattern. The dextrose-insulin test was positive in six of seven (85.7%) patients (kappa 0.79, p=0.02) that was confirmed with a pharmacologic test (kappa 1, p=0.003). One had an inconclusive test, and two with a negative test had an early repolarization ECG pattern. All subjects in group II had a negative test (pECG patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

A comprehensive survey of wearable and wireless ECG monitoring systems for older adults.

Science.gov (United States)

Baig, Mirza Mansoor; Gholamhosseini, Hamid; Connolly, Martin J

2013-05-01

Wearable health monitoring is an emerging technology for continuous monitoring of vital signs including the electrocardiogram (ECG). This signal is widely adopted to diagnose and assess major health risks and chronic cardiac diseases. This paper focuses on reviewing wearable ECG monitoring systems in the form of wireless, mobile and remote technologies related to older adults. Furthermore, the efficiency, user acceptability, strategies and recommendations on improving current ECG monitoring systems with an overview of the design and modelling are presented. In this paper, over 120 ECG monitoring systems were reviewed and classified into smart wearable, wireless, mobile ECG monitoring systems with related signal processing algorithms. The results of the review suggest that most research in wearable ECG monitoring systems focus on the older adults and this technology has been adopted in aged care facilitates. Moreover, it is shown that how mobile telemedicine systems have evolved and how advances in wearable wireless textile-based systems could ensure better quality of healthcare delivery. The main drawbacks of deployed ECG monitoring systems including imposed limitations on patients, short battery life, lack of user acceptability and medical professional's feedback, and lack of security and privacy of essential data have been also discussed.

Fetal ECG extraction using independent component analysis by Jade approach

Science.gov (United States)

Giraldo-Guzmán, Jader; Contreras-Ortiz, Sonia H.; Lasprilla, Gloria Isabel Bautista; Kotas, Marian

2017-11-01

Fetal ECG monitoring is a useful method to assess the fetus health and detect abnormal conditions. In this paper we propose an approach to extract fetal ECG from abdomen and chest signals using independent component analysis based on the joint approximate diagonalization of eigenmatrices approach. The JADE approach avoids redundancy, what reduces matrix dimension and computational costs. Signals were filtered with a high pass filter to eliminate low frequency noise. Several levels of decomposition were tested until the fetal ECG was recognized in one of the separated sources output. The proposed method shows fast and good performance.

A novel ECG data compression method based on adaptive Fourier decomposition

Science.gov (United States)

Tan, Chunyu; Zhang, Liming

2017-12-01

This paper presents a novel electrocardiogram (ECG) compression method based on adaptive Fourier decomposition (AFD). AFD is a newly developed signal decomposition approach, which can decompose a signal with fast convergence, and hence reconstruct ECG signals with high fidelity. Unlike most of the high performance algorithms, our method does not make use of any preprocessing operation before compression. Huffman coding is employed for further compression. Validated with 48 ECG recordings of MIT-BIH arrhythmia database, the proposed method achieves the compression ratio (CR) of 35.53 and the percentage root mean square difference (PRD) of 1.47% on average with N = 8 decomposition times and a robust PRD-CR relationship. The results demonstrate that the proposed method has a good performance compared with the state-of-the-art ECG compressors.

ECG changes in epilepsy patients

DEFF Research Database (Denmark)

Tigaran, S; Rasmussen, V; Dam, M

1997-01-01

To investigate the frequency of ECG abnormalities suggestive of myocardial ischaemia in patients with severe drug resistant epilepsy and without any indication of previous cardiac disease, assuming that these changes may be of significance for the group of epileptic patients with sudden unexpected...

Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors.

Science.gov (United States)

Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

2016-01-01

Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Motion artifacts were significantly reduced for all structures by ECG gating ( p =0.0089 for the lungs and p ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion ( p =0.03). ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures.

Pattern recognition in paediatric ecgs: the hidden secrets to clinical ...

African Journals Online (AJOL)

remain as important as ever, but may play only secondary roles in the diagnostic value of ... the more complex ones are best left to the experts. This article ... ECG 1 is a normal ECG of an 8-year-old child, showing sinus rhythm, a heart rate of ...

A stretchable electrode array for non-invasive, skin-mounted measurement of electrocardiography (ECG), electromyography (EMG) and electroencephalography (EEG).

Science.gov (United States)

Ma, Rui; Kim, Dae-Hyeong; McCormick, Martin; Coleman, Todd; Rogers, John

2010-01-01

This paper reports a class of stretchable electrode array capable of intimate, conformal integration onto the curvilinear surfaces of skin on the human body. The designs employ conventional metallic conductors but in optimized mechanical layouts, on soft, thin elastomeric substrates. These devices exhibit an ability to record spontaneous EEG activity even without conductive electrolyte gels, with recorded alpha rhythm responses that are 40% stronger than those collected using conventional tin electrodes and gels under otherwise similar conditions. The same type of device can also measure high quality ECG and EMG signals. The results suggest broad utility for skin-mounted measurements of electrical activity in the body, with advantages in signal levels, wearability and modes of integration compared to alternatives.

Prospectively ECG-triggered sequential dual-source coronary CT angiography in patients with atrial fibrillation: comparison with retrospectively ECG-gated helical CT

Energy Technology Data Exchange (ETDEWEB)

Xu, Lei; Yang, Lin; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); Wang, Yining; Jin, Zhengyu [Chinese Academy of Medical Sciences, Department of Radiology, Peking Union Medical College Hospital, Beijing (China); Zhang, Longjiang; Lu, Guangming [Nanjing University, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing, Jiangsu (China)

2013-07-15

To investigate the feasibility of applying prospectively ECG-triggered sequential coronary CT angiography (CCTA) to patients with atrial fibrillation (AF) and evaluate the image quality and radiation dose compared with a retrospectively ECG-gated helical protocol. 100 patients with persistent AF were enrolled. Fifty patients were randomly assigned to a prospective protocol and the other patients to a retrospective protocol using a second-generation dual-source CT (DS-CT). Image quality was evaluated using a four-point grading scale (1 = excellent, 2 = good, 3 = moderate, 4 = poor) by two reviewers on a per-segment basis. The coronary artery segments were considered non-diagnostic with a quality score of 4. The radiation dose was evaluated. Diagnostic segment rate in the prospective group was 99.4 % (642/646 segments), while that in the retrospective group was 96.5 % (604/626 segments) (P < 0.001). Effective dose was 4.29 {+-} 1.86 and 11.95 {+-} 5.34 mSv for each of the two protocols (P < 0.001), which was a 64 % reduction in the radiation dose for prospective sequential imaging compared with retrospective helical imaging. In AF patients, prospectively ECG-triggered sequential CCTA is feasible using second-generation DS-CT and can decrease >60 % radiation exposure compared with retrospectively ECG-gated helical imaging while improving diagnostic image quality. (orig.)

Biosignal PI, an Affordable Open-Source ECG and Respiration Measurement System

Directory of Open Access Journals (Sweden)

Farhad Abtahi

2014-12-01

Full Text Available Bioimedical pilot projects e.g., telemedicine, homecare, animal and human trials usually involve several physiological measurements. Technical development of these projects is time consuming and in particular costly. A versatile but affordable biosignal measurement platform can help to reduce time and risk while keeping the focus on the important goal and making an efficient use of resources. In this work, an affordable and open source platform for development of physiological signals is proposed. As a first step an 8–12 leads electrocardiogram (ECG and respiration monitoring system is developed. Chips based on iCoupler technology have been used to achieve electrical isolation as required by IEC 60601 for patient safety. The result shows the potential of this platform as a base for prototyping compact, affordable, and medically safe measurement systems. Further work involves both hardware and software development to develop modules. These modules may require development of front-ends for other biosignals or just collect data wirelessly from different devices e.g., blood pressure, weight, bioimpedance spectrum, blood glucose, e.g., through Bluetooth. All design and development documents, files and source codes will be available for non-commercial use through project website, BiosignalPI.org.

A Novel Approach to ECG Classification Based upon Two-Layered HMMs in Body Sensor Networks

Science.gov (United States)

Liang, Wei; Zhang, Yinlong; Tan, Jindong; Li, Yang

2014-01-01

This paper presents a novel approach to ECG signal filtering and classification. Unlike the traditional techniques which aim at collecting and processing the ECG signals with the patient being still, lying in bed in hospitals, our proposed algorithm is intentionally designed for monitoring and classifying the patient's ECG signals in the free-living environment. The patients are equipped with wearable ambulatory devices the whole day, which facilitates the real-time heart attack detection. In ECG preprocessing, an integral-coefficient-band-stop (ICBS) filter is applied, which omits time-consuming floating-point computations. In addition, two-layered Hidden Markov Models (HMMs) are applied to achieve ECG feature extraction and classification. The periodic ECG waveforms are segmented into ISO intervals, P subwave, QRS complex and T subwave respectively in the first HMM layer where expert-annotation assisted Baum-Welch algorithm is utilized in HMM modeling. Then the corresponding interval features are selected and applied to categorize the ECG into normal type or abnormal type (PVC, APC) in the second HMM layer. For verifying the effectiveness of our algorithm on abnormal signal detection, we have developed an ECG body sensor network (BSN) platform, whereby real-time ECG signals are collected, transmitted, displayed and the corresponding classification outcomes are deduced and shown on the BSN screen. PMID:24681668

Application of Handheld Tele-ECG for Health Care Delivery in Rural India

Directory of Open Access Journals (Sweden)

Meenu Singh

2014-01-01

Full Text Available Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG developed by Bhabha Atomic Research Center (BARC to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058 residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3% was the commonest abnormality followed closely by old myocardial infarction (5.3%. Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

Electrocardiogram (ECG Signal Modeling and Noise Reduction Using Hopfield Neural Networks

Directory of Open Access Journals (Sweden)

F. Bagheri

2013-02-01

Full Text Available The Electrocardiogram (ECG signal is one of the diagnosing approaches to detect heart disease. In this study the Hopfield Neural Network (HNN is applied and proposed for ECG signal modeling and noise reduction. The Hopfield Neural Network (HNN is a recurrent neural network that stores the information in a dynamic stable pattern. This algorithm retrieves a pattern stored in memory in response to the presentation of an incomplete or noisy version of that pattern. Computer simulation results show that this method can successfully model the ECG signal and remove high-frequency noise.

Assessment of the effect of revascularization early after CABG using ECG-gated perfusion single-photon emission tomography

International Nuclear Information System (INIS)

Kubo, Shigeto; Tadamura, Eiji; Kudoh, Takashi; Inubushi, Masayuki; Konishi, Junji; Ikeda, Tadashi; Koshiji, Takaaki; Nishimura, Kazunobu; Komeda, Masashi; Tamaki, Nagara

2001-01-01

When an arterial graft is used, reversible perfusion defects on single-photon emission tomography (SPET) perfusion images are occasionally observed early after coronary artery bypass graft surgery (CABG), owing to the restricted flow capacity. The purpose of this study was to determine whether the functional information obtained with electrocardiography (ECG)-gated perfusion SPET could be helpful in evaluating the effect of revascularization early after CABG. Twenty-three patients (18 men and 5 women, mean age 65±9 years) underwent stress/re-injection thallium-201 ECG-gated SPET before and 4 weeks after CABG (13 with exercise and 10 with dipyridamole). Patency of all grafts was confirmed by coronary angiography 1 month after CABG. Cardiac functional data including the left ventricular ejection fraction (LVEF) and the transient ischaemic dilatation (TID) ratio were analysed using a commercially available automated program. The conventional stress and re-injection tomograms were interpreted by means of a five-point scoring system in a nine-segment model. Stress-induced reversible 201 Tl perfusion defects were present in 64% of the myocardial segments bypassed by patent arterial grafts, in contrast to 42% of the myocardial segments bypassed by patent venous grafts (χ 2 =7.8, P=0.005). Of the 23 patients, 12 showed improvement in summed ischaemic scores (group 1), while 11 had no change or deterioration (group 2), although all grafts were patent on postoperative catheterization. The TID ratio improved in both group 1 and group 2 before and after CABG (1.14±0.13 vs 0.99±0.07, P=0.001 and 1.09±0.07 vs 0.94±0.05, P=0.002, respectively). However, LVEF did not significantly improve in group 1 or group 2 after CABG (42.5%±9.9% vs 47.5%±11.8%, and 52.1%±7.5% vs 53.1%±5.9%, respectively). Perfusion imaging or LVEF assessment is of limited value early after CABG. The TID ratio obtained with ECG-gated perfusion SPET may be a useful marker to evaluate the effect of

A Novel Automatic Detection System for ECG Arrhythmias Using Maximum Margin Clustering with Immune Evolutionary Algorithm

Directory of Open Access Journals (Sweden)

Bohui Zhu

2013-01-01

Full Text Available This paper presents a novel maximum margin clustering method with immune evolution (IEMMC for automatic diagnosis of electrocardiogram (ECG arrhythmias. This diagnostic system consists of signal processing, feature extraction, and the IEMMC algorithm for clustering of ECG arrhythmias. First, raw ECG signal is processed by an adaptive ECG filter based on wavelet transforms, and waveform of the ECG signal is detected; then, features are extracted from ECG signal to cluster different types of arrhythmias by the IEMMC algorithm. Three types of performance evaluation indicators are used to assess the effect of the IEMMC method for ECG arrhythmias, such as sensitivity, specificity, and accuracy. Compared with K-means and iterSVR algorithms, the IEMMC algorithm reflects better performance not only in clustering result but also in terms of global search ability and convergence ability, which proves its effectiveness for the detection of ECG arrhythmias.

Imaging of pulmonary vein anatomy using low-dose prospective ECG-triggered dual-source computed tomography

International Nuclear Information System (INIS)

Blanke, Philipp; Baumann, Tobias; Langer, Mathias; Pache, Gregor

2010-01-01

To prospectively investigate the feasibility, image quality and radiation dose estimates for computed tomography angiography (CTA) of the pulmonary veins and left atrium using prospective electrocardiography (ECG)-triggered sequential dual-source (DS) data acquisition at end-systole in patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation. Thirty-five patients (mean age 66.2 ± 12.6 years) with paroxysmal atrial fibrillation underwent prospective ECG-triggered sequential DS-CTA with tube current (250 mAs/rotation) centred 250 ms past the R-peak. Tube voltage was adjusted to the BMI ( 2 : 100 kV, >25 kg/m 2 : 120 kV). Presence of motion or stair-step artefacts was assessed. Effective radiation dose was calculated from the dose-length product. All data sets could be integrated into the electroanatomical mapping system. Twenty-two patients (63%) were in sinus rhythm (mean heart rate 69.2 ± 11.1 bpm, variability 1.0 ± 1.7 bpm) and 13 (37%) showed an ECG pattern of atrial fibrillation (mean heart rate 84.8 ± 16.6 bpm, variability 17.9 ± 7.5 bpm). Minor step artefacts were observed in three patients (23%) with atrial fibrillation. Mean estimated effective dose was 1.1 ± 0.3 and 3.0 ± 0.5 mSv for 100 and 120 kV respectively. Imaging of pulmonary vein anatomy is feasible using prospective ECG-triggered sequential data acquisition at end-systole regardless of heart rate or rhythm at the benefit of low radiation dose. (orig.)

Fetal ECG extraction via Type-2 adaptive neuro-fuzzy inference systems.

Science.gov (United States)

Ahmadieh, Hajar; Asl, Babak Mohammadzadeh

2017-04-01

We proposed a noninvasive method for separating the fetal ECG (FECG) from maternal ECG (MECG) by using Type-2 adaptive neuro-fuzzy inference systems. The method can extract FECG components from abdominal signal by using one abdominal channel, including maternal and fetal cardiac signals and other environmental noise signals, and one chest channel. The proposed algorithm detects the nonlinear dynamics of the mother's body. So, the components of the MECG are estimated from the abdominal signal. By subtracting estimated mother cardiac signal from abdominal signal, fetal cardiac signal can be extracted. This algorithm was applied on synthetic ECG signals generated based on the models developed by McSharry et al. and Behar et al. and also on DaISy real database. In environments with high uncertainty, our method performs better than the Type-1 fuzzy method. Specifically, in evaluation of the algorithm with the synthetic data based on McSharry model, for input signals with SNR of -5dB, the SNR of the extracted FECG was improved by 38.38% in comparison with the Type-1 fuzzy method. Also, the results show that increasing the uncertainty or decreasing the input SNR leads to increasing the percentage of the improvement in SNR of the extracted FECG. For instance, when the SNR of the input signal decreases to -30dB, our proposed algorithm improves the SNR of the extracted FECG by 71.06% with respect to the Type-1 fuzzy method. The same results were obtained on synthetic data based on Behar model. Our results on real database reflect the success of the proposed method to separate the maternal and fetal heart signals even if their waves overlap in time. Moreover, the proposed algorithm was applied to the simulated fetal ECG with ectopic beats and achieved good results in separating FECG from MECG. The results show the superiority of the proposed Type-2 neuro-fuzzy inference method over the Type-1 neuro-fuzzy inference and the polynomial networks methods, which is due to its

Portable ECG design and application based on wireless sensor network

Directory of Open Access Journals (Sweden)

Gül Fatma TÜRKER

2016-05-01

Full Text Available In this study, in order to follow the heart signals of patients that needs to be monitored instantly and continuously without mobility restrictions, a portable electrocardiogram circuit is designed. After performing the detection, upgrading, cleaning and digitizing of ECG signal received from patient via disposable electrodes, ECG signals was performed that transmit to a central node with Wireless Sensor Network (WSN based on ZigBee 802.11.4 standard. Central node is connected to the serial port of a computer. Received data from the central node is processed on computer and continuous flow graph is obtained. The obligation to use wires for tracing patients’ ECG has been removed with this portable system. As it can be seen in this study, thanks to WSN’s property of forming network by itself and its augmentable loop property, the restrain of ECG signals to reach far away distances can be surmounted. The transmission of biological signals with WSN will light on many studies that follow of patients from a distance.

A Novel Approach to ECG Classification Based upon Two-Layered HMMs in Body Sensor Networks

Directory of Open Access Journals (Sweden)

Wei Liang

2014-03-01

Full Text Available This paper presents a novel approach to ECG signal filtering and classification. Unlike the traditional techniques which aim at collecting and processing the ECG signals with the patient being still, lying in bed in hospitals, our proposed algorithm is intentionally designed for monitoring and classifying the patient’s ECG signals in the free-living environment. The patients are equipped with wearable ambulatory devices the whole day, which facilitates the real-time heart attack detection. In ECG preprocessing, an integral-coefficient-band-stop (ICBS filter is applied, which omits time-consuming floating-point computations. In addition, two-layered Hidden Markov Models (HMMs are applied to achieve ECG feature extraction and classification. The periodic ECG waveforms are segmented into ISO intervals, P subwave, QRS complex and T subwave respectively in the first HMM layer where expert-annotation assisted Baum-Welch algorithm is utilized in HMM modeling. Then the corresponding interval features are selected and applied to categorize the ECG into normal type or abnormal type (PVC, APC in the second HMM layer. For verifying the effectiveness of our algorithm on abnormal signal detection, we have developed an ECG body sensor network (BSN platform, whereby real-time ECG signals are collected, transmitted, displayed and the corresponding classification outcomes are deduced and shown on the BSN screen.

Making Sense of the ECG - Cases for Self-Assessment Houghton Andrew R Gray David Making Sense of the ECG - Cases for Self-Assessment 290pp Hodder Education 9780340946893 034094689X [Formula: see text].

Science.gov (United States)

2010-10-27

This practical, pocket-book approach to ECG interpretation accompanies the well-known text Making Sense of the ECG, by the same authors. It is also designed to be used alone to test knowledge of ECG interpretation and to make clinical decisions based on presented scenarios.

Reliability of the exercise ECG in detecting silent ischemia in patients with prior myocardial infarction

International Nuclear Information System (INIS)

Yamagishi, Takashi; Matsuda, Yasuo; Satoh, Akira

1991-01-01

To assess the reliability of the exercise ECG in detecting silent ischemia, ECG results were compared with those of stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) in 116 patients with prior myocardial infarction and in 20 normal subjects used as a control. The left ventricle (LV) was divided into 20 segmental images, which were scored blindly on a 5-point scale. The redistribution score was defined as thallium defect score of exercise subtracted by that of redistribution image and was used as a measure of amount of ischemic but viable myocardium. The upper limit of normal redistribution score (=4.32) was defined as mean+2 standard deviations derived from 20 normal subjects. Of 116 patients, 47 had the redistribution score above the normal range. Twenty-five (53%) of the 47 patients showed positive ECG response. Fourteen (20%) of the 69 patients, who had the normal redistribution score, showed positive ECG response. Thus, the ECG response had a sensitivity of 53% and a specificity of 80% in detecting transient ischemia. Furthermore, the 116 patients were subdivided into 4 groups according to the presence or absence of chest pain and ECG change during exercise. Fourteen patients showed both chest pain and ECG change and all these patients had the redistribution score above the normal range. Twenty-five patients showed ECG change without chest pain and 11 (44%) of the 25 patients had the abnormal redistribution. Three (43%) of 7 patients who showed chest pain without ECG change had the abnormal redistribution score. Of 70 patients who had neither chest pain nor ECG change, 19 (27%) had the redistribution score above the normal range. Thus, limitations exist in detecting silent ischemia by ECG in patients with a prior myocardial infarction, because the ECG response to the exercise test may have a low degree of sensitivity and a high degree of false positive and false negative results in detecting silent ischemia. (author)

Identification of the QRS Complex in the ECG

Directory of Open Access Journals (Sweden)

Martin Paralič

2016-12-01

Full Text Available The cardiovascular heart diseases are one of the most common causes of leading to death of man. Unfortunately, the symptoms vary and the most common reason for critical delays in medical treatment is lack of early warning and patient unawareness. In this paper, we present a development of the mobile application for Electrocardiogram measurements based on communication with a smart clothing using Bluetooth. The objectives of the application are a wireless data collection and analysis of ECG signal. The analysis is aimed for precise detection of QRS complex parameters plus detection of P-wave and T-wave. Measurement and evaluation of multiple PQRST parameters in a series allows detection of anomalies which leads to different heart diseases. Early warning system can help to make preventive actions to avoid severe heart disease. The recorded data are exported to format of the MIT/BIH arrhythmia database to be compatible with the professional medical software. This program will be devoted to the purposes of research and home healthcare instead of clinical diagnosis.

Simultaneous ECG-gated PET imaging of multiple mice

International Nuclear Information System (INIS)

Seidel, Jurgen; Bernardo, Marcelino L.; Wong, Karen J.; Xu, Biying; Williams, Mark R.; Kuo, Frank; Jagoda, Elaine M.; Basuli, Falguni; Li, Changhui; Griffiths, Gary L.

2014-01-01

Introduction: We describe and illustrate a method for creating ECG-gated PET images of the heart for each of several mice imaged at the same time. The method is intended to increase “throughput” in PET research studies of cardiac dynamics or to obtain information derived from such studies, e.g. tracer concentration in end-diastolic left ventricular blood. Methods: An imaging bed with provisions for warming, anesthetic delivery, etc., was fabricated by 3D printing to allow simultaneous PET imaging of two side-by-side mice. After electrode attachment, tracer injection and placement of the animals in the scanner field of view, ECG signals from each animal were continuously analyzed and independent trigger markers generated whenever an R-wave was detected in each signal. PET image data were acquired in “list” mode and these trigger markers were inserted into this list along with the image data. Since each mouse is in a different spatial location in the FOV, sorting of these data using trigger markers first from one animal and then the other yields two independent and correctly formed ECG-gated image sequences that reflect the dynamical properties of the heart during an “average” cardiac cycle. Results: The described method yields two independent ECG-gated image sequences that exhibit the expected properties in each animal, e.g. variation of the ventricular cavity volumes from maximum to minimum and back during the cardiac cycle in the processed animal with little or no variation in these volumes during the cardiac cycle in the unprocessed animal. Conclusion: ECG-gated image sequences for each of several animals can be created from a single list mode data collection using the described method. In principle, this method can be extended to more than two mice (or other animals) and to other forms of physiological gating, e.g. respiratory gating, when several subjects are imaged at the same time

Preliminary application of 320-detector spiral CT with ECG editing for assessing coronary artery in-stent restenosis

International Nuclear Information System (INIS)

Li Zhiming; Tan Lilian; Li Shuxin; Fu Xi; He Weihong; Liu Ke; Huang Yong; Yu Lin

2011-01-01

Objective: To determine the value of 320-detector spiral CT with retrospective ECG gating and editing software for detecting coronary artery in-stent restenosis. Methods: CT scans of 14 patients with coronary artery stnets were retrospectively analyzed. The examinations were performed using a 320-detector spiral CT scanner and retrospective ECG gating combined with ECG editing software. The image quality of reconstructed coronary artery in-stents was compared before and after the editing of synchronously recorded ECG. The paired-sample t test was used for statistical analysis. Results: Before ECG editing, arrhythmia and in-stent artifact resulted in image blurring, missing arterial segments, significant stepladder artifacts or non-visualization of the interior of stents. Of 14 cases before ECG editing, in-stent restenosis was detected in 10 and patency in 3. The coronary artery stent and distal bifurcation were delineated in one patient. After ECG editing, the image quality of coronary artery stents was improved with detection of in-stent restenosis (4 cases) including the one case that not evaluable before ECG editing. The average image quality score before ECG editing (2.14±0.86) was significantly (P<0.001) lower than that after ECG editing (3.07±0.73). Conclusion: Retrospective ECG gating combined with ECG editing of 320-detector spiral CT can reduce the artifacts produced by arrhythmia or in-stent swings and improve the imaging quality of coronary artery stents. (authors)

Interoperability in digital electrocardiography: harmonization of ISO/IEEE x73-PHD and SCP-ECG.

Science.gov (United States)

Trigo, Jesús D; Chiarugi, Franco; Alesanco, Alvaro; Martínez-Espronceda, Miguel; Serrano, Luis; Chronaki, Catherine E; Escayola, Javier; Martínez, Ignacio; García, José

2010-11-01

The ISO/IEEE 11073 (x73) family of standards is a reference frame for medical device interoperability. A draft for an ECG device specialization (ISO/IEEE 11073-10406-d02) has already been presented to the Personal Health Device (PHD) Working Group, and the Standard Communications Protocol for Computer-Assisted ElectroCardioGraphy (SCP-ECG) Standard for short-term diagnostic ECGs (EN1064:2005+A1:2007) has recently been approved as part of the x73 family (ISO 11073-91064:2009). These factors suggest the coordinated use of these two standards in foreseeable telecardiology environments, and hence the need to harmonize them. Such harmonization is the subject of this paper. Thus, a mapping of the mandatory attributes defined in the second draft of the ISO/IEEE 11073-10406-d02 and the minimum SCP-ECG fields is presented, and various other capabilities of the SCP-ECG Standard (such as the messaging part) are also analyzed from an x73-PHD point of view. As a result, this paper addresses and analyzes the implications of some inconsistencies in the coordinated use of these two standards. Finally, a proof-of-concept implementation of the draft x73-PHD ECG device specialization is presented, along with the conversion from x73-PHD to SCP-ECG. This paper, therefore, provides recommendations for future implementations of telecardiology systems that are compliant with both x73-PHD and SCP-ECG.

ECG Based Heart Arrhythmia Detection Using Wavelet Coherence and Bat Algorithm

Science.gov (United States)

Kora, Padmavathi; Sri Rama Krishna, K.

2016-12-01

Atrial fibrillation (AF) is a type of heart abnormality, during the AF electrical discharges in the atrium are rapid, results in abnormal heart beat. The morphology of ECG changes due to the abnormalities in the heart. This paper consists of three major steps for the detection of heart diseases: signal pre-processing, feature extraction and classification. Feature extraction is the key process in detecting the heart abnormality. Most of the ECG detection systems depend on the time domain features for cardiac signal classification. In this paper we proposed a wavelet coherence (WTC) technique for ECG signal analysis. The WTC calculates the similarity between two waveforms in frequency domain. Parameters extracted from WTC function is used as the features of the ECG signal. These features are optimized using Bat algorithm. The Levenberg Marquardt neural network classifier is used to classify the optimized features. The performance of the classifier can be improved with the optimized features.

Effects of electrocardiography contamination and comparison of ECG removal methods on upper trapezius electromyography recordings.

Science.gov (United States)

Marker, Ryan J; Maluf, Katrina S

2014-12-01

Electromyography (EMG) recordings from the trapezius are often contaminated by the electrocardiography (ECG) signal, making it difficult to distinguish low-level muscle activity from muscular rest. This study investigates the influence of ECG contamination on EMG amplitude and frequency estimations in the upper trapezius during muscular rest and low-level contractions. A new method of ECG contamination removal, filtered template subtraction (FTS), is described and compared to 30 Hz high-pass filter (HPF) and averaged template subtraction (ATS) methods. FTS creates a unique template of each ECG artifact using a low-pass filtered copy of the contaminated signal, which is subtracted from contaminated periods in the original signal. ECG contamination results in an over-estimation of EMG amplitude during rest in the upper trapezius, with negligible effects on amplitude and frequency estimations during low-intensity isometric contractions. FTS and HPF successfully removed ECG contamination from periods of muscular rest, yet introduced errors during muscle contraction. Conversely, ATS failed to fully remove ECG contamination during muscular rest, yet did not introduce errors during muscle contraction. The relative advantages and disadvantages of different ECG contamination removal methods should be considered in the context of the specific motor tasks that require analysis. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

International Nuclear Information System (INIS)

Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E.; Schauerte, P.

2006-01-01

Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

Energy Technology Data Exchange (ETDEWEB)

Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany); Schauerte, P. [Medizinische Klinik 1, Universitaetsklinikum RWTH Aachen (Germany)

2006-02-15

Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

Sleep Apnoea Detection in Single Channel ECGs by Analyzing Heart Rate Dynamics

National Research Council Canada - National Science Library

Zywietz, C

2001-01-01

.... Sleep disorders are typically investigated by means of polysomnographic recordings. We have analyzed 70 eight-hour single-channel ECG recordings to find out to which extent sleep apneas may be detected from the ECG alone...

Chaos control applied to cardiac rhythms represented by ECG signals

International Nuclear Information System (INIS)

Borem Ferreira, Bianca; Amorim Savi, Marcelo; Souza de Paula, Aline

2014-01-01

The control of irregular or chaotic heartbeats is a key issue in cardiology. In this regard, chaos control techniques represent a good alternative since they suggest treatments different from those traditionally used. This paper deals with the application of the extended time-delayed feedback control method to stabilize pathological chaotic heart rhythms. Electrocardiogram (ECG) signals are employed to represent the cardiovascular behavior. A mathematical model is employed to generate ECG signals using three modified Van der Pol oscillators connected with time delay couplings. This model provides results that qualitatively capture the general behavior of the heart. Controlled ECG signals show the ability of the strategy either to control or to suppress the chaotic heart dynamics generating less-critical behaviors. (paper)

ECG scaling properties of cardiac arrhythmias using detrended fluctuation analysis

International Nuclear Information System (INIS)

Rodriguez, E; Echeverria, J C; Alvarez-Ramirez, J; Lerma, C

2008-01-01

We applied detrended fluctuation analysis to characterize at very short time scales during episodes of cardiac arrhythmias the raw electrocardiogram (ECG) waveform, aiming to get a global insight into its dynamical behaviour in patients who experienced sudden death. We found that in 15 recordings involving different types of arrhythmias (taken from PhysioNet's Sudden Cardiac Death Holter Database), the ECG waveform, besides showing a less-random dynamics, becomes more regular during bigeminy, ventricular tachycardia or even atrial fibrillation and ventricular fibrillation. The ECG waveform scaling properties thus suggest that reduced complexity dominates the underlying mechanisms of arrhythmias. Among other explanations, this may result from shorted or restricted (i.e. less diverse) pathways of conduction of the electrical activity within ventricles

Classification of a Driver's cognitive workload levels using artificial neural network on ECG signals.

Science.gov (United States)

Tjolleng, Amir; Jung, Kihyo; Hong, Wongi; Lee, Wonsup; Lee, Baekhee; You, Heecheon; Son, Joonwoo; Park, Seikwon

2017-03-01

An artificial neural network (ANN) model was developed in the present study to classify the level of a driver's cognitive workload based on electrocardiography (ECG). ECG signals were measured on 15 male participants while they performed a simulated driving task as a primary task with/without an N-back task as a secondary task. Three time-domain ECG measures (mean inter-beat interval (IBI), standard deviation of IBIs, and root mean squared difference of adjacent IBIs) and three frequencydomain ECG measures (power in low frequency, power in high frequency, and ratio of power in low and high frequencies) were calculated. To compensate for individual differences in heart response during the driving tasks, a three-step data processing procedure was performed to ECG signals of each participant: (1) selection of two most sensitive ECG measures, (2) definition of three (low, medium, and high) cognitive workload levels, and (3) normalization of the selected ECG measures. An ANN model was constructed using a feed-forward network and scaled conjugate gradient as a back-propagation learning rule. The accuracy of the ANN classification model was found satisfactory for learning data (95%) and testing data (82%). Copyright © 2016 Elsevier Ltd. All rights reserved.

The Telemetric and Holter ECG Warehouse Initiative (THEW): a Data Repository for the Design, Implementation and Validation of ECG-related Technologies

Science.gov (United States)

Couderc, Jean-Philippe

2011-01-01

We present an initiative supported by the National Heart Lung, and Blood Institute and the Food and Drug Administration for the development of a repository containing continuous electrocardiographic information to be shared with the worldwide scientific community. We believe that sharing data reinforces open scientific inquiry. It encourages diversity of analysis and opinion while promoting new research and facilitating the education of new researchers. In this paper, we present the resources available in this initiative for the scientific community. We describe the set of ECG signals currently hosted and we briefly discuss the associated clinical information (medical history. Disease and study-specific endpoints) and software tools we propose. Currently, the repository contains more than 250GB of data from eight clinical studies including healthy individuals and cardiac patients. This data is available for the development, implementation and validation of technologies related to body-surface ECGs. To conclude, the Telemetric and Holter ECG Warehouse (THEW) is an initiative developed to benefit the scientific community and to advance the field of quantitative electrocardiography and cardiac safety. PMID:21097349

Measurement of ventricular function by ECG gating during atrial fibrillation

International Nuclear Information System (INIS)

Bacharach, S.L.; Green, M.V.; Bonow, R.O.; Findley, S.L.; Ostrow, H.G.; Johnston, G.S.

1981-01-01

The assumptions necessary to perform ECG-gated cardiac studies are seemingly not valid for patients in atrial fibrillation (AF). To evaluate the effect of AF on equilibrium gated scintigraphy, beat-by-beat measurements of left-ventricular function were made on seven subjects in AF (mean heart rate 64 bpm), using a high-efficiency nonimaging detector. The parameters evaluated were ejection fraction (EF), time to end-systole (TES), peak rates of ejection and filling (PER,PFR), and their times of occurrence (TPER, TPFR). By averaging together single-beat values of EF, PER, etc., it was possible to determine the true mean values of these parameters. The single-beam mean values were compared with the corresponding parameters calculated from one ECG-gated time-activity curve (TAC) obtained by superimposing all the single-beat TACs irrespective of their length. For this population with slow heart rates, we find that the values for EF, etc., produced from ECG-gated time-activity curves, are very similar to those obtained from the single-beat data. Thus use of ECG gating at low heart rates may allow reliable estimation of average cardiac function even in subjects with AF

Wireless and Non-contact ECG Measurement System – the “Aachen SmartChair”

Directory of Open Access Journals (Sweden)

A. Aleksandrowicz

2007-01-01

Full Text Available This publication describes a measurement system that obtains an electrocardiogram (ECG by capacitively coupled electrodes. Fordemonstration purposes, this measurement system was integrated into an off-the-shelf office chair (so-called “Aachen SmartChair”.Whereas in usual clinical applications adhesive, conductively-coupled electrodes have to be attached to the skin, the described system is able to measure an ECG without direct skin contact through the cloth. A wireless communication module was integrated for transmitting theECG data to a PC or to an ICU patient monitor. For system validation, a classical ECG with conductive electrodes and an oxygensaturation signal (SpO2 were obtained simultaneously. Finally, system-specific problems of the presented device are discussed.

Comparing IM Residents with EM Resident for Their Skills of ECG Interpretation and Outlining Management Plan Accordingly

Directory of Open Access Journals (Sweden)

Hamid Reza Karimpoor Tari

2009-06-01

Full Text Available Background and Purpose: Electrocardiogram (ECG is one of the most commonly performed investigations in cardiac diseases and ECG abnormalities can reveal the early manifestations of cardiac ischemia, metabolic disorders, or life-threatening disrhythmias. Misinterpretation of ECG and its consequent mistreatment or performing inessential  interventions may cause life-threatening cardiac events. Since EM residents and internal medicine (IM residents are usually the first to visit at bedside and start treatments based on patient’s ECG, we intended to evaluate the ability of EM residents to interpret ECGs and to compare it with that of IM residents using various ECG samples.Method: 63 participants including 33 IM residents and 30 EM residents from two education hospitals of Shahid Beheshti University of Medical Sciences were enrolled in our study. A diagnosis test consisting of 15 ECG samples associated with a questionnaire containing questions about gender, academic year and proficiency in ECG interpretation was taken from all participants. This study was conducted under the supervision of a cardiologist and an emergency specialist who supervised the ECG selection, answers and scoring of each ECG. The maximum score for each ECG was 6 which were given to a completely correct diagnosis and -0.25 negative point was given if the answer was wrong or any differential diagnosis was mentioned. After the test, the answer sheets were collected and wereanalyzed with SPSS program, by two of study authors who were kept blind to the real identities of participants.Results: After classification of groups, the overall mean score was 45.5/100 (38-60. The mean score of IM and EM residents was 56.0/100 (44.9-72 and 38.9/100 (31.5-45.5, respectively (p< 0.001.No significant correlation was found between the diagnosis scores and participant’s self-judgment on her/his ECG interpretation skills (p=0.897, r=0.017. Five ECGs were considered as the most important and

Locally-adaptive Myriad Filters for Processing ECG Signals in Real Time

Directory of Open Access Journals (Sweden)

Nataliya Tulyakova

2017-03-01

Full Text Available The locally adaptive myriad filters to suppress noise in electrocardiographic (ECG signals in almost in real time are proposed. Statistical estimates of efficiency according to integral values of such criteria as mean square error (MSE and signal-to-noise ratio (SNR for the test ECG signals sampled at 400 Hz embedded in additive Gaussian noise with different values of variance are obtained. Comparative analysis of adaptive filters is carried out. High efficiency of ECG filtering and high quality of signal preservation are demonstrated. It is shown that locally adaptive myriad filters provide higher degree of suppressing additive Gaussian noise with possibility of real time implementation.

Joint protocol relating to the application of the Vienna Convention and the Paris Convention. Status list as of 12 September 2000. Signature, ratification, acceptance, approval or accession

International Nuclear Information System (INIS)

2000-01-01

The document presents the status of signature, ratification, acceptance, approval or accession of the Joint Protocol Relating to the Application of the Vienna Convention and the Paris Convention as of 12 September 2000. The Joint Protocol entered into force on 27 April 1992

Application of a New Robust ECG T-Wave Delineation Algorithm for the Evaluation of the Autonomic Innervation of the Myocardium