Computer analysis of implanted cardiac pacemaker rhythm (original) (raw)
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Enhanced software based detection of implanted cardiac pacemaker stimuli
2009 36th Annual Computers in Cardiology Conference, 2009
With increasing use and sophistication of implantable cardiac pacemaker devices, new techniques are required to ensure accurate detection of pacemaker stimuli. This study aimed to (i) compare the accuracy of enhanced pacemaker spike detection logic using 32,000 samples/sec (sps) data against existing software based on current AAMI/IEC standards; (ii) assess the ability of the new logic to aid in the detection of biventricular (BiV) pacing; (iii) develop and test a method for the detection of BiV pacing based on QRS morphology. 72 patients were recruited. 63 were used to assess spike detection accuracy and 62 to assess the accuracy of reporting BiV pacing. 33/62 had BiV pacemakers. 9 patients were excluded for various reasons. The new logic improved accuracy of spike detection from 46/63 to 62/63. For BiV pacing, the new logic had a sensitivity of 97% and a specificity of 100% while the QRS morphology logic had a sensitivity of 70% and a specificity of 93%.
2007 Computers in Cardiology, 2007
Pacemaker outputs are poorly recorded and displayed by the standard ECG. A new high resolution ECG system optimized for recording outputs from electronic pacemakers was evaluated. Three ECGs with different pulse settings were recorded in 42 patients with pacemakers at a sampling rate of 75 kHz using a new ECG acquisition module. Atrial and ventricular pulses were detected and the measured pulse widths and amplitudes were compared to the programmed values. For the atrium, the correlations between programmed and measured width and amplitude were 0.85 and 0.74, while for the ventricle they were 0.99 and 0.8. Leads II and V1 had the highest atrial amplitude, and leads V3, V4 and V5 had the highest ventricular amplitude. The new high resolution ECG pacemaker system dramatically improved the reproduction of pacemaker outputs, allowing accurate measurement of pulse duration for both atrial and ventricular pulses.
Implanted cardiac pacemaker pulses as recorded from the body surface
Journal of Electrocardiology, 2012
This study investigates the characteristics of contemporary pacemaker pulses as recorded from the body surface. Twelve-lead paced ECGs from 140 patients (68±12 years, 71% males) were collected at 32,000 samples per second. Pacer pulses were manually annotated based on the high-sampling rate data stream. The results show that durations of the various pulses are stable, while amplitudes exhibit large variations. Also, more than 50% of pulses have either durations b0.5 ms or amplitudes b2 mV, which are the AAMI/IEC thresholds for detection and marking of pacemaker pulses on an ECG report. Therefore the current standards for pacemaker pulse detection are not fit for purpose and require to be updated. Further, this study suggests that a high-sampling rate database should be used as a standard test for pacemaker annotation and detection from body surface ECGs.
Pace-pacing and Clinical Electrophysiology, 1993
The detection of atrial activation from a standard ventricular pacing lead with standard ventricular electrodes would provide patients with VVI and VVIR pacing systems atrial rate response and atrial synchrony. In addition to potentially increasing cardiac output appropriately in these patients at rest and during moderate exercise, P wave sensing with such a device could help reduce pacemaker syndrome. In this study, unipolar signals from distal and proximal intraventricular electrodes were recorded from the right ventricular apex in 20 patients. Unipolar eJectrograms from 16 patients were recorded using temporary electrophysiology catheters and in four patients using permanent pacemaker leads. Approximately 3 minutes of data per patient were acquired and analyzed. After selection of a P wave template, the difference in baseline normalized area between the template and signal was calculated on a point-by-point basis. The percent of atrial depolarizations correctly detected was determined for each patient and lead configuration at the optimal threshold. Far-field P wave accuracy was better at the proximal electrode (74 ± 25%) than at the distal electrode (57 ± 34%) (P < 0.025). At the proximal electrode, 15/20 (75%) patients had > 70% accuracy and 11/20 (55%) patients had > 80% accuracy. At the distal electrode, 10/21 (48%) patients had > 70% accuracy and 7/21 (33%) patients had > 80% accuracy. In conclusion, far-field detection of atrial activation at the ventricular proximal electrode appears possible with sufficient accuracy to provide periods of atrial rate response and synchrony in patients with a single standard lead.
Computer diagnosis of the heart - pacemaker interface
Measurement, 1989
The object of the so-called Electrocardiographic Inverse Problem is the algorithmic analysis and diagnosis of the electrocardiogram (ECG). A part of this general problem is the Pacemaker Inverse Problem, which means the analysis of the ECG in order to establish details of heart-pacemaker interaction (HPI) with special reference to the diagnosis of pacemaker failure. The solution to this problem is of practical importance, because it is often impossible to evaluate such records clinically. The ECG patterns of natural cardiac activity and of the events stimulated by the pacemaker may not be distinguishable and many combinations of potential response of the implanted device have to be taken into account. A computer system providing automatic analysis of the HPI, based on ECG data, has been developed and implemented on an IBM PC AT computer. The system uses a complex algorithm which enables the evaluation of all possible combinations of HPI events, and establishes for each of these combinations its correspondence to the specified pacemaker algorithm. The system is written in Turbo Pascal and its source text has more than 11000 lines.
Computerized interpretation of the paced ECG
Journal of Electrocardiology, 1991
Analysis of the paced electrocardiogram (ECG) is important to the follow-up evaluation of patients with implanted pacemakers. Because of the complexity and variability of pacemaker algorithms, diagnosis of paced ECGs is often considerably more difficult than the interpretation of usual ECGs. Automated interpretation of the paced ECG can provide great clinical benefit because few clinicians are adequately trained in the diagnosis of such ECGs for the interpretation of pacemaker functionality. However, comparatively little work has been done in this area, mainly because the diversity and complexity of pacemaker logic makes interpretation, automated or manual, a difficult task. The following paper reviews research in computer interpretation of the pacemaker ECG and presents a new automated method which yields more detailed and accurate results than any previous technique. Key words: pacemaker. electrocardiogram, computer, diagnosis.
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2008
Correct pacemaker (PM) diagnosis of paroxysmal atrial tachyarrhythmias is crucial for their prevention and intervention with specific atrial pacing programmes. The PM mode switch to only ventricular pacing after detection of atrial tachyarrhythmias is often used as the parameter to quantify the 'burden' of atrial tachyarrhythmias. This review addresses potential errors in the detection and diagnosis of atrial tachyarrhythmias, sometimes resulting in incorrect mode switches. The interpretation of PM-stored data of patients with atrial tachyarrhythmias and the results of trials of pace prevention and intervention can be better appreciated with more insight into the technical options and pitfalls. Literature and clinical experience demonstrate that the correctness of PM-derived diagnosis of atrial tachyarrhythmias depends on 1) the sensitivity setting to detect the onset and perpetuation of atrial tachyarrhythmias frequently characterised by variable and low-voltage signals, 2)...
Methods for Detecting Pacemaker Pulses in ECG Signal : A Review
2014
This paper reviews some different methods for detecting the pulses created by an implanted cardiac pacemaker in the ECG signal. It includes a hardware method implemented in a Texas Instruments circuit, software method proposed by Herleikson and patented by Hewlett-Packard, an upgrade of Herleikson’s algorithm reported by Polpetta and Banelli and an software pace pulse detection embedded in the analog front end module of Analog Devices – ADAS1000.
Cardiovascular Engineering, 2004
Automatic mode switching, enabling the pacemaker to pace at an independent ventricular rate when atrial fibrillation occurs, was introduced to provide protection against rapid ventricular pacing during atrial arrhythmia. This study proposes a technique to test automatic mode switching performance. It is based on a programmable system (Arrhythmia Simulator) generating pulse trains that, when applied to the patient's skin, may interfere with the implanted device simulating supraventricular arrhythmias. The amplitude of the output signals is 5 V and they are delivered through an output resistance of 50 k limiting the current to 100 µA that guarantees no risk of muscle stimulation during the test and meanwhile low noise signals on the surface ECG. The duration of pulses is 20 ms. Pulses delivered by the Arrhythmia Simulator were correctly sensed by the pacemaker's atrial channel, and the detected amplitude was 2 ± 0.8 mV, ranging from 1 to 3 mV. The performance of the system was reliable and safe in every patient despite the use of different pacemaker leads. Automatic mode switching was induced in every patient at every attempt. The pulses delivered by Arrhythmia Simulator didn't alter the quality of ECG tracings making easy and reliable the analysis.