Data prediction for cases of incorrect data in multi-node electrocardiogram monitoring

The development of a mesh topology in multi-node electrocardiogram (ECG) monitoring based on the ZigBee protocol still has limitations. When more than one active ECG node sends a data stream, there will be incorrect data or damage due to a failure of synchronization. The incorrect data will affect signal interpretation. Therefore, a mechanism is needed to correct or predict the damaged data. In this study, the method of expectation-maximization (EM) and regression imputation (RI) was proposed to overcome these problems. Real data from previous studies are the main modalities used in this study. The ECG signal data that has been predicted is then compared with the actual ECG data stored in the main controller memory. Root mean square error (RMSE) is calculated to measure system performance. The simulation was performed on 13 ECG waves, each of them has 1000 samples. The simulation results show that the EM method has a lower predictive error value than the RI method. The average RMSE for the EM and RI methods is 4.77 and 6.63, respectively. The proposed method is expected to be used in the case of multi-node ECG monitoring, especially in the ZigBee application to minimize errors.

A Long-Term, Portable ECG Patch Monitor Based on Flexible Dry Electrode

PurposeLong-term electrocardiogram (ECG) monitoring is an essential approach for the early diagnosis of cardiovascular diseases. Flexible dry electrodes that contains electrolyte without water could be a potential substitution of wet electrodes for long-term ECG monitoring. Therefore, this paper developes a long-term, portable ECG patch based on flexible dry electrodes, namely SEUECG-100.MethodA device consists of analog-front-end acquisition, data acquisition, and storage modules is developed and tested. An impedance test was conducted to compare the skin-electrode impedance of the flexible dry electrode and the Ag/AgCl wet electrode. The ECG signals were simutanously collected from the same subject using the SEUECG-100 and Shimmer device , which were then compared and analyzed from the perspective of ECG morphology, RR interval, and signal quality indices (SQI).ResultsThe experimental results reveal that the flexible dry electrode has the characteristics of low skin-electrode impedance. SEUECG-100 could collect high-quality ECG signals. The ECG signals collected by the two devices have a high RR interval correlation (r=0.999). SQI results show that SEUECG-100 is better than the Shimmer device in overcoming baseline drift. Long-term ECG acquisition and storage experiments show that SEUECG-100 could collect ECG signals with good stability and high reliability.ConclusionThe implementation of the proposed system design with dry electrodes could can effectively record long-term ECG monitoring with high quality in comparison to systems with wet electrodes from both impedance characteristics and signal morphology aspects.

Correction of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm during antireflux operations

Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

LONG-TERM AMBULATORY ECG MONITORING AN ESSENTIAL DIAGNOSTIC TOOL FOR CURRENT TIMES

Ambulatory ECG (AECG) monitoring with diary correlation of symptoms has been proven to provide significant diagnostic, therapeutic and prognostic benefit with an arrhythmic cause of symptoms. Arrhythmias can range from premature atrial and ventricular complexes (APCs/ PVCs usually benign), to Atrial and Ventricular Fibrillation which causes significant morbidity and mortality. Symptoms such as palpitations, shortness of breath, chest pain and syncope are common during arrhythmias and their frequency determines the choice of investigation needed to diagnose the arrythmia. Arrhythmias can be a manifestation of many cardiac and non-cardiac diseases. These also include congenital diseases and are often missed due to inadequate monitoring. Since most arrhythmias are intermittent they are more likely to be detected during extended ECG monitoring. Other uses of ambulatory ECG devices include ST segment analysis, heart rate variability, signal averaged ECGs, diurnal QT and QTc analysis (including patients with long QT) (1) obstructive sleep apnea and vectorcardiography (2). These factors have been shown to have relation to significant cardiovascular diseases aiding the diagnosis of various arrhythmias. Syncope although mostly benign, could potentially be a consequence of a life-threatening arrhythmia in up to 20% patients(3). Nonetheless syncope poses a significant cause of disturbance in a patients’ life and definitive diagnosis is necessary to ensure patients well-being. ESC Guidelines on Syncope (2018) recommend further testing with AECG via Holter monitoring, wearable patch recorder, external and internal loop recorders etc. depending on the frequency after initial examination is negative for a definite cause. Atrial Fibrillation (AF) increases risk of stroke more than five times. Atrial Fibrillation diagnosed after stroke is an important hallmark of recurrent stroke risk. (7) Many studies have demonstrated post stroke AECG increases the chances of detecting AF (15% vs 5%) when compared to standard monitoring. An increase incidence in atrial arrythmias (atrial high rate episodes AHRE) has been seen in patients with Permanent Pacemakers which should be documented by AECG to be treated accordingly.(4). Uses can be prognostic if rate was to be monitored in AF to assess efficacy of rate control treatment and offer adequate anticoagulation according to the 2020 ESC atrial fibrillation guidelines. (8) Some limitations of twenty-four hours Holter monitoring have recently been overcome by improvements in hardware and software technology including adhesive patches and wireless telemetry. Newer adhesive patches are softer, waterproof and electrode free monitors which offer unprecedented mobility and ease of carrying out daily routine by the patient. They operate as either recorders or wireless streaming devices (5). These devices were safe and effective during the pandemic even when delivered home through mail to critically ill patients.(6) The advent of smart phones has added endless potential for recording through wireless Bluetooth transmission. Smart devices like the OMSHIRTtm have the added advantage of being comfortable to wear. Newer devices for example Cardiostat has been shown to offer equal quality tracings when compared to standard Holter monitoring, often up to the 99% sensitivity and specificity through better designed R wave (QRS) detection algorithms(7) (8)Studies have shown these newer devices to be easily operable and can even be mailed to patients homes for self-attachment with an equal efficacy to hospital applied machine (6). Many studies have shown a preference over intra cardiac monitors (ICM) due to these above mentioned advantages (9). The effectiveness of even longer recordings through Implantable Loop Recorder has also been satisfactory when following patients after Ablation therapy leading to practice updating guideline changes in rhythm management(10). A recent review article summarized that although physicians in the US had knowledge of how and when to offer monitoring devices based on the frequency of symptoms, they were often seen prescribing Holter monitoring due to familiarity. Data also showed that in case the initial investigation was inconclusive, the physician would still repeat the same investigation(3). In a country like Pakistan where there are limited resources, diagnosis and management of arrythmias still has a long way to go. This article sheds light on the need of utilizing the recommended available devices.

ECG monitoring of post-stroke occurring arrhythmias: an observational study using 7-day Holter ECG

Post-stroke arrhythmias represent a risk factor for complications and worse prognosis after cerebrovascular events. The aims of the study were to detect the rate of atrial fibrillation (AF) and other cardiac arrhythmias after acute ischemic stroke, by using a 7-day Holter ECG which has proved to be superior to the standard 24-h recording, and to evaluate the possible association between brain lesions and arrhythmias. One hundred and twenty patients with cryptogenic ischemic stroke underwent clinical and neuroimaging assessment and were monitored with a 7-day Holter ECG. Analysis of the rhythm recorded over 7 days was compared to analysis limited at the first 24 h of monitoring. 7-day Holter ECG detected AF in 4% of patients, supraventricular extrasystole (SVEB) in 94%, ventricular extrasystole (VEB) in 88%, short supraventricular runs (SVRs) in 54%, supraventricular tachycardia in 20%, and bradycardia in 6%. Compared to the first 24 h of monitoring, 7-Holter ECG showed a significant higher detection for all arrhythmias (AF p = 0.02; bradycardia p = 0.03; tachycardia p = 0.0001; SVEB p = 0.0002; VEB p = 0.0001; SVRs p = 0.0001). Patients with SVRs and bradycardia were older (p = 0.0001; p = 0.035) and had higher CHA2DS2VASc scores (p = 0.004; p = 0.026) respectively, in the comparison with patients without these two arrhythmias. An association was found between SVEB and parietal (p = 0.013) and temporal (p = 0.013) lobe lesions, whereas VEB correlated with insular involvement (p = 0.002). 7-day Holter ECG monitoring proved to be superior as compared to 24-h recording for the detection of all arrhythmias, some of which (SVEB and VEB) were associated with specific brain areas involvement. Therefore, 7-day Holter ECG should be required as an effective first-line approach to improve both diagnosis and therapeutic management after stroke.

AN EXPLORATORY STUDY OF PREDICTORS OF LATE ARRHYTHMIA RECURRENCES IN PATIENTS WITH PERSISTENT ATRIAL FI BRILLATION AFTER CARDIOVERSION

Introduction. The existing guidelines do not contain a clear algorithm for predicting the late recurrences of atrial fibrillation (AFib). Objectives. We have studied the predictors of late recurrence of arrhythmia in patients with persistent AFib after the restoration of sinus rhythm (SR). Research methods. A prospective single-center study included 120 hospitalized patients with persistent AFib who underwent successful cardioversion. The recurrence of AFib was assessed in the early period after cardioversion by recording 12-channel ECG, Holter ECG monitoring and event ECG monitoring. After a nine-month period follow-up visit was performed. Baseline demographic, clinical-functional features and comorbidities were compared in group with (n = 87) and without (n = 33) late recurrences of Afib. Results. There were no differences in demographic, anthropometric data and comorbidities. Patients with late recurrence of AFib had a lower heart rate (HR) after SR recovery (p <0.001). Early recurrences of AFib were found in 43 (49.4%) patients with late recurrences of arrhythmia and only in two (6.0%) without late recurrences (p <0.001). Patients with late recurrences of arrhythmia had a lower average daily HR (p <0.001), a higher number of single atrial extrasystoles (p = 0.001), atrial pairs and runs (p = 0.01) recorded by Holter ECG monitoring. Conclusions. Late recurrences of arrhythmia during the nine-month follow-up period were reported in 72.5% of patients. Groups of patients with and without late recurrence of arrhythmia had significant differences in the incidence of early recurrences, mean HR on SR, and the presence of atrial extrasystoles after rhythm recovery.

Surveillance of arrhythmia in post-myocardial infarction patients using wearable ECG patch devices: a prospective cohort study (Preprint)

BACKGROUND Acute myocardial infarction may be associated with new-onset arrhythmias. Myocardial infarction patients may manifest with serious arrhythmias such as ventricular tachyarrhythmias or atrial fibrillation. Frequent, prolonged electrocardiogram (ECG) monitoring can prevent devastating outcomes by these arrhythmias. OBJECTIVE We investigated the incidence of arrhythmias in post-myocardial infarction patients using a patch-type device: ATP-C120. METHODS This study is a non-randomized, single-center, prospective cohort study. We evaluated 71 patients with post-myocardial infarction who had been admitted to our hospital. The ATP-C120 device was attached for 11 days and analyzed by two cardiologists for new-onset arrhythmic events. RESULTS One participant was concordantly diagnosed with atrial fibrillation. Atrial premature beats occurred in 91.5% and 84.5% of participants, and ventricular premature beats occurred in 53.5% and 62.0%, respectively. Interestingly, 56.3% of the patients showed less than 2 minutes of sustained paroxysmal atrial tachycardia. Among participants with atrial tachycardia, the use of beta blockers was significantly lower (70.0% vs. 90.3%, p=0.037). However, different dosages of beta blockers did not show significant differences. CONCLUSIONS Wearable patch ECG monitoring devices are easy to apply and can correlate symptoms and ECG rhythm disturbances among post-myocardial infarction patients. Further study is necessary regarding clinical implications and appropriate therapies for arrhythmias detected early, post-myocardial infarction, to prevent adverse outcomes.