JP2002224069A - Body surface multi-lead electrocardiogram device and analytical method using this device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a body surface multi-lead electrocardiogram device for analyzing and displaying a conduction mode of a fibrillary wave on a body surface and the body surface distribution of the frequency analyzing frequency or part identification of atrial period outside shrinkage. SOLUTION: This body surface multi-lead electrocardiogram device is characterized by having an electrode 1 installed on an organism, an amplifying means 2 amplifying an electrocardiogram signal led from the electrode, an analog digital converting means 3 connected to the amplifying means, and digitally converting an XYZ lead electrocardiogram, a voltage calibrating part 4 calibrating voltage of a signal from the analog digital converting means, a storage part 6 storing the signal from the voltage calibrating part, an operation part 5 analyzing the atrial fibrillation wave or the atrial period outside shrinkage on the basis of the signal from the voltage calibrating part and the signal from the storage part, and a display part 7 displaying output from the operation part.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrocardiographic apparatus, and more particularly to a method of conducting atrial fibrillation waves on a body surface, analyzing the frequency thereof, distributing the frequency to the body surface, and identifying a site of premature atrial contraction. The present invention relates to a body surface multi-lead electrocardiogram apparatus for analyzing and displaying the data.

[0002]

2. Description of the Related Art An electrocardiogram will now be described.
As shown in FIG. 10, the electrocardiogram includes a P-wave, an R-wave, a T-wave, and a U-wave in a waveform of one cardiac cycle (one beat). This electrocardiogram is a schematic / standard one, and the part of each name is missing or has two or more parts depending on the individual or due to the lead. FIG. 11 shows a normal 5-second standard 12-lead ECG.
FIG. 12 shows a standard 12-lead electrocardiogram in which atrial fibrillation was recorded for 5 seconds, and FIG. 13 shows a standard 12-lead electrocardiogram in which atrial extrasystole was recorded.

[0003] In the normal state, the atrium of the heart is about 70 per minute.
There is an arrhythmia that oscillates but is atrial fibrillation, which is about 300-600 minute movements per minute that are not coordinated with ventricular movements. Over the age of 60, 3 to 5 percent of people have atrial fibrillation. Atrial fibrillation tends to form a blood clot in the atrium, which is considered to be one of the leading causes of cerebral thrombosis that jumps to the brain.

[0004]

By the way, although it can be understood from the normal standard 12-lead electrocardiogram as shown in FIG. 12 that atrial fibrillation has occurred, the characteristics of atrial fibrillation are examined and any part of the atria is examined. There is a problem that there is no method for analyzing the spatial distribution of whether or not the patient is arising, and it is difficult to determine whether an appropriate treatment for atrial fibrillation can be performed.

In order to solve this problem, it is necessary to analyze atrial fibrillation waves. In the case of atrial fibrillation waves, a QRST wave, which is a motion (excitation) of a ventricle, is placed on the atrial fibrillation waves. The overlap is large, and the QRST wave is larger than the atrial fibrillation wave and becomes noise in frequency analysis. Furthermore, when trying to see the continuous potential change of the atrial fibrillation wave, the atrial fibrillation wave is buried in the QRST wave and cannot be seen, making the analysis difficult (in FIG. 12, the size differs depending on the lead, but T
The fine swing recorded in the next QRS wave part from the end of the wave is the atrial fibrillation wave. In the QRST wave part, it does not overlap and cannot be seen. ), There is a problem that it is necessary to remove this QRST wave. It should be noted that the atrial fibrillation wave recorded as fine shaking in the standard 12-lead electrocardiogram in which atrial fibrillation is recorded in FIG. The atrial fibrillation wave and the QRST wave, which is the excitation of the ventricle, are not interlocked and are independent of each other.

[0006] The onset of atrial fibrillation often starts with abnormal abnormal movement (excitation) in the atria, called atrial extrasystole. Atrial fibrillation that begins with atrial premature contraction can be treated by burning the local atrial muscle, which is the source of atrial premature contraction, by catheter ablation. The origin of the atrial premature contraction can be analyzed by analyzing the atrial wave (P wave) of the atrial premature contraction by analyzing the morphology and potential distribution. However, the atrial premature contraction occurs from the abnormal atrial site at a timing earlier than the normal timing heart motion (excitation) that occurs after the normal timing heart motion (excitation). (P wave) is often superimposed on the T wave of the preceding normal timing electrocardiogram, and the P wave of atrial extrasystole is buried in the T wave which is much larger than the P wave, and the waveform cannot be recognized ( FIG.
(The fifth QRST wave is an atrial premature contraction, but its P wave overlaps with the previous T wave, and it is not clear.) Currently, a method for non-invasively evaluating this atrial extrasystole has been established. There is a problem that there is no. In the standard 12-lead electrocardiogram in which the atrial premature contraction of FIG. 13 is recorded, the atrial premature contraction is the P of the atrial premature contraction originating from the abnormal atrial site.
A wave and its excitation are transmitted to the ventricle, and the ventricle excitation (QRST wave of atrial extrasystole) is collectively referred to.

In this apparatus, the analysis of the temporal and spatial characteristics of the atrial fibrillation wave in atrial fibrillation and the characteristics of atrial extrasystole are performed.
It is an object of the present invention to provide a body surface multi-lead electrocardiogram apparatus that integrates source analysis and solve the above problems. The first reason is that in the treatment of arrhythmia called atrial fibrillation, the treatment for atrial premature contraction that causes atrial fibrillation and the treatment for atrial fibrillation itself are a series, and the second is ECG. The means used for both analyzes, such as the electrocardiogram averaging means, the R-wave synchronized electrocardiogram waveform subtracting means, and the mapping display means such as an equipotential diagram by a multi-lead electrocardiogram, are common.

In the body surface multi-lead electrocardiogram apparatus of the present invention, an electrocardiogram averaging means and an R-wave synchronized electrocardiogram waveform subtracting means are applied. First, an atrial fibrillation electrocardiogram QRST wave portion is deleted and only an atrial fibrillation wave is obtained. The waveform is obtained, and the spatial conduction mode and the time characteristic and spatial distribution of the frequency component obtained by the frequency analysis are obtained. In addition, second, the atrial premature contraction atrial wave (P wave) superimposed on the preceding electrocardiographic T wave is eliminated from the T wave to obtain only the atrial wave, and the spatial conduction mode and the origin in the atrium are determined. Identify.

[0009]

The technical solution adopted by the present invention is an electrode mounted on a living body, an amplifying means for amplifying an electrocardiogram signal induced from the electrode, and an XYZ connected to the amplifying means. Analog-to-digital conversion means for digitally converting a lead electrocardiogram, a voltage calibration unit for calibrating a signal from the analog-to-digital conversion means, a storage unit for storing a signal from the voltage calibration unit, and a signal from the voltage calibration unit An arithmetic unit that performs atrial fibrillation wave analysis or analysis of atrial extrasystole based on a signal from the storage unit,
A body surface multi-lead electrocardiogram device comprising a display unit for displaying an output from a calculation unit. The arithmetic unit fetches the multi-electrode measurement electrocardiogram and outputs the template QRS
ECG lead selecting means for selecting one ECG lead to be displayed and operated to form a T waveform, and QRST waveform forming means (6b) for forming a template QRST waveform based on the ECG selected by the ECG lead selecting means. , The QRS
QRST waveform subtracting means (6c) for synchronizing the template QRST waveform formed by the T waveform forming means with the R wave from the QRST wave of the multi-electrode measurement electrocardiogram, and subtracting the atrial required for atrial fibrillation wave analysis. Frequency analysis means (6d) for analyzing the frequency of the fibrillation wave, and equipotential and isofrequency diagrams based on signals from the QRST waveform subtraction means (6c) or the frequency analysis means (6d). A display means (6e) for forming a mapping such as a frequency power value diagram and an equi-integrated potential diagram.
2. The body surface multi-lead electrocardiogram device according to 1. A template QRST wave is formed based on the atrial fibrillation electrocardiogram, and the template QRST waveform is subtracted from the atrial fibrillation electrocardiogram to obtain Q
An atrial fibrillation wave analysis method characterized in that a waveform of only atrial fibrillation not including an RST wave is obtained, a frequency power spectrum is obtained by frequency analysis of the obtained atrial fibrillation wave, and displayed. A template QRST wave is formed based on the recorded electrocardiogram of atrial extrasystole, and this template QRS
Based on the T waveform and the QRS wave immediately before the atrial premature contraction, an atrial waveform from which the T wave was removed and the P wave of the atrial premature contraction became clear was obtained, and the P of the atrial extrasystole was determined. This is an atrial extrasystole analysis method characterized by displaying a potential distribution that changes with time of a wave.

[0010]

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a block diagram of an electrocardiographic apparatus according to an embodiment of the present invention, and FIG. 2 is a flowchart of an operation section of the apparatus. . The present electrocardiogram apparatus first obtains an atrial fibrillation wave by erasing a QRST wave part in the case of an atrial fibrillation electrocardiogram based on an electrocardiogram obtained from a conventional multi-lead electrocardiogram apparatus, analyzes the frequency, and analyzes the frequency component. Secondly, in the analysis of atrial premature contraction, the T wave of the electrocardiogram preceding the atrial premature contraction is eliminated and only the atrial wave is obtained. The major feature is that a means for specifying the spatial conduction mode and the origin in the atrium is added.

In FIG. 1, 1 is an electrode, 2 is an amplifying means, 3
Is an A / D converter, 4 is a voltage calibration unit, 5 is an operation unit, 6 is a storage unit, 7 is a display unit, 8 is an input unit, 9 is a recording unit,
Electrocardiogram signals guided from a large number of electrodes 1 attached to the body are respectively amplified by an amplifier 2 and then converted to time-series digital data by an A / D converter 3, and all subsequent processing is performed by software. It is performed by Further, the signal output from the storage unit 6 is subjected to voltage calibration in a voltage calibration unit 4 and is subjected to arithmetic processing by an arithmetic unit 5 described later. Based on the result, the temporal characteristics and spatial distribution of the frequency component of the atrial fibrillation wave, The conduction mode and origin of the P wave of atrial premature contraction are displayed on the display unit 8 and can be measured.

The arithmetic unit 5 will now be described in detail with reference to FIG. 2. The arithmetic unit 5 takes in two minutes of the multi-electrode measurement electrocardiogram from the storage means and uses it for an electrocardiogram subtraction process which will be described later. ECG lead selecting means (6a) for selecting one ECG lead to be displayed and operated to form a template QRST waveform (see FIGS. 3 and 7 and the description thereof), and one selected by the selecting means. One QRST waveform to be added and averaged from two electrocardiogram leads for two minutes to form a template QRST waveform is selected, and the QRST waveform of several tens of beats is added and averaged by well-known R-wave synchronized template matching to obtain a template QRST waveform. And a QRT waveform synchronizing means for subtracting the template QRST waveform from the QRST wave for two minutes of the multi-electrode measurement electrocardiogram in synchronization with the R wave. T waveform subtraction means (6c), frequency analysis means (6d) for analyzing the frequency of atrial fibrillation waves in the case of atrial fibrillation wave analysis, and equipotential, equi-frequency and equi-frequency power value diagrams A means (6e) for forming a mapping such as an equi-integral potential diagram.

In the case of atrial fibrillation wave analysis, the QRST waveform subtraction means (6c) performs subtraction by synchronizing a template QRST waveform with an R wave from a QRST wave for two minutes of a multi-electrode measurement electrocardiogram. In the case of atrial premature contraction, a QRST wave portion not involved in atrial premature contraction is used as a template QRST waveform and subtraction is performed in synchronization with the QRS wave immediately before the atrial premature contraction. To do
The QRST waveform subtraction means (6c) is configured to achieve both functions (details will be described later). Then, it is determined whether to perform atrial fibrillation wave analysis or atrial extrasystole analysis based on an input signal from an operation means (not shown), and a subtraction corresponding to this determination is performed.

Here, the processing in the arithmetic means 5 will be described in detail separately for the case of atrial fibrillation wave analysis and the case of atrial premature contraction based on the drawings. In the case of atrial fibrillation wave analysis, a procedure for removing the QRST wave and creating a waveform of only the atrial fibrillation wave will be described with reference to FIG. (7a) is an atrial fibrillation electrocardiogram.
Dozens of QRST wave portions of the electrocardiogram are averaged in synchronization with the R wave. Then, since the QRST wave and the atrial fibrillation wave of the electrocardiogram are independent of each other, the atrial fibrillation wave cancels out as noise and a QRST wave not including the atrial fibrillation wave is formed. This is the template QRST waveform (7b). This template QRST waveform is generated in synchronization with the QRS wave of the atrial fibrillation electrocardiogram 7a , and the end point of the T wave and the start point of the next QRS wave are linearly interpolated as 7c. When this 7c is subtracted from the atrial fibrillation electrocardiogram of 7a, QRST is obtained.
A waveform (7d) of only atrial fibrillation without waves is obtained.
The same process is performed for 32 leads and the QRST wave is not included.
A guided atrial fibrillation wave (see FIG. 4) is obtained. Next, frequency analysis is performed on the atrial fibrillation wave. That is, a known fast Fourier transform (Fast F) is applied to an arbitrary section of the atrial fibrillation wave.
Our Transform (FFT) 3
A frequency power spectrum for two leads (see FIG. 5) is obtained.

The frequency power spectrum is a frequency value,
The power value and the like are displayed on the display unit 7 in FIG.
The measurement can be displayed as shown in FIG. In the representative example of the frequency power spectrum in 9b of FIG. 5, it is difficult to treat atrial fibrillation in the case of transient atrial fibrillation (9b-1) which can treat atrial fibrillation (9b-1) compared to chronic atrial fibrillation (9b-2). Thus, it can be seen that the frequency showing the maximum value of the power is lower. In addition, a potential distribution that changes with time of the 32-lead atrial fibrillation wave as an equipotential diagram, and a distribution of a frequency having a maximum power value in each lead from a frequency power spectrum as an isofrequency diagram,
The distribution of the power value at an arbitrary frequency is
As a value diagram, 10a and 10a in FIG.
It can be displayed as shown in FIG. From these, the excitement mode in the atrial fibrillation is evaluated, and the selection of the treatment method and the evaluation of the treatment effect are performed.

In the case of analysis of atrial premature contraction, a procedure for removing a T wave overlapping with a P wave of atrial premature contraction and forming a waveform of only a P wave will be described with reference to FIG. 11a is a recorded electrocardiogram of atrial premature contraction. A QRST wave portion of the electrocardiogram that is not involved in atrial extrasystole (for example, 11 in FIG. 7)
a) as a template QRST waveform (11b), synchronized with the QRS wave just before the atrial extrasystole,
Is subtracted from the electrocardiogram of 11a to obtain a waveform (11c) in which the T wave is removed and the P wave of atrial premature contraction becomes clear. A similar process was performed for lead 32, and a clear P-wave of atrial extrasystole that did not overlap with the T-wave for 32 leads (1 in FIG. 8)
2a, 12b). Next, the potential distribution that changes with the time of the P wave of atrial premature contraction is shown as an equipotential diagram,
The distribution of the time integral of the P wave of atrial premature contraction can be displayed as an isointegral value diagram on the display unit 7 of FIG. 1 as shown by 13a and 13b in FIG.

While the embodiments of the present invention have been described above, the present invention can be embodied in any other form without departing from the spirit or main features. Therefore, the above-described embodiment is merely an example in every aspect and should not be interpreted in a limited manner. For example, the frequency analysis is not limited to the FFT, and other methods such as a linear prediction method (Burg method) can be adopted as long as a similar analysis can be performed.

[0018]

As described above, according to the present invention, in a conventional electrocardiographic apparatus, it is difficult to analyze only atrial fibrillation waves in the case of atrial fibrillation because a QRST wave, which is an excitation of a ventricle, exists. Is a template QR using ECG averaging means
The characteristics of atrial fibrillation can be analyzed by applying a QRST wave removing means based on ST waveform formation to a body surface multi-lead electrocardiogram and using a processing means for mapping and displaying. Further, in the case of atrial premature contraction, the occurrence site can be specified by using the same processing means. There is no ECG analyzer equipped with these functions, and it meets clinical needs. In addition, the lead method and the number of leads of the electrocardiogram are only 32 leads, and various combinations that should not be interpreted in a limited manner are possible.

[Brief description of the drawings]

FIG. 1 is a block diagram of the present apparatus.

FIG. 2 is a processing flow diagram of five operation units in the block diagram of FIG. 1;

FIG. 3 is a diagram illustrating a means for extracting only an atrial fibrillation wave from an atrial fibrillation electrocardiogram in the case of atrial fibrillation by the processing of five arithmetic units.

FIG. 4 is a diagram of an atrial fibrillation electrocardiogram of 32 leads in the case of atrial fibrillation and only a 32 lead atrial fibrillation wave processed by a 5-calculation unit.

FIG. 5 is a diagram (9b) of a power spectrum (9a) for 32 leads and a typical power spectrum subjected to frequency analysis in five arithmetic units in the case of atrial fibrillation.

FIG. 6 is an equi-frequency diagram (10a) and an equi-potential diagram (10b) created by a 5-calculation unit in the case of atrial fibrillation.

FIG. 7 is a diagram illustrating a means for extracting only the P wave from the atrial premature contraction electrocardiogram in the case of atrial premature contraction by the processing of the five arithmetic units.

FIG. 8 shows a 32-lead atrial premature contraction electrocardiogram (12a) in the case of atrial premature contraction and a diagram (12b) showing only the P-wave of the 32-lead atrial premature contraction processed by the five calculation section. .

FIG. 9 is an equipotential diagram (13a) and an equi-integral potential diagram (13b) created by the 5 calculation unit in the case of atrial premature contraction.

FIG. 10 shows an electrocardiogram of one cardiac cycle (one beat) and names of respective parts thereof.

FIG. 11 is a normal 5-second standard 12-lead ECG.

FIG. 12 is a 5 second standard 12-lead electrocardiogram with atrial fibrillation recorded.

FIG. 13 is a standard 12-lead electrocardiogram with recorded atrial extrasystole.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Electrode 2 Amplification means 3 A / D conversion means 4 Voltage calibration part 5 Operation part 6 Storage part 7 Display part 8 Input part 9 Recording part

 ──────────────────────────────────────────────────続 き Continued on the front page F term (reference) 4C027 AA02 EE01 EE08 FF01 FF03 FF05 GG01 GG02 GG11 GG13 GG16 HH11 HH13 KK05

Claims (4)

[Claims] An electrode mounted on a living body, amplifying means for amplifying an electrocardiogram signal induced from the electrode, an analog-to-digital converting means connected to the amplifying means for digitally converting an XYZ lead electrocardiogram, and the analog-to-digital conversion A voltage calibrator for calibrating the signal from the means, a memory for storing the signal from the voltage calibrator, and atrial fibrillation wave analysis or atrial activity based on the signal from the voltage calibrator and the signal from the memory. A body surface multi-lead electrocardiogram device, comprising: a calculation unit for performing analysis of extrasystole; and a display unit for displaying an output from the calculation unit. 2. The arithmetic unit includes: an electrocardiogram lead selecting means for taking in a multi-electrode measurement electrocardiogram and selecting one electrocardiogram lead to be displayed and operated for forming a template QRST waveform;
QRST waveform forming means (6b) for forming a template QRST waveform based on the electrocardiogram selected by the electrocardiogram lead selecting means, and a QRS of the multi-electrode measurement electrocardiogram using the template QRST waveform formed by the QRST waveform forming means.
QRST waveform subtraction means (6c) for synchronizing and subtracting R waves from T waves, frequency analysis means (6d) for analyzing the frequency of atrial fibrillation waves required for atrial fibrillation wave analysis, and the QRST waveform A display for forming a mapping such as an equipotential diagram, an isofrequency diagram, an isofrequency power value diagram, or an equipotential diagram based on a signal from the subtracting means (6c) or the frequency analyzing means (6d). The body surface multi-lead electrocardiogram device according to claim 1, further comprising means (6e). 3. A template QR based on an atrial fibrillation electrocardiogram.
An ST wave is formed, the template QRST waveform is subtracted from the atrial fibrillation electrocardiogram to obtain a waveform of only atrial fibrillation not including the QRST wave, and the obtained atrial fibrillation wave is frequency-analyzed by frequency analysis. A method for analyzing atrial fibrillation waves, characterized by displaying and displaying. 4. A template QRST wave is formed based on an electrocardiogram in which atrial premature contraction is recorded, and the template QRST waveform and the QRS wave immediately before the atrial premature contraction are also generated. An atrial waveform in which the T-wave is removed and the P-wave of the atrial premature contraction is clarified, and a time-varying potential distribution of the P-wave of the atrial extrasystole is displayed. Extrasystole analysis method.