JP2019088643A - Electrocardiogram analysis apparatus and control method thereof - Google Patents

Abstract

To provide an electrocardiogram analyzer and a control method thereof capable of easily acquiring the waveform of an arrhythmia occurring in daily life as a control signal used for mapping in catheter ablation.SOLUTION: A section corresponding to a condition of a predetermined arrhythmia is detected from a measured electrocardiogram signal. If the posture of a subject at the time when the detected section is measured is a predetermined posture at the time of performing catheter ablation, the signal is extracted as a control signal for the pace mapping of the catheter ablation.SELECTED DRAWING: Figure 2

Description

  The present invention relates to an electrocardiogram analysis apparatus and a control method thereof.

  Among arrhythmias, catheter ablation is known as a treatment for tachycardia. Catheter ablation is a method of cauterizing myocardial tissue, which is a source of arrhythmia, to radically eliminate the occurrence of arrhythmia, using an ablation catheter (electrode catheter) inserted into the cardiovascular system through a vein or artery. Literature 1).

Atsushi Okumura et al., "Guidelines for diagnosis and treatment of cardiovascular disease (2010-2011 joint research report) Guidelines for indications and procedures for catheter ablation", [online], 2012, The Japanese Society of Cardiovascular Society, etc. [Heisei Search on November 9, 29], Internet <URL: http://www.j-circ.or.jp/guideline/pdf/JCS2012_okumura_h.pdf>

  Treatment with catheter ablation requires identifying the location of myocardial tissue that is the source of the arrhythmia to be arrested. Specifically, at the time of sinus rhythm, stimulation is given to various parts of the heart to measure an electrocardiogram, and an electrocardiogram waveform similar to an electrocardiogram waveform (control signal) serving as a sample of an arrhythmia to try to stop generation is obtained. Identify the position to be ablated by searching the site (pace mapping).

  The control signal used for pace mapping needs to be the waveform of the subject's own arrhythmia. For this reason, it is performed to measure an electrocardiogram in a situation where arrhythmia is likely to occur, by dosing or stimulating the subject. However, the waveform of arrhythmia can not be measured easily, and the time required for mapping may increase. Further, the waveform of the arrhythmia thus measured is obtained in a state of being anesthetized while the subject is lying down, and is the same as the waveform of the arrhythmia generated in daily life. Not exclusively.

  The present invention has been made in view of the problems of the prior art as described above, and an electrocardiogram analysis apparatus capable of easily acquiring a waveform of an arrhythmia generated in daily life as a control signal used for mapping in catheter ablation and It aims at providing the control method.

  The above-described object is to acquire an electrocardiogram signal and information indicating the position of a subject at the time of measurement of the electrocardiogram signal, and to detect a section corresponding to a predetermined arrhythmia condition from the electrocardiogram signal And means for determining whether or not the information indicating the body position of the subject indicates the first body position for each of the detected sections, and showing the body position of the subject among the detected sections. An electrocardiogram analyzer including: output means for outputting an electrocardiogram signal of a section determined to have a first body position as a control signal for pace mapping of catheter ablation performed in the first body position Achieved by

  According to such a configuration, according to the present invention, an electrocardiogram analysis apparatus capable of easily acquiring the waveform of arrhythmia generated in daily life as a control signal used for mapping in catheter ablation and a control method thereof are provided. can do.

It is a block diagram showing an example of functional composition of a Holta electrocardiograph as an example of an electrocardiogram analysis device concerning an embodiment of the present invention. It is a flow chart for explaining the electrocardiogram analysis processing operation concerning an embodiment. It is a flow chart for explaining correction signal generation processing operation concerning an embodiment.

  Hereinafter, the present invention will be described in detail based on the exemplary embodiments with reference to the drawings. FIG. 1 is a block diagram showing an example of a functional configuration of a Holter electrocardiograph 100 as an example of an electrocardiogram analysis apparatus according to an embodiment of the present invention. Although the electrocardiogram analysis apparatus of the present embodiment has a configuration for acquiring an electrocardiogram (lead signal) from a subject, the configuration for acquiring an electrocardiogram from a subject in the present invention is not essential. . The electrocardiogram analysis apparatus according to the present invention can be realized by any electronic device that can be acquired by any method, such as acquiring electrocardiogram data measured in advance from a storage device or storage medium connected directly or through a network. It is. Such electronic devices include not only medical devices such as an electrocardiograph, a biological information monitor, a sleep evaluation device (polygraphy), and a sphygmograph, but also general computer devices (smartphones and tablets) capable of executing an electrocardiogram analysis application Terminals, media players, smart watches, game consoles, etc.), but is not limited thereto.

  In FIG. 1, the CPU 1 controls the entire Holter electrocardiograph 100 by reading a control program stored in the ROM 2 into the RAM 3 and executing the control program. The ROM 2 is a non-volatile memory for storing a program to be executed by the CPU 1, GUI data for displaying a menu screen, etc., user setting data, initial setting data, etc., parameters necessary for processing, etc. It may be.

  The RAM 3 is used as an area for developing a program to be executed by the CPU 1 or as a temporary storage area for variables and data. The memory card 4 is a storage device for storing, in the form of digital data, biological information input from the biological electrode 11, that is, a biological electric signal itself, or other biological information or data obtained by processing the biological electric signal. Memory card 4 is detachably attached to card slot 5. Although the configuration using the removable memory card 4 as a recording medium has been described here, a configuration using a non-volatile internal memory may be used.

  The display unit 6 is, for example, a dot matrix type display device, and is, for example, a liquid crystal or an organic EL display. The display unit 6 is used to display a waveform of a bioelectric signal during measurement or recorded in the memory card 4, and display a GUI screen such as a menu screen for setting the Holter electrocardiograph 100 and various messages.

  The operation unit 8 includes switches, buttons, and the like for performing power on / off, measurement start / stop, various event inputs, and various settings. When the display unit 6 is a touch display, the operation unit 8 includes a touch panel provided on the display unit 6.

An analog-digital converter (A / D converter) 9 converts an analog bioelectric signal supplied from the sensor I / F 10 into a digital bioelectric signal, and sequentially stores the digital bioelectric signal in the RAM 3. The sensor I / F 10 is an interface for connecting the living body electrode 11. In addition to the living body electrode 11, an SpO ₂ (arterial blood oxygen saturation) sensor, a blood pressure / pulse wave measurement cuff, or the like may be connectable to the sensor I / F 10. The sensor I / F 10 performs noise removal and amplification on the bioelectric signal input from the bioelectrode 11 and supplies the signal to the A / D converter 9.

  The living body electrode 11 is an electrode for acquiring a bioelectric signal, and in this embodiment, is an electrode for acquiring an electrocardiogram (electrocardiogram signal). There is no particular limitation on the type of electrocardiogram to be acquired, but since pace mapping is generally performed while measuring a standard 12-lead electrocardiogram, this embodiment for generating a control signal for pace mapping is also standard 12-lead. It shall acquire. The number of electrodes of the living body electrode 11 differs depending on the type of the bioelectric signal to be acquired, and for example, when acquiring a standard 12-lead electrocardiogram, it comprises a total of 10 electrodes. In addition, when acquiring a standard 12-lead electrocardiogram with a Holta electrocardiograph, Mason-Liker, which is usually attached to the left and right clavicle and left and right anterior iliac crest (or lower left and right ribs) Use the induction method. When standard 12 leads are synthesized using the lead conversion technology, or when the types of leads to be measured are different, the number of electrodes may be smaller. The biological electrode 11 has an electrode part mounted on a living body, a connector part for connecting to the sensor I / F 10, and a lead wire part for connecting the electrode part and the connector part.

  The posture sensor 12 is a sensor for detecting the posture of the subject wearing the Holter electrocardiograph 100 by detecting the posture of the Holter electrocardiograph 100. The attitude sensor 12 may be, for example, a 3-axis acceleration sensor. The posture sensor 12 is mounted to have a specific positional relationship with respect to the housing of the Holter electrocardiograph 100, and the posture of the Holter electrocardiograph 100 can be specified from its output. Therefore, by attaching the Holta electrocardiograph 100 to the subject in a specific posture, the body position of the subject from the output of the posture sensor 12 (e.g., right side, left side, supine (supine)) , Prone position (in prone position), and standing position) can be determined. In this embodiment, a state in which characters (logo, model number) and the like printed around the display unit 6 can be read correctly with the display unit 6 in a substantially vertical state is referred to as “standing position” (reference posture). The attitude of a total of 100 is to be determined.

  The standing position does not necessarily mean that only the entire body is upright, and it is sufficient if the mounting site of the Holter electrocardiograph 100 is standing. For example, when the Holta electrocardiograph 100 is mounted on the upper body of the subject, the state in which only the upper body is raised from the supine position may be regarded as standing.

  The communication interface 20 is, for example, a communication interface for communicating with an external device 40 such as a host computer or a printer, and has a configuration conforming to a wired and / or wireless communication standard.

  The clock 13 is a general built-in clock, and the CPU 1 can acquire the current time from the clock 13. The current time can also be acquired from the external device 40 through the communication I / F 20.

  When acquisition and recording of an electrocardiogram (lead waveform) are performed using the Holta electrocardiograph 100 having such a configuration, the Holter heart is placed on the chest or waist of the subject using the mounting tool that houses the Holta electrocardiograph 100. The electrometer 100 is held. Then, the connector portion of the biological electrode 11 is connected to the connector of the sensor I / F 10, and the electrode portion of the biological electrode 11 is attached to a predetermined position on the body surface.

  For example, when the power is turned on by the operation of the operation unit 8, the CPU 1 performs setting processing of an operation mode for acquiring an electrocardiogram waveform at timing before starting acquisition of a bioelectric signal such as initialization processing. Can.

  In addition, before the start of the recording operation of the bioelectric signal, the CPU 1 may, as necessary, input a date and time, and an information screen for causing the user to set information (e.g., a subject ID) which can identify the subject. May be displayed. Then, the CPU 1 starts the recording operation of the bioelectric signal, for example, in response to the input of the recording start instruction from the operation unit 8 or the elapse of a predetermined time from the time the power is turned on. Note that acquisition of the bioelectric signal itself may be performed before the start of the recording process. For example, by displaying the waveform of the bioelectric signal currently being acquired on the display unit 6, it is possible to confirm the connection state including whether the biological electrode is properly attached.

  When the recording operation is started, a standard 12-lead digital electrocardiogram signal is sequentially accumulated in the RAM 3 through the sensor I / F 10 and the A / D converter 9. The CPU 1 applies analysis processing to the digital electrocardiogram signal stored in the RAM 3, adds information obtained by the analysis processing as necessary, and stores the digital electrocardiogram signal in a data file of a predetermined format and sequentially The memory card 4 is recorded. Further, the CPU 1 determines the posture of the Holter electrocardiograph 100 (subject) based on the integration amount of the acceleration signal of each axis output from the posture sensor 12 for each predetermined time, and records the posture together with the digital electrocardiogram signal. Alternatively, the integrated amount of each axis may be recorded without performing the posture determination at the time of recording. The CPU 1 can determine the attitude of the Holter electrocardiograph 100 from the positional relationship between the direction of gravity and each axis of the attitude sensor by calculating the direction of gravity based on the integrated amount of each axis of the attitude sensor 12. Furthermore, when it is detected that the event switch included in the operation unit 8 is pressed, the CPU 1 records information on the event switch pressed in the memory card 4 in association with the detection time. When a predetermined time (for example, 24 hours) has elapsed since the start of the recording operation, or the recording operation stop instruction is issued through the operation unit 8, the CPU 1 ends the recording operation.

(Analytical processing of electrocardiogram signal)
Next, an analysis processing operation of an electrocardiogram signal by the Holter electrocardiograph 100 of the present embodiment will be described with reference to the flowchart of FIG. The analysis process may be performed at the time of measurement (recording) of the electrocardiogram signal, or may be performed on the recorded electrocardiogram signal. Further, as described above, the present invention may be performed by an apparatus having no measurement function other than the measurement apparatus such as the Holter electrocardiograph 100. In the following, the analysis program of the electrocardiogram signal stored in advance in the ROM 2 is expanded in the RAM 3 and executed by the CPU 1 to execute the analysis processing, but at least a part of the analysis processing is performed by dedicated hardware such as ASIC. It may be realized.

  In S101, the CPU 1 acquires an electrocardiogram signal (all leads) of a predetermined section (for a predetermined time) from the RAM 3, the memory card 4, or the external device 40 communicably connected, and stores the electrocardiogram signal (all leads) in the predetermined area of the RAM 3. Here, the predetermined time may be, for example, an integral multiple or an integer fraction of a period (here, one minute) in which the determination of the body position is not determined during the period in which the determination of the body position does not change.

  Next, in S103, if it is determined that the electrocardiogram signal for a predetermined time corresponds to the condition of arrhythmia, the CPU 1 advances the process to S105, and if not determined, to S111. Here, in particular, it is determined whether or not the condition corresponds to the condition of ventricular arrhythmia (such as ventricular tachycardia (VT), ventricular fibrillation (Vf), and premature ventricular contraction (PVC)) for which pace mapping is performed. However, it may be determined together with other arrhythmia conditions. The condition of the arrhythmia may be, for example, a known condition such as an abnormality in the RR interval.

  If it is determined that the electrocardiogram signal for a predetermined time is measured in the supine position (first body position) in S105, the CPU 1 determines in S109 that the body position is different from the supine position (second body position). The process proceeds to S107. As described above, together with the electrocardiogram signal, the integrated amount of the output of the posture sensor 12 or the body position determined therefrom is recorded. Therefore, the CPU 1 can determine the body position by referring to the determined body position information or based on the integrated amount of the output of the posture sensor 12 for the electrocardiogram signal for a predetermined time.

  In the present embodiment, assuming that the body position of the subject at the time of catheter ablation is supine, it is determined whether the body position at the time of measurement of the electrocardiogram signal of arrhythmia is supine. That is, the determination process of S105 is a determination of whether or not measurement is performed at the same body position as at the time of catheter ablation.

  At S107, the CPU 1 corrects the electrocardiogram signal for a predetermined time to the electrocardiogram signal measured in the supine position. For example, based on the difference between an electrocardiogram signal measured in the supine position on the same subject and an electrocardiogram signal measured in each of the other body positions, the CPU 1 supine on the electrocardiogram signal measured in the body position different from the supine position. It corrects (converts) the signal measured by the position. The CPU 1 performs this correction for each induction.

  At S109, the CPU 1 controls the electrocardiogram signal for the predetermined time acquired at S101 as it is if it is measured in the supine position, if it is measured at another body position, it is corrected at S107 and then used for pace mapping of catheter ablation. The signal is recorded on the memory card 4 as a signal.

  If it is determined that the measured electrocardiogram signal has been analyzed to the end in S111, the CPU 1 ends the analysis process, and if not determined, returns the process to S101 and continues the analysis process on the electrocardiogram signal for the next predetermined time Do. As described above, the section corresponding to the condition of arrhythmia is detected among the measured electrocardiogram signals, and if it is measured at the same position as at catheter ablation, it is measured at the same position if it is measured at a different position. Correction to the control signal.

  Here, an example of a method of generating a correction signal used in the correction process in S107 will be described using the flowchart of FIG. In addition, this process may be performed at the time of measurement of an electrocardiogram signal, and may be implemented about the measured electrocardiogram signal. The correction signal generation mode may be provided as the operation mode of the Holter electrocardiograph 100, and the following processing may be performed when the correction signal generation mode is set.

  In S201, the CPU 1 acquires an electrocardiogram signal for a predetermined time (for example, 10 seconds) for each body position. For example, when the measurement of the electrocardiogram is performed for a long time using a Holta electrocardiograph, the installation of the electrodes and the start of the measurement are performed by medical personnel at a medical institution. Therefore, an electrocardiogram signal for each body position can be measured by causing the subject to take an individual body position and performing measurement before the start of measurement of an electrocardiogram for a long time or during a predetermined period from the start of measurement. Such measurement may be performed in S201, or an electrocardiogram signal that has already been measured and recorded in the memory card 4 may be read out. By the process of S201, an electrocardiogram signal for each body position is stored in the RAM 3.

  In S203, the CPU 1 calculates a difference signal between the electrocardiogram signal measured in the supine position and the electrocardiogram signal measured in the body position other than the supine position. The CPU 1 calculates a differential signal for each corresponding lead.

  Then, in S205, the CPU 1 adds and averages the difference signals between each body position and the electrocardiogram signal measured in the supine position obtained for each lead for each beat to obtain a correction signal. The CPU 1 records the obtained correction signal in, for example, the memory card 4 in association with the identification information of the subject.

  The measurement position of the electrocardiogram signal measured at a posture other than the supine position is corrected (converted) to be equivalent to the supine position by adding the correction signal obtained in this way to each beat of the measured electrocardiogram signal be able to. Note that the method of generating the correction signal illustrated here is only one possible example, and the correction signal may be generated by another method.

(Modification)
The electrocardiogram signal measured in the supine position and the electrocardiogram signal measured in the body position to be corrected, which are used when generating the correction signal, may be acquired from the long-term electrocardiogram signal. For example, a non-arrhythmic electrocardiogram signal most recently measured in the same posture and supine position as the measurement position of the electrocardiogram signal of the arrhythmia to be corrected may be used.

  As described above, according to this embodiment, an electrocardiogram signal of an arrhythmia which actually occurs in daily life can be used as a control signal for pace mapping. Therefore, it is possible to accurately search for the source of arrhythmia. In addition, the ECG signal measured at a position different from the body posture at the time of pace mapping is corrected to an electrocardiogram signal equivalent to the body position at the time of pace mapping, so it is possible to suppress the change in waveform due to the difference in the body position. It can be used as a signal. Furthermore, since control signals can be obtained in advance, the time required for catheter ablation can be significantly reduced.

  The electrocardiogram analysis apparatus according to the present invention can also be realized as a program (application software) that causes a general-purpose information processing apparatus, such as a personal computer, which is generally available, to execute the above-described operation. Therefore, such a program and a storage medium storing the program (an optical recording medium such as a CD-ROM or a DVD-ROM, a magnetic recording medium such as a magnetic disk, a semiconductor memory card, etc.) also constitute the present invention. .

DESCRIPTION OF SYMBOLS 1 ... CPU, 2 ... ROM, 3 ... RAM, 4 ... Memory card, 6 ... Display part, 8 ... Operation part, 10 ... Sensor I / F, 11 ... Living body electrode

Claims (7)

Acquisition means for acquiring an electrocardiogram signal and information indicating a body position of the subject at the time of measurement of the electrocardiogram signal;
Detection means for detecting a section corresponding to a predetermined arrhythmia condition from the electrocardiogram signal;
A determination unit that determines whether the information indicating the body position of the subject indicates a first body position for each of the detected sections;
Control for pace mapping of catheter ablation in which the electrocardiogram signal of the section in which the information indicating the body position of the subject is determined to be the first body position among the detected sections is performed in the first body position Output means for outputting as a signal;
An electrocardiogram analyzer characterized by having. The correction means for correcting the signal of the section in which the information indicating the position of the subject is determined to be the second body position among the detected sections is equivalent to the signal measured in the first body position In addition,
The output means also outputs an electrocardiogram signal of the section corrected by the correction means as the control signal.
The electrocardiogram analysis apparatus according to claim 1, wherein   The correction means performs the correction by applying a correction signal based on a difference between electrocardiogram signals which do not fall under the condition of the arrhythmia, which are measured in the first body position and the second body position. The electrocardiogram analysis device according to claim 2.   The electrocardiogram analysis apparatus according to any one of claims 1 to 3, wherein the detection means detects a section corresponding to a condition of ventricular arrhythmia.   An electrocardiograph comprising the electrocardiogram analysis device according to any one of claims 1 to 4. An acquiring step of acquiring an electrocardiogram signal and information indicating a body position of the subject at the time of measuring the electrocardiogram signal;
Detecting a section corresponding to a predetermined arrhythmia condition from the electrocardiogram signal;
A determination step of determining whether the information indicating the body position of the subject indicates a first body position for each of the detected sections;
Control for pace mapping of catheter ablation in which the electrocardiogram signal of the section in which the information indicating the body position of the subject is determined to be the first body position among the detected sections is performed in the first body position An output process for outputting as a signal,
And a control method of an electrocardiogram analyzer.   The program for functioning a computer as each means of the electrocardiogram analysis apparatus of any one of Claims 1-4.

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