WO1985005547A1 - Appareil et procede d'electrocardiographie ambulatoire - Google Patents

Appareil et procede d'electrocardiographie ambulatoire Download PDF

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Publication number
WO1985005547A1
WO1985005547A1 PCT/US1984/000825 US8400825W WO8505547A1 WO 1985005547 A1 WO1985005547 A1 WO 1985005547A1 US 8400825 W US8400825 W US 8400825W WO 8505547 A1 WO8505547 A1 WO 8505547A1
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WO
WIPO (PCT)
Prior art keywords
recorder
switching
individual
electrode
electrodes
Prior art date
Application number
PCT/US1984/000825
Other languages
English (en)
Inventor
Ricardo G. Kortas
Original Assignee
Kortas Ricardo G
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Kortas Ricardo G filed Critical Kortas Ricardo G
Priority to EP84902311A priority Critical patent/EP0182782A1/fr
Priority to PCT/US1984/000825 priority patent/WO1985005547A1/fr
Publication of WO1985005547A1 publication Critical patent/WO1985005547A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/30—Input circuits therefor
    • A61B5/307—Input circuits therefor specially adapted for particular uses
    • A61B5/308—Input circuits therefor specially adapted for particular uses for electrocardiography [ECG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/332—Portable devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/30—Input circuits therefor
    • A61B5/303—Patient cord assembly, e.g. cable harness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/333—Recording apparatus specially adapted therefor
    • A61B5/336—Magnetic recording apparatus

Definitions

  • This invention relates generally to the technical field of devices used in the practice of cardiology and more particularly to such devices especially useful for am ⁇ bulatory electrocardiography.
  • Ischemia is a term used by physicians to describe a physiological state in which the rate at which oxygen is supplied to any organ of the body is less than that at which the organ is consuming oxygen. That is, ischemia is a physiological state in which an organ's oxygen consumption exceeds its oxygen supply. Thus the term ischemia may be applied to describe an episode during which an organ in ⁇ creases its metabolism thereby increasing its use of oxygen such as may occur in skeletal muscles during physical exer ⁇ cise. "Myocardial ischemia” is a term used by physicians, and more particularly cardiologists, to describe the particular physiological state in which the heart's oxygen consumption exceeds its oxygen supply.
  • an episode of myocardial ischemia may occur as a natural consequence of physical exercise or it may occur as a consequence of a diseased state of the heart in which insufficient blood is supplied to that organ. Consequently, myocardial ischemia occurs during a myocardial infarction (heart attack) when the blood supplied to the heart is temporarily reduced or stopped. However, even in a resting or ambulatory individual it appears that episodes of myocardial ischemia occur more frequently than do myocardial infarctions. Electrocardiog ⁇ raphy is the most readily available method to detect ///
  • 16 electrodes are located at the vertices of a four-by-four matrix whose vertical columns begin at an individual's side under his left arm and extend horizontally almost completely across his chest toward his right arm. The electrodes are then secured in those locations using ad ⁇ hesive tape sufficiently tight to stabilize them.
  • any procedure attempting to identify individuals experiencing episodes of myocardial ischemia appears to require using at least a 16 electrode precordial surface mapping technique described in The '78 Fox Article. Further, it appears that such testing requires using either an exercise stress test or continuous ambulatory electrocardiographic monitoring to successfully identify such individuals. Since continuous ambulatory electrocardiographic monitoring is capable of recording the signals from an individual's heart during his usual daily activity and does not require special, dedicated test facilities such as those required for exercise stress testing with their attendant cost, it appears that con ⁇ tinuous ambulatory electrocardiographic monitoring may be a preferred way of testing for silent myocardial ischemia. In
  • Ambulatory electrocardiographic monitoring was first introduced by a engineer, Norman J. Holter, during the 1950's. In an article entitled “New Method for Heart Studies 5 Continuous Electrocardiography of Active Subjects” published during 1961 in volume 134 of Science at page 1214, Doctor Holter reported transmitting the heart's signal from an exercising individual to a nearby radio receiver using a cumbersome, heavy (85 lb) radio transmitter. Doctor Holter 0 subsequently developed a "electrocardiocorder" which would record up to a 10 hour, two electrode, electrocardiogram using a portable magnetic tape recorder worn by the in ⁇ dividual being monitored.
  • electrocardiocorder Presently there are various distinct categories of electrocardiocorder. For example there are continuous or "Holter” recorders which continuously record signals from two electrodes onto a magnetic tape for 24 hours. A varia ⁇ tion of these continuous electrocardiocorders are real-time analysis systems which analyze the signal received by the electrocardiocorder and store only certain parameters of the data and/or only a few periods of the electrocardiogram. Yet another type of electrocardiocorder only records signals intermittently perhaps at preselected intervals or if cer ⁇ tain predefined events are detected. Frequently, the re ⁇ corders of the various types allow the patient to manually activate recording if symptoms occur.
  • electrocardiocorders While there are various types of electrocardiocorders available from several manufacturers, none are suitable for recording the signals from a 16 electrode precordial map apparently so necessary to reliably identifying an episode of silent myocardial ischemia.
  • present con ⁇ tinuous electrocardiocorders such as the model 445B manufac ⁇ tured by Del Mar Avionics of Irvine, California, even though approximately ten times more expensive than a comparable audio tape recorder, is capable of simultaneously recording signals from only two electrodes.
  • a recorder having good low frequency recording characteristics is critical to preserving a record 5 of episodes of silent myocardial ischemia.
  • This frequency response criterion in combination with the need to record signals continuously during a 24 hour interval establish a demanding technical performance criterion for an electroca ⁇ rdiocorder.
  • the preceding economic and technical considera- o tions conclusively demonstrate the impracticality of simply and directly extending present electrocardiocorder technol ⁇ ogy to record the 16 signals from the electrodes of a precordial map.
  • Electrocardiocorder for continuous ambulatory electrocar ⁇ diographic monitoring by a cable made up of two separate sections.
  • the first section of such a cable one end of which attaches to the individual electrodes, consists of a plurality of individual wires adapted to clip onto in- dividual electrodes.
  • Individual jacks are attached at the other ends of this section's wires to plug into mating sockets of a multi-wire connector located at one end of the cable's second section. The other end of this second section plugs directly into an electrocardiocorder which is secured to an individual's body.
  • cardiologists attempt to minimize the possibility of generating electrical noise at the junction between the electrode and the cable by forming circularly shaped "stress loops" in each of the cable's individual wires immediately adjacent to the electrode to which it is connected. Each such stress loop is then in ⁇ dividually taped to the body by two pieces of adhesive tape arranged in an X-shape across the stress loop's diameter. Further, adhesive tape is also used to secure the individual jacks into the multi-wire connector, and to secure the connector itself to the body about the navel.
  • the use of the preceding techniques does not eliminate excessive electrical noise pickup in continuous ambulatory electrocar ⁇ diographic monitoring. Besides being ineffective for preventing the generation of electrical noise, the area on an individual's chest occupied by the stress loops and tape significantly reduces the maximum number of electrodes which may be secured to an individual's chest.
  • An object of the present invention is to enhance the technology of continuous ambulatory electrocardiographic monitoring and improve the techniques for its use. /// ///
  • OMPI Another ob ect of the present invention is to make continuous ambulatory electrocardiographic monitoring a practical technique for reliably detecting changes in the S- T segment of an electrocardiogram.
  • Another object of the present: invention is to make continuous ambulatory electrocardiographic monitoring a practical technique for reliably detecting silent myocardial ischemia.
  • the present invention is a electrocardiocorder system which includes a electrocardiocorder having a switch ⁇ ing means for automatically and repetitively switching sequentially through the signals transmitted from a plurality of electrodes attached to an individual.
  • This switching means successively couples signals from electrodes to the input of the electrocardiocorder.
  • This repetitive switching successively through the electrodes signals ap ⁇ plies each successive signal continuously to the electroca- rdiocorder's respective inputs for an interval several times longer than the period of the physiological signal being recorded before switching from that signal to the next successive signal.
  • a suitable length of time for recording the signal from an individual electrode is approximately 7.5 seconds.
  • the signal from each of the 16 electrodes will be 5 individually and continuously recorded for a 7.5 second interval, approximately the duration of seven heartbeats. Further, each electrode's signal will 'be recorded for such a 7.5 second interval once every minute. Since a myocardial ischemia episode most frequently lasts longer than one 0 minute, it is virtually impossible to miss such an episode while making this recording.
  • each signal would be successively applied to an input of the electrocardiocorder for an interval which could not exceed
  • the electrocardio- corder system of the present invention further includes an improved cable assembly for interconnecting numerous electrodes secured to an individual and such an electroca- rdiocorder.
  • This improved cable assembly reduces noise in the electrode signal recorded by the electrocardiocorder by collecting the plurality of individual wires into a unitary assembly extending between the electrodes and the electroca ⁇ rdiocorder.
  • the cable assembly of the present invention eliminates the need for stress loops by mechani ⁇ cally securing the cable's individual wires in a trunk portion of the cable immediately adjacent to the electrode to which an individual wire connects.
  • This trunk is itself mechanically secured to the individual at its end adjacent to the electrodes to support the cable assembly's weight and to maintain the spatial relationship between this end of the cable assembly's trunk and the electrodes attached to the individual.
  • An advantage of the present invention is that it en ⁇ hances the technology of continuous ambulatory electrocar ⁇ diographic monitoring and improves the techniques for its use.
  • Another advantage of the present invention is that it makes continuous ambulatory electrocardiographic monitoring a practical technique for reliably detecting changes in the S-T segment of an electrocardiogram.
  • Another advantage of the present * invention is that it makes continuous ambulatory electrocardiographic monitoring a practical technique for reliably detecting silent myocar- dial ischemia.
  • Fig. 1 is a diagramatic plan view of a human torso depicting an ambulatory recorder system including cable assemblies and an electrode signal switching recorder in accordance with the present invention which shows the place ⁇ ment of a plurality of electrodes on the torso for recording a 16 electrode precordial map as taught in The '78 Fox Article;
  • Fig. 2 is a diagramatic representation depicting one period of an electrical signal as is transmitted via the cable assembly from an electrode of Fig. 1 to the input of ///
  • FIG. 3 is a diagramatic functional-type block diagram of an electronic switching circuit included in the electrode signal switching recorder of Fig. 1 for switching among the various electrode signals applied thereto via the cable assemblies;
  • ⁇ j Q Fig. 4 is a diagramatic timing chart depicting a plurality of electrical signals transmitted from a plurality of the electrodes shown in Fig. 1 and also depicting an output signal from the electronic switching circuit of Fig. 3 as may be preserved by recording it with an electrocardio-
  • a human torso 8 to which is attached ambulatory recorder system in Q accordance with the present invention referred to by the general reference character 10.
  • the ambulatory recorder system 10 as depicted in Fig. 1 is adapted for recording a precordial map in according with the teaching of The '78 Fox Article.
  • the ambulatory recorder system 10 includes a 5 plurality of electrodes 11 through 26 fixed to the human torso 8 which generate 16 electrocardiographic signals needed to record the precordial map. Also fixed to the lower right hand side of the human torso 8 below and to one side of the vertical column of electrodes 11 through 14 is a 0 ground electrode 28.
  • a negative reference electrode 30 is fixed to the upper left hand side of the human torso 8 above and approximately between vertical columns of electrodes 15 through 18 and 19 through 22.
  • the particular type of electrodes 11 through 26, 28, and 30 used 5 in the ambulatory recorder system 10 may be chosen from among those marketed by various manufacturers such as the model Offset Dx manufactured by Graphic Controls Corp. of Buffalo, New York. /// .
  • FIG. 2 depicted there a single period of an electrocardiographic signal referred to by the general 5 reference character 32 as may be transmitted from electrode 17 during a single heart beat.
  • Cardiologists routinely employ various names to identify particular locations and or features on this electrocardiographic signal 32. Thus during the period of each heart beat cardiologists identify a "P
  • S-T segment 44 That segment of the electrocardiographic signal 32 joining the S wave 40 and the T wave 42, depicted by a plurality of dashed curves in Fig. 2, is referred to as the "S-T segment" 44.
  • S-T segment 44 The point at which the S-T segment 44
  • the S-T segment 44 commences, immediately adjacent to the S wave 40, is iden ⁇ tified as a "J point" 46.
  • the S-T segment 44 is depicted with a plurality of dashed curves to indicate that its morphology (shape) may change depending upon the state of the individual, e.g. resting versus exercising, and/or
  • the ambulatory recorder system 10 also includes a plurality of connectors 52 which mate with and attach to the equal plurality of electrodes 11 through 26, 28 and 30. Each connector 52 is also secured to
  • Electrode signal wire 54 one terminal end of a electrode signal wire 54 to which it couples the electrical signals respectively transmitted by the electrodes 11 through 26, 28, and 30.
  • the electrode signal wires 54 coupled to the electrodes 11 through 18 and to the ground electrode 28 by the connectors 52 are gathered
  • the electrode signal wires 54 coupled to the electrodes 19 through 26 and to the negative reference electrode 30 by the connectors 52 are
  • a pair of adhesive foam pads 68 that will adhere to the skin of an individual. Either electrodes such as the Offset Dx iden- o tified above or simply foamed material coated with adhesive may be used for the adhesive foam pads 68.
  • Each pair of adhesive foam pads 68 respectively secured to the cable assemblies 58 and 64 is longitudinally separated along the length of their respective trunks 56 and 62. Thus when the 5 adhesive foam pads 68 adhere to the skin of an individual they support the weight of the cable assemblies 58 and 64.
  • the separated locations for the adhesive foam pads 68 along the lengths of the trunks 56 and 62 and the exten ⁇ sion of the electrode signal wire 54 therefrom are selected 0 to maintain the spatial relationship between the trunk 56 and the electrodes 11 through 18 and 28, and between the trunk 62 and the electrodes 19 through 26 and 30.
  • This secure attachment of the trunks 56 and 62 of the cable assemblies 58 and 64 to the human torso 8 eliminates the 5 need for the stress loops as taught in the prior art. Fur ⁇ ther, this attachment of the cable assemblies 58 and 64 to the human torso 8. strictly controls lead placement necessary to accurately monitor the S-T segment 44 of the electrocar ⁇ diographic signals 32.
  • each of the cable assemblies 58 and 64 furthest from the adhesive foam pads 68 is one-half of a multi-pin connector 72.
  • the mating half of each multi-pin connector 72 is mounted on a housing 74 which encloses an electronic switch- 5 ing circuit referred to by the general reference character 76 as depicted in Fig. 3.
  • Each of the electrode signal wires 54 in each of the cable assemblies 58 and 64 is respectively connected to an individual pin of the multi-pin connector 72
  • a multi-conductor cable 78 which couples the output signals of the electronic switching circuit 76 to the various inputs of 'a standard, continuous "Holter” type electrocardiocorder 80 such as a Del Mar Avionics model 445B dual channel electrocardiocorder.
  • the combined electronic switching circuit 76 as enclosed in the housing 74, the multi-conductor cable 78, and the electroca ⁇ rdiocorder 80 together constitute an electrode signal switching recorder adapted to preserve representation of an electrocardiogram.
  • the electronic switching circuit 76 includes two integrated circuit, analog signal multiplexers 82, each multiplexer 82 having eight switched signal inputs 83.
  • Digital control signals applied to three control signal inputs 84 cause each multiplexer 82 to couple one of the signals from its switched signal inputs 83 to a switched signal output 85.
  • the signal transmitted from the switched signal output 85 of each multiplexer 82 is coupled via a multiplexer output signal line 86 t ⁇ a non-inverting input 87 of a buffer amplifier 88 associated with each multiplexer 82.
  • each multiplexer 82 selects one particular input signal applied to its eight switched signal inputs 83 and then applies that selected signal to the non-inverting input 87 of its associated buffer amplifier 88.
  • OMPI corder 80 The signals from electrodes 11 through 18 are applied through separate, identical high-pass filters 89 to the eight switched signal inputs 83 of one multiplexer 82 while the signals from electrodes 19 through 26 are applied through separate identical high-pass filters 89 to the eight switched signal inputs 83 of the other multiplexer 82.
  • a diagram depicting one of the identical electronic circuits used in each of the high-pass filters 89 interposed between each switched signal input 83 of the multiplexers 82 and the signals from the electrodes 11 through 26 is shown in Fig. 3 as receiving the signal from electrode 25.
  • each high-pass filter 89 consists of a capacitor 90 connected in series between a switched signal input 83 of the multiplexer 82 and the signal received by the electronic switching circuit 76 from one of the electrodes 11 through 26 combined with a resistor 91 connected between the switched signal input 83 of the multiplexer 82 and circuit ground of the electronic switching circuit 76.
  • the capacitor 90 of each high-pass filter 89 has a value of approximately 33 microfarads and its resistor 91 has a value of one megohm.
  • the multiplexers 82 may be selected from various commercial types of integrated circuits such as the type CD4051BM analog multiplexer/demultiplexer marketed by Na ⁇ tional Semiconductor of Santa Clara, California.
  • the signals trans ⁇ mitted by the ground electrode 28 and the negative reference electrode 30 are not applied to inputs of a multiplexer 82. Rather, within the housing 74 the signal received from the ground electrode 28 is connected directly to the circuit ground of the electronic switching circuit 76 while the signal from the negative reference electrode 30 passes
  • the multiplexers 82 require certain control signals to 5 repetitively switch among the various electrode's signals applied to their switched signal inputs 83 and thus to sequentially select one particular input signal to be trans ⁇ mitted to the non-inverting input 87 of the corresponding buffer amplifier 88.
  • These control signals are provided by o combining an integrated circuit clock 96 and counter 98.
  • Connected between a pair of timing circuit inputs 100 to the clock 96 is a capacitor 102 and an adjustable resistor 104 connected in series. The capacitor 102 and the adjustable resistor 104 establish a time interval for a periodic clock 5 signal transmitted from the clock 96 to the counter 98 over the clock line 106.
  • the counter 98 In response to this periodic signal from the clock 96, the counter 98 operates as a three binary digit counter the output signals of which repetitively increment through their possible binary values (000 through 0 111) during successive periods of the clock signal. These three binary digit output signals are transmitted from the counter 98 over binary digit lines 108 to the control signal inputs 84 of the multiplexers 82.
  • the counter 98 main ⁇ tains output signals representing a particular three digit binary number on the binary digit lines 108.
  • the multiplexer 82 responding to the digital control signals which it receives from the counter 98 via the binary digit lines 108, 0 couples one of the signals from its switched signal inputs 83 to its switched signal output 85.
  • the counter 98 increments to the next successive binary digit.
  • the multiplexers 82 couple the next successive signal from their respective switched signal inputs 83 to their respective switched signal output 85.
  • V counter 98 reaches the largest binary digit which it can represent (111), at the beginning of the next successive time interval of the periodic signal transmitted by the clock 96, the counter 98 returns to the smallest binary digit which it can represent (000). THus because the counter 98 repetitively counts through all possible three digit binary numbers in response to signals transmitted by the clock 96, the multiplexers 82, responding to the control signals represented by those numbers, each repetitively couple a sequence of signals present on their eight switched signal inputs 83 to their switched signal output 85.
  • a suitable length of time for recording successive signals from individual electrodes is approximately 7.5 seconds.
  • the type of integrated circuit used for the clock 96 ' is a CD4047BM multivibrator marketed by National Semiconductor of Santa Clara, California, then a capacitor 102 having a value of 20 microfarads and an adjustable resistor 104 having a value of 1 megohm may be used to establish such a periodic clock signal time interval.
  • the output signal from the CD4047BM integrated circuit used for the clock 96 is suitable for driving a MM74C93 binary counter marketed by National Semi ⁇ conductor of Santa Clara, California as the counter 98 which transmits digital control signals to the control signal inputs 84 of the multiplexer 82.
  • the clock 96 immediately commences transmitting periodic /// -20- . .
  • the counter 98 operates as a three binary digit counter which repetitively incre ⁇ ments through the successive three digit binary values during successive periods of the clock signal to transmit digital control signals via the binary digit lines 108 to the control signal input 84 of the multiplexer 82.
  • the multiplexer 82 couples one of the signals present at its switched signal inputs 83 to its switched signal output 85.
  • Fig. 4 depicted there are a plurality of electrocardiographic signals, similar to the electrocar-
  • the multiplexer 82 couples one of the signals transmitted by electrodes 11 through 18 from one of its switched signal input 83 to its switched signal output 85. Because an ambulatory individual's normal muscle move ⁇ ment generates electrical noise which may mask the
  • a sequence for selecting the signals from the electrodes 11 through 18 is chosen in which, on the average, successive selected signals are transmitted from electrodes at widely separated locations.
  • 35 signal transmitted by electrode 11 is coupled to the multi ⁇ plexer output signal line 86.
  • the signal -transmitted by electrode 17 is coupled to the multiplexer output signal line 86. This /// -21 -
  • the process of coupling a signal transmitted by one of the electrodes 11 through 18 to the multiplexer output signal line 86 continues in accordance with the electrode numbers shown in Fig. 4 for eight periods of the 7.5 second time interval 120 until all eight electrode signals have been coupled from the inputs switched signal input 83 to the multiplexer output signal line 86 during the one minute time interval 118.
  • the multiplexer 82 generates a composite electrode signal as shown in Fig. 4 which is transmitted from the switched signal output 85 via the multiplexer output signal line 86 to the non-inverting input 87 of the buffer amplifier 88 with which the multiplexer 82 is as- sociated.
  • the signal from the electrodes 19 through 26 selected by the other multiplexer 82 is chosen to be from an electrode which, on the average, is widely separated location from that being simultaneously selected from electrodes 11 through 16.
  • the sequence of paired electrode signals selected simultaneously by the multi ⁇ plexers 82 is that depicted adjacent to the multi-pin con- nectors 72 of Fig. 3,i.e. 11 and 22, 17 and 24, 15 and 26, 13 and 20, 18 and 23, 12 and 21, 14 and 19, and 16 and 25.
  • each buffer amplifier 88 which may be selected from various commercial types of integrated circuit amplifiers such as the type LF442 dual low power operational amplifier marketed by National Semi ⁇ conductor of Santa Clara, California, has an output 122 which is coupled back to its inverting input 124.
  • each buffer amplifier 88 operates at unity gain and presents a high impedance to the switched signal output 85 of its associated multiplexer 82.
  • the output 122 of one of the buffer amplifiers 88 is coupled via a first composite electrode signal wire 126 of the multi-conductor cable 78 to one signal recording input of the electrocardiocorder 80
  • the buffer amplifiers 88 isolate the signals transmitted by the electrodes 11 through 26 from the relatively low impedance of the signal recording inputs of the electrocardiocorder 80.
  • the signal of the nega ⁇ tive reference electrode 30 is applied to both negative
  • the 25 corder it records on one of its channels the composite signal present at the switched signal output 85 of one multiplexer 82 while its other channel records the signal present at the switched signal output 85 of the other multi ⁇ plexer 82.
  • ambulatory recorder system 10 of the present invention achieves an eight fold compression of the electrocar ⁇ diographic data without significantly increasing the pos ⁇ sibility of failing to detect an episode of myocardial ischemia.
  • the record thus preserved may be most conveniently analyzed using a digital computer by techniques well known in the art.
  • the computer program which analyzes the recorded signals may determine the beginning and end of each 7.5 second interval during which the signal from successive electrode were recorded. Further, the differences among these signals also allows a computer program to recognize the particular electrode which transmitted each 7.5 second long signal.
  • the computer program analyzing the recorded signal may employ signal averaging to improve the signal to noise ratio of the recorded data without significantly increasing the possibility of failing to detect an episode of myocar ⁇ dial ischemia.
  • the electronic switching circuit 76 enclosed within the housing 74 may alternatively be enclosed within the electrocardiocorder 80 together with the one-half of the multi-pin connectors 72 mounted thereon thereby eliminating all need for the housing 74. If the electronic switching circuit 76 were thus in ⁇ tegrated into the electrocardiocorder 80 the multi-conductor cable 78 could then be totally enclosed within the electro ⁇ cardiocorder 80. Further, if so integrated, the electrical power to operate the electronic switching circuit 76 could be obtained from the batteries of the electrocardiocorder 80 and the 9 volt batteries 116 could be eliminated. /// ///
  • the ambulatory recorder system 10 of the present invention uniquely adapted for preserving a representation of a precordial map in accordance with the teachings of The '78 Fox Article, it may be easily adapted to record alterna ⁇ tive types of precordial maps or alternative electrode matrices.
  • using the ambulatory recorder system 10 for recording different types of precordial maps or electrode matrices could be achieved by further adding a multi-position mode switch to the electronic switching circuit 76. In a first position of such a mode switch, the ambulatory recorder system 10 would operate in the manner described above.
  • the ambulatory recorder system 10 of the present invention is particularly adapted for continuous ambulatory electrocardiographic monitoring, it is also suitable for non-ambulatory use perhaps during monitoring performed in a hospital immediately following a myocardial ischemia.
  • the dual cable assemblies 58 and 64 without adversely af ⁇ fecting the accurate recording of the S-T segment 44 even during continuous ambulatory electrocardiographic monitor ⁇ ing. Particularly if the ambulatory recorder system 10 of the present invention is used in a hospital environment the strict control of lead placement afforded by the dual cable assemblies 58 and 64 may prove unnecessary. While the best mode ambulatory recorder system 10 of the present invention has been described as employing a conventional, dual channel, continuous electrocardiocorder 80, the cable assemblies 58 and 64 and the electronic switching circuit 76 may, in general, be used with any type of electrocardiocorder. Thus, the cable assemblies 58 and 64 and the electronic switching circuit 76 may be used with real-time analysis electrocardiocorders and with intermit ⁇ tent electrocardiocorders.

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Abstract

Le domaine médical concerné est celui de la cardiologie et plus particulièrement le domaine du monitoring électrocardiographique ambulatoire continu utilisant une technique de topographie précordiale à 16 électrodes pour enregistrer les épisodes de l'ischémie du myocarde. La présente invention est un système enregistreur ambulatoire (10) qui comprend des assemblages de câble (58 et 64) et un enregistreur de commutation de signaux des électrodes, lequel comprend un circuit de commutation électronique (76) enfermé dans un boîtier (74) auquel sont connectés les assemblages de câbles (58, 64), un électrocardioenregistreur à double canal (80), et un câble à conducteurs multiples (78) interconnectant le circuit de commutation électronique (76) et l'électrocardioenregistreur (80). Le circuit de commutation électronique (76) commute automatiquement et de manière répétitive et séquentielle les signaux transmis à partir de la pluralité d'électrodes (11) à (26), lesquelles électrodes sont fixées à un individu. Cette commutation répétitive et successive permet l'application de chaque signal successif en continu aux bornes d'entrée respectives de l'électrocardioenregistreur (80) pour sept battements cardiaques approximativement. Etant donné que chaque signal d'électrode est enregistré pour un tel intervalle une fois par minute, il est virtuellement impossible de manquer la détection d'un épisode d'ischémie du myocarde car de tels épisodes durent la plupart du temps plus d'une minute.
PCT/US1984/000825 1984-05-29 1984-05-29 Appareil et procede d'electrocardiographie ambulatoire WO1985005547A1 (fr)

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EP84902311A EP0182782A1 (fr) 1984-05-29 1984-05-29 Appareil et procede d'electrocardiographie ambulatoire
PCT/US1984/000825 WO1985005547A1 (fr) 1984-05-29 1984-05-29 Appareil et procede d'electrocardiographie ambulatoire

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PCT/US1984/000825 WO1985005547A1 (fr) 1984-05-29 1984-05-29 Appareil et procede d'electrocardiographie ambulatoire

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2604888A1 (fr) * 1986-10-09 1988-04-15 Atesys Sa Dispositif pour l'alimentation en courant electrique d'appareils medicaux portes par des patients ambulatoires
WO2008049016A2 (fr) * 2006-10-18 2008-04-24 Medicomp, Inc. Système de surveillance d'événement cardiaque
AU2014202977B2 (en) * 2006-10-18 2016-02-11 Medicomp, Inc. Cardiac event monitoring system
CN113543709A (zh) * 2019-03-06 2021-10-22 通用电气精准医疗有限责任公司 用于经由非粘附性直接接触电极装置来获得患者的心电图信号的方法和系统

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FR2604888A1 (fr) * 1986-10-09 1988-04-15 Atesys Sa Dispositif pour l'alimentation en courant electrique d'appareils medicaux portes par des patients ambulatoires
WO2008049016A2 (fr) * 2006-10-18 2008-04-24 Medicomp, Inc. Système de surveillance d'événement cardiaque
WO2008049016A3 (fr) * 2006-10-18 2008-06-19 Medicomp Inc Système de surveillance d'événement cardiaque
JP2010506690A (ja) * 2006-10-18 2010-03-04 メディコンプ・インコーポレーテッド 心イベント監視システム
EP2374409A1 (fr) * 2006-10-18 2011-10-12 Medicomp, INC. Systeme de surveillance d'evenement cardiaque
AU2007311112B2 (en) * 2006-10-18 2014-03-06 Medicomp, Inc. Cardiac event monitoring system
US8983583B2 (en) 2006-10-18 2015-03-17 Medicomp, Inc. Cardiac event monitoring system
US9198590B2 (en) 2006-10-18 2015-12-01 Medicomp, Inc. Cardiac event monitoring system
AU2014202977B2 (en) * 2006-10-18 2016-02-11 Medicomp, Inc. Cardiac event monitoring system
US9498145B2 (en) 2006-10-18 2016-11-22 Medicomp, Inc. Cardiac event monitoring system
CN113543709A (zh) * 2019-03-06 2021-10-22 通用电气精准医疗有限责任公司 用于经由非粘附性直接接触电极装置来获得患者的心电图信号的方法和系统

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