A surgical procedure and tethering system for chronic blood sampling, infusion, and temperature monitoring in caged nonhuman primates

A jacket and tethering system was used to maintain chronic catheters in monkeys, which provided catheter access and manipulability without further restraint. Surgical placement of catheters and a temperature probe allowed for a common cutaneous exit and interface with the jacket and tether. Monkeys were fitted in a sterile leather or denim jacket which was attached to a sterilized flexible stainless steel cable. Through this conduit, an indwelling temperature probe, as well as catheters from the internal jugular and femoral veins, were attached to a swivel unit located on the upper portion of the cage. The internal jugular catheter was used for the continuous infusion of support solution. The catheter from the femoral vein was maintained with a heparin lock and used for serial blood sampling. Using this system, it was possible to obtain frequent blood samples and body temperature readings, and to administer a continuous intravenous infusion without chemical or excessive physical restraint. To date, 367 monkeys, 322 cynomolgus (Macaca fasicularis), 16 rhesus (Macaca mulatta), and 21 African green (Cercopithecus aethiops) have been studied using this procedure.     

Clinical trials of a dual-sensor diagnostic pacemaker

The results of clinical trials of a dual-sensor diagnostic pacemaker are described. The system monitors and records intraventricular electrical and pressure waveforms using a special lead incorporating bipolar electrodes together with a piezoelectric pressure transducer. The recorded waveforms, which are shown in conjunction with Holter recordings made simultaneously, demonstrate the value of pressure measurements and illustrate several cardiac events, including an ECG pause, bradycardia, a pressure pause, ectopic beats and tachycardia. The pacing function of the device is shown and capture is demonstrated.     

Effect of adaptive motion-artifact reduction on QRS detection

Motion artifact resulting from electrode and patient movement is a significant source of noise in ECG, EEG, EMG, and impedance pneumography recording. Noise resulting from motion is particularly troublesome in ambulatory ECG recordings, such as those made during Holter monitoring or stress tests, because the bandwidth of the motion artifact overlaps with the ECG signal bandwidth. The authors investigated the effect of an adaptive motion-artifact removal algorithm on the performance of a standard QRS detector. They made four ECG recordings on each of the three subjects while manually generating artifact. Adaptive noise removal was applied to the ECG signal using a skin-stretch signal as the noise reference. Adaptive noise removal reduced the number of false QRS detections in the records from 380 to 104, for an average reduction in false detections of 72.6%. False-detection reductions for individual records ranged from 12% to 93%.     

A New Algorithm to Diagnose Atrial Ectopic Origin from Multi Lead ECG Systems - Insights from 3D Virtual Human Atria and Torso

Rapid atrial arrhythmias such as atrial fibrillation (AF) predispose to ventricular arrhythmias, sudden cardiac death and stroke. Identifying the origin of atrial ectopic activity from the electrocardiogram (ECG) can help to diagnose the early onset of AF in a cost-effective manner. The complex and rapid atrial electrical activity during AF makes it difficult to obtain detailed information on atrial activation using the standard 12-lead ECG alone. Compared to conventional 12-lead ECG, more detailed ECG lead configurations may provide further information about spatio-temporal dynamics of the body surface potential (BSP) during atrial excitation. We apply a recently developed 3D human atrial model to simulate electrical activity during normal sinus rhythm and ectopic pacing. The atrial model is placed into a newly developed torso model which considers the presence of the lungs, liver and spinal cord. A boundary element method is used to compute the BSP resulting from atrial excitation. Elements of the torso mesh corresponding to the locations of the placement of the electrodes in the standard 12-lead and a more detailed 64-lead ECG configuration were selected. The ectopic focal activity was simulated at various origins across all the different regions of the atria. Simulated BSP maps during normal atrial excitation (i.e. sinoatrial node excitation) were compared to those observed experimentally (obtained from the 64-lead ECG system), showing a strong agreement between the evolution in time of the simulated and experimental data in the P-wave morphology of the ECG and dipole evolution. An algorithm to obtain the location of the stimulus from a 64-lead ECG system was developed. The algorithm presented had a success rate of 93%, meaning that it correctly identified the origin of atrial focus in 75/80 simulations, and involved a general approach relevant to any multi-lead ECG system. This represents a significant improvement over previously developed algorithms.     

The value of Holter monitoring in the assessment of Pediatric patients

Aims

Holter monitoring (HM) has been established as one of the most effective noninvasive clinical tools in the diagnosis, assessment and risk stratification of cardiac patients. However, studies in the pediatric age group are limited. The present work aims at determining the value of HM in the diagnosis and management of children.

Settings and Design

Retrospective study conducted at a tertiary referral arrhythmolology service.

Methods and Material

Holter records of 1319 pediatric patients (54.1% males and 45.9% females) were reviewed. Their average age was 6.7± 4.1 years (5 days-16 years). Indications for which Holter monitoring was done were analysed as well as all the abnormalities diagnosed and factors that may increase Holter yield.

Statistical analysis used

Statistical Package of social science (SPSS) version 9,0 was used for analysis of data.

Results

The most common indications were palpitations (19.8%), syncope (17.8%), cardiomyopathy (12.6%), chest pain (10%), evaluation of antiarrhythmic therapy (6.8%), postoperative assessment (2.6%) and complete AV Block (2.4%). A sum of 141 Holter recordings were found abnormal with a total diagnostic yield of 10.7%. The highest contribution to diagnosis was in postoperative assessment (32.4%) and in cardiomyopathy (19.9%) where the most common abnormalities were frequent supraventricular / ventricular premature beats, supraventricular tachycardia, ventricular tachycardia and AV block. Diagnostic yield was low in patients with palpitations (5.7%) and syncope (0.4%). An abnormal ECG was significantly associated with a higher diagnostic yield (p=0.0001). None of the children with chest pain had abnormal Holter recordings.

Conclusions

HM has an extremely valuable role in the assessment of high risk patients (postoperative and cardiomyopathy). However in children with palpitations, syncope and chest pain HM has a low yield. In this group of patients an abnormal ECG is more likely to be associated with abnormal Holter recordings.     

老年人动态心电图心律失常特点及对阵发性 房颤的诊断

目的:分析65岁以上老年人十二导联动态心电图(12-Holter)心律失常的特点及其对阵发性房颤的诊断价值。方法:①采用回顾性分析的方法,随机选择500例65岁以上老年人的动态心电图进行心律失常情况的统计分析,并同时选择500例小于65岁的心电图作为对照;②另选择500例65岁以上老年人的十二导联普通心电图(ECG)作为对照,对比分析12-Holter与ECG两种方法对老年人阵发性房颤的检出率。结果:①65岁以上老年人动态心电图各种心律失常、ST-T改变的发生率高。而在各类心律失常中房性早搏、室性期前收缩、房性心动过速、房颤发生率较高。②动态心电图对于阵发性房颤的检出率显著高于普通十二导联心电图。结论:①老年人动态心电图检查结果异常率高;②与普通心电图比较,动态心电图诊断老年人阵发性房颤有较高的价值。     

A Novel Algorithm for Movement Artifact Removal in ECG Signals Acquired from Wearable Systems Applied to Horses

This study reports on a novel method to detect and reduce the contribution of movement artifact (MA) in electrocardiogram (ECG) recordings gathered from horses in free movement conditions. We propose a model that integrates cardiovascular and movement information to estimate the MA contribution. Specifically, ECG and physical activity are continuously acquired from seven horses through a wearable system. Such a system employs completely integrated textile electrodes to monitor ECG and is also equipped with a triaxial accelerometer for movement monitoring. In the literature, the most used technique to remove movement artifacts, when noise bandwidth overlaps the primary source bandwidth, is the adaptive filter. In this study we propose a new algorithm, hereinafter called Stationary Wavelet Movement Artifact Reduction (SWMAR), where the Stationary Wavelet Transform (SWT) decomposition algorithm is employed to identify and remove movement artifacts from ECG signals in horses. A comparative analysis with the Normalized Least Mean Square Adaptive Filter technique (NLMSAF) is performed as well. Results achieved on seven hours of recordings showed a reduction greater than 40% of MA percentage (between before- and after- the application of the proposed algorithm). Moreover, the comparative analysis with the NLMSAF, applied to the same ECG recordings, showed a greater reduction of MA percentage in favour of SWMAR with a statistical significant difference (p–value < 0.0.5).     

Non-Invasive Drosophila ECG Recording by Using Eutectic Gallium-Indium Alloy Electrode: A Feasible Tool for Future Research on the Molecular Mechanisms Involved in Cardiac Arrhythmia

Background

Drosophila heart tube is a feasible model for cardiac physiological research. However, obtaining Drosophila electrocardiograms (ECGs) is difficult, due to the weak signals and limited contact area to apply electrodes. This paper presents a non-invasive Gallium-Indium (GaIn) based recording system for Drosophila ECG measurement, providing the heart rate and heartbeat features to be observed. This novel, high-signal-quality system prolongs the recording time of insect ECGs, and provides a feasible platform for research on the molecular mechanisms involved in cardiovascular diseases.

Methods

In this study, two types of electrode, tungsten needle probes and GaIn electrodes, were used respectively to noiselessly conduct invasive and noninvasive ECG recordings of Drosophila. To further analyze electrode properties, circuit models were established and simulated. By using electromagnetic shielded heart signal acquiring system, consisted of analog amplification and digital filtering, the ECG signals of three phenotypes that have different heart functions were recorded without dissection.

Results and Discussion

The ECG waveforms of different phenotypes of Drosophila recorded invasively and repeatedly with n value (n>5) performed obvious difference in heart rate. In long period ECG recordings, non-invasive method implemented by GaIn electrodes acts relatively stable in both amplitude and period. To analyze GaIn electrode, the correctness of GaIn electrode model established by this paper was validated, presenting accuracy, stability, and reliability.

Conclusions

Noninvasive ECG recording by GaIn electrodes was presented for recording Drosophila pupae ECG signals within a limited contact area and signal strength. Thus, the observation of ECG changes in normal and SERCA-depleted Drosophila over an extended period is feasible. This method prolongs insect survival time while conserving major ECG features, and provides a platform for electrophysiological signal research on the molecular mechanism involved in cardiac arrhythmia, as well as research related to drug screening and development.     

Chronic instrumentation and longterm investigation in the fetal and maternal baboon: tether system, conditioning procedures and surgical techniques

A tether system, conditioning procedures and surgical techniques were designed to maintain chronic catheters and electrodes in the pregnant baboon and her fetus. The tether system was comprised of a lightweight metal backpack containing catheters and electrodes, couplers, pressure transducers and electrical cabling. The backpack was held snugly in place by shoulder and body straps. A flexible metal tether connected the pack to a ball bearing assembly mounted on the top of the animal's home cage. Attached to the assembly were two infusion pumps, fluid reservoir and slip ring electrical connector. The entire system rotated freely with the movements of the animal; thus, the instrumentation and connectors were secure while access was maintained for continuous physiologic recording and intravascular infusion or intermittent blood sampling with minimal physical restraint. Animals were conditioned to accept the system prior to pregnancy and animals who demonstrated tolerance were bred. An initial group of 10 pregnant animals were sham tethered during pregnancy at 102 +/- 7 days with term gestation estimated at 180 days. Surgical procedures were done at 136 +/- 4 days with placement of catheters in the maternal femoral artery and vein, fetal carotid artery jugular vein and trachea, amniotic fluid cavity, and electrodes for fetal electrocardiogram and electroencephalogram. The mean fetal survival time was 9.3 (range 0 to 29) days. The major complications which led to early delivery were placental abruption and rupture of amniotic membranes. With ultrasonic localization of the placenta and determination of fetal position before surgery, these complications may be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of 50 Hz electric and magnetic fields on the pulse rate of human heart

This investigation studied the effects of 50 Hz electric and magnetic fields on the pulse rate of the human heart. The ECG (electrocardiograms) of 41 male volunteers were recorded with a Holter recorder. Twenty-six subjects were measured in and outside real fields, and 15 subjects were measured in and outside “sham” fields. The blood pressure and EEG (electroencephalogram) were also measured, but this article presents only the results of ECG recordings. The measurements took 3 h. The subjects were first sitting for 1 h outside the fields, then 1 h in the real or “sham” fields, and then, again, 1 h outside the fields. The electric field strength varied from 3.5 to 4.3 kV/m and the magnetic flux density from 1.4 to 6.6 μT. An analysis of the ECG recordings showed that the subjects' pulse rates were the same in and outside the fields. No response occurred when the subjects were exposed to real or “sham” fields. © 1994 Wiley-Liss, Inc.     

Employing ICA and SOM for spike sorting of multielectrode recordings from CNS

For classification of action potential shapes in multineuron recordings, we present a spike sorting system employing independent component analysis (ICA) and an unsupervised artificial neural network (Kohonen's self-organizing map, SOM). We focus on how ICA in the first stage of the spike sorting system can be used to address specific problems arising in recordings using multielectrode arrays in the CNS. Using real data recorded from the pontine nuclei in rats and simulated data, we evaluate the performance of several ICA algorithms to remove cross-talk between electrodes using data from continuous recording (or simulation). When using cut-out data, the standard format of extracellular spike recordings, new problems emerge and robust algorithms are needed. We demonstrate that several ICA algorithms show a good performance on cut-out data from multielectrode array recordings (simulated and real data). In tetrode recordings the same neuron is purposely recorded by several electrodes simultaneously and we show, how independent component analysis can be used in this case to identify redundant information and hence to compress relevant information, improving subsequent clustering of a SOM.     

Influence of 50 Hz electric and magnetic fields on the human heart

This investigation studied the effect of 50 Hz electric and magnetic fields on the human heart. The electrocardiograms of 27 transmission-line workers and 26 male volunteers were recorded with a Holter recorder both in and outside the fields. The measurements took from half an hour to a few hours. The electric field strength varied from 0.14 to 10.21 kV/m and the magnetic flux density from 1.02 to 15.43 μT. Analysis of the ECG recordings showed that extrasystoles or arrhythmias were as frequent outside the field as in the field. In some cases a small decrease in heart rate was observed after field exposure. © 1993 Wiley-Liss, Inc.     

Wireless ECG measurement system with capacitive coupling]

This paper describes a measurement system that captures an electrocardiogram (ECG) using capacitively coupled electrodes. The measurement system was integrated into an off-the-shelf office chair (so-called "Aachen SmartChair"). Whereas for classical ECG measurement adhesive is used to attach conductively coupled electrodes to bare skin, the system presented allows ECG measurement through clothing without direct skin contact. Furthermore, a ZigBee communication module was integrated to allow wireless transmission of ECG data to a PC or an ICU patient monitor. For system validation, classical ECG using conductive electrodes was obtained simultaneously. First measurement results, including variations of cloth thickness and material, are presented and some of the system-specific problems of this approach are discussed.     

Pulses of oxytocin in the cerebrospinal fluid of rhesus monkeys.

Cerebrospinal fluid (CSF) samples were collected at frequent intervals (every 10-15 min) to determine if oxytocin pulses were present in the CSF of monkeys. Temporary indwelling subarachnoid catheters, with the tip of the catheter at the T12-L1 subarachnoid space, were placed in 4 nonlactating and 3 lactating (4 months post partum) female monkeys. Monkeys were maintained on jacket/tether/swivel systems in a constant photoperiod (07.00-19.00 h). CSF was continuously withdrawn at a rate of 1.2 ml/h by peristaltic pump, and CSF was collected in 15-min fractions (from 3 lactating monkeys and 1 nonlactating monkey) or in 10-min fractions (from the other 3 nonlactating monkeys) using a fraction collector. CSF oxytocin was measured by radioimmunoassay. Pulses of oxytocin were analyzed using the computerized Pulsar pulse detection algorithm. A pulsatile pattern of oxytocin concentrations was found in the CSF of lactating and nonlactating monkeys. The ultradian pulses of oxytocin were superimposed upon the diurnal rhythm of oxytocin in CSF. We conclude that frequent sampling of CSF provides a way to monitor moment-to-moment changes in central nervous system concentrations of oxytocin in primates.     

Change of Diurnal Heart Rate Patterns During Pregnancy and Lactation in Dogs (<Emphasis Type="Italic">Canis familiaris</Emphasis>)

Pregnancy and lactation involve great demands on the cardiovascular system. The purpose of this study was to investigate how the heart rate and diurnal heart rate pattern change when dogs become pregnant or lactate. Five clinically healthy female beagle dogs were mated, and delivered three to seven healthy puppies. The heart rate was investigated with 24-h ECG (Holter) once during anoestrus, at 3, 5, 7 and 9 weeks of pregnancy, and at week 4 postpartum (lactation). However, at 9 weeks, the ECG could not be recorded for the fully 24 h in 4 of 5 dogs, because labour started and the dogs then appeared disturbed by the recordings. The results at this date are not included in the statistical comparison. The heart rate increased progressively during pregnancy and was still elevated at 4 weeks of lactation. During late pregnancy the difference in heart rates between daytime and nighttime became smaller, but the heart rate was significantly higher in daytime in all periods. In conclusion, the increased heart rates during pregnancy and lactation reflect increased demands on the cardiovascular system and may be important to consider in clinical practice.     

24 Hour ST Segment Analysis in Transient Left Ventricular Apical Ballooning

Objective

The etiologic basis of transient left ventricular apical ballooning, a novel cardiac syndrome, is not clear. Among the proposed pathomechanisms is coronary vasospasm. Long-term ST segment analysis may detect vasospastic episodes but has not been reported.

Methods

30 consecutive patients with transient left ventricular apical ballooning, left ventricular dysfunction and normal or near-normal coronary arteries were investigated. A 24-hour Holter ECG was obtained after emergency admission. ST segment analysis was performed automatically in 2 leads and confirmed by visual inspection. Criteria for an ischemic event were: 1. ST elevation or 2. horizontal or down-sloping ST segments ≥1 min duration and ≥100 µV J+80 point deviation corrected for baseline ST-deviation.

Results

Patients presented with ST segment elevation (n = 19) and/or T wave inversion (n = 20) on admission ECG. Ejection fraction was 50±12%. No transient ST elevations were observed during Holter ECG analysis. In 3 patients, 8 transient episodes of ST depression were recorded. Durations of episodes varied between 75s and 790s (mean 229s). Maximal ST deviation averaged −191±71 µV. Ischemic burden was −1 to −22 mVs (mean −8 mVs). 27 patients showed no ischemic events.

Conclusions

ST segment analysis of 24 h Holter recordings revealed minor ischemic events in only 10% of patients with transient left ventricular apical ballooning. Overall, ST segment changes were not indicative of recurrent coronary spasm playing a major role in the genesis of transient left ventricular apical ballooning.     

Identifying an increased risk of epileptic seizures using a multi-feature EEG–ECG classification

Epilepsy, a neurological disorder in which patients suffer from recurring seizures, affects approximately 1% of the world population. In spite of available drug and surgical treatment options, more than 25% of individuals with epilepsy have seizures that are uncontrollable. For these patients with intractable epilepsy, the unpredictability of seizure occurrence underlies an enhanced risk of sudden unexpected death or morbidity. A system that could warn the patient of the impending event or trigger an antiepileptic device would dramatically increase the quality of life for those patients. Here, we proposed a patient-specific algorithm for possible seizure warning using machine learning classification of 34 algorithmic features derived from EEG–ECG recordings. We evaluated our algorithm on unselected and continuous recordings of 12 patients (total of 108 seizures and 3178-h). Good out-of-sample performances were observed around 25% of the patients with an average preictal period around 30 min and independently of the EEG type (scalp or intracranial). Inspection of the most discriminative EEG–ECG features revealed that good classification rates reflected specific physiological precursors, particularly related to certain stages of sleep. From these observations, we conclude that our algorithmic strategy enables a quantitative way to identify “pro-ictal” states with a high risk of seizure generation.     

Comparison of arrhythmia detection by conventional Holter and a novel ambulatory ECG system using patch and Android App,over 24 h period

BackgroundAmbulatory electrocardiogram (AECG) is done for evaluation of arrhythmia. Commonly used AECG system is 24 h Holter. Patch based second generation AECG monitoring devices, which can record for longer periods, are now available.ObjectiveAndroid App based WebCardio using WiPatch is a new AECG system which records ECG in two leads for 72 h. Our study compared the arrhythmia detection by WebCardio and conventional Holter by simultaneously connecting both for 24 h in patients having indication for AECG.MethodsThe AECG of patients who had simultaneous recording with WebCardio and conventional Holter, in the department of Cardiology, Medical College, Thrissur were evaluated. Ability to detect any of the 6 arrhythmias :1) atrial fibrillation (AF), 2) atrioventricular (AV) block, 3) sinus pause of ≥3 s (SP), 4) supraventricular tachycardia (SVT), 5) premature ventricular complex (PVC) and 6) ventricular tachycardia (VT)/ventricular fibrillation (VF) was compared. Detection of each arrhythmia was also compared.Results141 patients had simultaneous recordings by both systems of AECG. The WebCardio picked up at least one of the 6 arrhythmias; AF, AV block, SP, SVT, PVC or VT/VF in 98 cases compared to 88 in the Holter (McNemars test, two tail P = 0.006). In eleven cases WebCardio detected an arrhythmia where Holter could not. In one case Holter identified an arrhythmia and WebCardio could not. Individual arrhythmias; AF, SP, SVT and VT/VF were detected equally by both systems. AV block (23 Vs 18, p = 0.0625) and PVCs (83 Vs 74, p = 0.0636) were detected in more number of cases in WebCardio. In the five cases where WebCardio alone identified AV block, four had poor quality of P wave in the Holter.ConclusionArrhythmia was picked up in more number of patients by the WebCardio compared to Holter. This was due to higher pickup of AV block and PVCs by WebCardio. Difference in AV block identification was due to better quality of P in WebCardio. WebCardio is a good alternative to Holter for AECG.