Abstract
IntroductionWe describe initial validation of a new system for digital to analog conversion (DAC) and reconstruction of 12-lead ECGs. The system utilizes an open and optimized software format with a commensurately optimized DAC hardware configuration to accurately reproduce, from digital files, the original analog electrocardiographic signals of previously instrumented patients. By doing so, the system also ultimately allows for transmission of data collected on one manufacturer's 12-lead ECG hardware/software into that of any other.Materials and MethodsTo initially validate the system, we compared original and post-DAC re-digitized 12-lead ECG data files (∼5-minutes long) in two types of validation studies in 10 patients. The first type quantitatively compared the total waveform voltage differences between the original and re-digitized data while the second type qualitatively compared the automated electrocardiographic diagnostic statements generated by the original versus re-digitized data.ResultsThe grand-averaged difference in root mean squared voltage between the original and re-digitized data was 20.8 µV per channel when re-digitization involved the same manufacturer's analog to digital converter (ADC) as the original digitization, and 28.4 µV per channel when it involved a different manufacturer's ADC. Automated diagnostic statements generated by the original versus reconstructed data did not differ when using the diagnostic algorithm from the same manufacturer on whose device the original data were collected, and differed only slightly for just 1 of 10 patients when using a third-party diagnostic algorithm throughout.ConclusionOriginal analog 12-lead ECG signals can be reconstructed from digital data files with accuracy sufficient for clinical use. Such reconstructions can readily enable automated second opinions for difficult-to-interpret 12-lead ECGs, either locally or remotely through the use of dedicated or cloud-based servers.
Highlights
We describe initial validation of a new system for digital to analog conversion (DAC) and reconstruction of 12lead ECGs
Original analog 12-lead ECG signals can be reconstructed from digital data files with accuracy sufficient for clinical use
The methodological problem the system must solve is as follows: How can one begin with 8 independent data channels in the original digital data and yet drive at least 9 DAC channels uncoupled from Wilson’s central terminal (WCT) to produce these same data channels at the receiving ECG machine? In other words how can one do this as if the channels outputted by the DAC had come from the usual 10 electrodes on a patient, and with the right
Summary
We describe initial validation of a new system for digital to analog conversion (DAC) and reconstruction of 12lead ECGs. While the previous starts that have been made toward such interchanges such as those of Bailey et al [2] in the 1970s and of Willems et al [1] in 1990s are of great interest, the fact that such starts have never germinated into a clinically useful, potentially lifesaving tool speaks to the inertia that can be generated when certain commercial forces persist that are not necessarily ideal from a patient-centered medicine standpoint It was possibly this very non-ideality that in 1984 led Miyahara et al to take a slightly different approach of first collecting digital ECGs and painstakingly regenerating analog signals – one complex at a time by means of magnetic tape and a specially constructed ‘‘generator’’ – that they re-fed into 10 different interpretive ECG machines available in Japan [3]. The methods described by Miyahara et al are today obsolete, were very cumbersome, and possibly involved two serial (and clinically redundant) references to Wilson’s central terminal (WCT)
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