ECG Method Research Articles

Effectiveness of the ECG method in the correct positioning of PICC type central venous catheters in patients with atrial fibrillation.

The peripherally inserted central catheters (PICCs) are third generation silicone or polyurethane catheters, used as venous accesses for long- and medium-term care, and recommended in therapies that require venous access for more than six days. Current implantation methods recommend the radiological method, using standard chest RX in antero-posterior projection, as a method of assessing the correct positioning of the catheter tip. The observational study evaluated the effectiveness in terms of reliability of the intracavitary tip location system (ITLS) method, better known as the ECG method, for the correct positioning of the catheter tip in patients with atrial fibrillation (AFIB); the method exploits the recording of the electrical potential produced by the f waves, expression of the fibrillation of the atrium typical in patients with this disease, the measurement is based on the calculation of the peak-to-peak value of the f waves. They were implanted using this method 101 subjects with previous determination of anthropometric measurement, according to the rule of Peres modified according to Pittiruti, and then subjected to standard thoracic RX in projection antero-posterior and latero-lateral. Our study shows that 97% of the patients implanted with this method at radiological control had the PICC correctly positioned, at an average distance from the hull of 44.9mm; 100% of the patients did not present complications in either the short or medium term. The analysis of the data also shows that the anthropometric evaluations, carried out with the Peres method, corresponded to the correct radiological positioning of the catheter, evaluated with the hull method, only in 45.5% of cases. Our study tends to demonstrate that the ECG-ITLS method, used as a method of intra-procedural control of PICC-type CVC positioning, in patients with atrial fibrillation, has greater reliability than that of anthropometric measurement and equivalent to radiological measurement, but has less chance of incurring in error of reading or projection.

A novel compression framework using energy-sensitive QRS complex detection method for a mobile ECG

A novel compression framework using energy-sensitive QRS complex detection method for a mobile ECG

Right Ventricular Functional Status in Chronic Obstructive Pulmonary Disease Patient

Aim: To detect the right ventricular status by echocardiography of COPD patients.Background: Chronic obstructive pulmonary disease is an increasing cause of chronic morbidity and mortality worldwide. Smoking is the major cause and the patients consult with physicians very much late when become complicated. Echocardiography is the main determinant of outcome of COPD patient. We can assess the level of pulmonary hypertension which leads to right heart failure.Methods : This is a cross sectional study. Study place was Department of Medicine, Rangpur Medical College from 1st July to 30 September 2014.Clinically and post bronchodilator Spiro metrically diagnosed cases were taken. Patients were graded into Mild, Moderate, severe and very severe categories according to GOLD criteria. Statistical analysis was done with echo findings of RV dilatation and hypertrophy by using Chi-square test and statistical significance was taken as p < 0.05Results : Mean age was 61.50 (sd±9.76) years with male predominance. Mean duration of disease was 6.80 ( sd ± 4.71) years. Patients had a mean duration of smoking of 23.2 ±3.6 pack years. ECG and Echo findings such as RV dilatation, RV hypertrophy and pulmonary hypertension were showed significant correlation with severity and duration of disease. Diagnosis of cor-pulmonale was clinically 20%, ECG 50% and echocardiographically 92%.Conclusion : COPD is more common in males in 5th to 7th decade with the smoking history of more than 20 pack years. Most patients have moderate to severe disease at presentation. Echocardiography can detect the RV dysfunction in COPD patient earlier. ECG and Echo findings increase as the severity and duration of the disease increases and echocardiography is better than ECG or clinical methods in detecting RV dysfunction.Bangladesh J Medicine Jul 2018; 29(2) : 63-68

11637-Tesla Cardiac MRI for Ventricular and Valvular quantitation in healthy volunteers

Background: Ultra-high-field (B0 ≥7 Tesla) cardiovascular magnetic resonance (CMR) offers increased resolution, but cardiac imaging requiring ECG gating is significantly impacted from the magneto-hydrodynamic (MHD) effect, distorts the ECG trace (1–3). Previously, 7T CMR was constrained to using pulse oximetry for triggering, We explored the technical feasbility of a 7 T research MR scanner using of-the-art ECG trigger algorithm to assess left and right ventricular volumes, aortic and pulmonary valve flow. Methods: 7T CMR scans were performed on 10 healthy volunteers on whole-body research MRI scanner (Siemens Healthcare, Erlangen, Germany) with 8 channel Tx/32 channel Rx cardiac coil (MRI Tools GmbH, Berlin, Germany) under institutional review board approval. Vectorcardiogram ECG was successfully performed using a learning phase outside of the magnetic field, with a trigger algorithm with sufficient accuracy for CMR despite severe ECG signal distortions from the 7T field. Cine CMR was performed after 3rd-order B0 shimming using a high-resolution breath-held ECG-retro-gated segmented two-dimensional spoiled gradient echo sequence, and 2-dimensional phase contrast flow imaging. Analysis was performed using Cmr42 software (Circle CVi, Calgary). Results: Successful 7T CMR scans were acquired in all patients (100%) using the Vectorcardiogram 3-lead ECG method. Image quality was sufficient to quantitate both left and right ventricular volumes, ejection fraction, aortic and pulmonary blood flow and regurgitant fractions in 9/10 (90%) of volunteers (figure 1), with one volunteer having difficulty with breath-holding and ventricular ectopy causing gating artefacts.

ECG and fingerprint bimodal authentication

Security research on smart cities mostly focuses on the communication of “things” and rarely focuses on the interaction between “things” and people. Security breaches at this lower level will render higher-level security measures ineffective. In this paper, we propose to use a multimodal biometric approach (ECG and Fingerprint) to secure the interaction between “things” and people. ECG biometrics is a relatively new technique and its performance is still inferior to that of fingerprint biometrics. However, as opposed to ECG, fingerprint users touch objects and inadvertently leave behind their invisible fingerprints marks. Hackers can lift these invisible marks and gain illicit access to the devices of their victims. Moreover, ECG based authentication requires users to be alive, a quality that can prove important for smart cities. The latter is not true for fingerprint authentication. In this paper, we combine ECG and Fingerprint features in a bimodal biometric system. Our objective is to enhance the advantages of both biometric methods while minimizing their weaknesses. For the ECG method, we use an SVM classifier and for the Fingerprint technique we employ the minutiae extractor and matcher from NBIS. We fuse the results of the ECG and Fingerprint authentication at the decision level to distinguish between genuine users and impostors. The literature on ECG and Fingerprint bimodal biometrics is very limited, however, the obtained results show that this work presents an improvement in terms of EER (Equal Error Rate) compared to existing work.

Characterizing the Location and Extent of Myocardial Infarctions With Inverse ECG Modeling and Spatiotemporal Regularization.

Myocardial infarction (MI) is among the leading causes of death in the United States. It is imperative to identify and characterize MIs for timely delivery of life-saving medical interventions. Cardiac electrical activity propagates in space and evolves over time. Traditional works focus on the analysis of time-domain ECG (e.g., 12-lead ECG) on the body surface for the detection of MIs, but tend to overlook spatiotemporal dynamics in the heart. Body surface potential mappings (BSPMs) provide high-resolution distribution of electric potentials over the entire torso, and therefore provide richer information than 12-lead ECG. However, BSPM are available on the body surface. Clinicians are in need of a closer look of the electric potentials in the heart to investigate cardiac pathology and optimize treatment strategies. In this paper, we applied the method of spatiotemporal inverse ECG (ST-iECG) modeling to map electrical potentials from the body surface to the heart, and then characterize the location and extent of MIs by investigating the reconstructed heart-surface electrograms. First, we investigate the impact of mesh resolution on the inverse ECG modeling. Second, we solve the inverse ECG problem and reconstruct heart-surface electrograms using the ST-iECG model. Finally, we propose a wavelet-clustering method to investigate the pathological behaviors of heart-surface electrograms, and thereby characterize the extent and location of MIs. The proposed methodology is evaluated and validated with real data of MIs from human subjects. Experimental results show that negative QRS waves in heart-surface electrograms indicate potential regions of MI, and the proposed ST-iECG model yields superior characterization results of MIs on the heart surface over existing methods.

Pulse oximetry parameters to augment detection of myocardial ischemia – A feasibility study

Acute myocardial ischemia is a common cause of ventricular arrhythmias, yet recent ECG methods predicting susceptibility to ventricular tachyarrhythmia have not been fully evaluated during spontaneous ischemia. We sought to evaluate the clinical utility of alternans and non-alternans components of repolarization variability from the standard 10-second 12-lead ECG signals to risk stratify patients with acute chest pain.We enrolled consecutive, non-traumatic, chest pain patients transported through Emergency Medical Services (EMS) to three tertiary care hospitals with cardiac catheterization lab capabilities in Pittsburgh, PA. ECG signals were manually annotated by an electrophysiologist, then automatically processed using a custom-written software. Both T wave alternans (TWA) and non-alternans repolarization variability (NARV) were calculated using the absolute RMS differences over the repolarization window between odd/even averaged beats and between consecutive averaged pairs, respectively. The primary study outcome was the presence of acute myocardial infarction (AMI) documented by cardiac angiography.After excluding patients with secondary repolarization changes (n = 123) and those with excessive noise (n = 90), our final sample included 537 patients (age 57 ± 16 years, 56% males). Patients with AMI (n = 47, 9%) had higher TWA and NARV values (p < 0.01). Mean RR correlated with TWA, and noise measures correlated with TWA and NARV, after adjusting for potential confounders. There was a high collinearity between TWA and NARV, and each was separately predictive of AMI after controlling for number of analyzed beats, noise measures, and other clinical variables.Despite limitations imposed by signal quality, TWA and NARV are higher in patients with AMI, even after correction for potential confounders. The clinical value of TWA and NARV derived from standard ECG using our time-domain RMS method is questionable due to the small number of beats and significant noise.

Evaluation of beat-to-beat ventricular repolarization lability from standard 12‐lead ECG during acute myocardial ischemia

BackgroundAcute myocardial ischemia is a common cause of ventricular arrhythmias, yet recent ECG methods predicting susceptibility to ventricular tachyarrhythmia have not been fully evaluated during spontaneous ischemia. We sought to evaluate the clinical utility of alternans and non-alternans components of repolarization variability from the standard 10-second 12-lead ECG signals to risk stratify patients with acute chest pain. MethodsWe enrolled consecutive, non-traumatic, chest pain patients transported through Emergency Medical Services (EMS) to three tertiary care hospitals with cardiac catheterization lab capabilities in Pittsburgh, PA. ECG signals were manually annotated by an electrophysiologist, then automatically processed using a custom-written software. Both T wave alternans (TWA) and non-alternans repolarization variability (NARV) were calculated using the absolute RMS differences over the repolarization window between odd/even averaged beats and between consecutive averaged pairs, respectively. The primary study outcome was the presence of acute myocardial infarction (AMI) documented by cardiac angiography. ResultsAfter excluding patients with secondary repolarization changes (n=123) and those with excessive noise (n=90), our final sample included 537 patients (age 57±16years, 56% males). Patients with AMI (n=47, 9%) had higher TWA and NARV values (p<0.01). Mean RR correlated with TWA, and noise measures correlated with TWA and NARV, after adjusting for potential confounders. There was a high collinearity between TWA and NARV, and each was separately predictive of AMI after controlling for number of analyzed beats, noise measures, and other clinical variables. ConclusionsDespite limitations imposed by signal quality, TWA and NARV are higher in patients with AMI, even after correction for potential confounders. The clinical value of TWA and NARV derived from standard ECG using our time-domain RMS method is questionable due to the small number of beats and significant noise.

Electrocardiographic biomarkers to confirm drug's electrophysiological effects used for proarrhythmic risk prediction under CiPA

The ECG plays a critical role in the thorough QT study. This clinical study is part of the assessment of proarrhythmic potential of drugs under the current regulatory paradigm. While the current paradigm has been successful in preventing drugs with unexpected QT prolongation or torsade risk from reaching the market, the focus on QT prolongation has likely resulted in potentially beneficial compounds with minimal torsade risk being dropped from development. The Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative is developing and validating a new mechanistic-based paradigm for cardiac safety evaluation of drugs. The fourth component of CiPA uses ECG data in phase 1 clinical studies to confirm there are no unanticipated ion channel effects compared to nonclinical data. The J-Tpeak interval was identified as the best biomarker for differentiating QTc prolonging drugs with predominant hERG block from drugs with multichannel (hERG plus late sodium and/or calcium block). This manuscript describes ECG methods for J-Tpeak assessment and their relationship with the features of new ECG biomarkers for detecting multichannel effects under CiPA.

PATHOLOGICAL SIGNS OF EPILEPTIC AND NON-EPILEPTIC ORIGIN DETECTED IN AWAKE/SLEEP EEG PATTERNS DURING OUTPATIENT AND INPATIENT MONITORING: PROBLEMS OF INTERPRETATION

The aims of this study were: (a) to elucidate the role of prolonged computerized EEG in assessing the brain function in patients with focal lesions (stroke consequences, tumor, etc.), and (b) to summarize the experience of using outpatient and inpatient EEG monitoring in neurological practice. Materials and methods. The study included 99 patients with post-stroke and other focal lesions or with a neurological deficit (aphasia, paresis, etc.) or with focal slow-wave and paroxysmal (epileptiform) activity, or with suspected «epilepsy». The patients were monitored using the method of ECG in outpatient and / or neurological hospital settings. The diagnosis of symptomatic epilepsy was confirmed in 81 patients (86%), and not confirmed – in 13 patients (14%). The patients’ age ranged from 16 to 78 years (average 56); the male/female ratio was 37/57. Results . The outpatient and impatient Holter EEG monitoring revealed various EEG patterns both in norm and pathology. Among those: different epileptiform signs (detected in all groups of patients) with different occurrence rates: PLEDs – rhythmic delta, frontal – FIRDA, temporal – TIRDA, spikes and complexes on the left and / or right, generalized paroxysms and photosensitivity. Examples of these EEG patterns (awake and sleep) are presented. Of special interest is the epileptiform pattern where polyspikes are combined with K complexes in the 2nd stage of sleep. Both generalized and focal patterns – mostly typical for sleep EEG – are demonstrated. The method of multiple dipole localization (MDL) was used to directly localize the sources of the abnormal EEG activity (slow-wave and paroxysmal) in the brain. In this report, combined results of EEG and MRI indicating the sources of the abnormal electrical activity are presented to compare the localization of the spike activity with that of the rhythmic slow waves. Two major causes of functional deficiency in post-stroke aphasia and plegia (and similar disorders) are proposed. Firstly, it is the presence of an ischemic focus with a decreased cerebral blood flow in this zone that results in a focal slow-wave activity (delta focus). Secondly, a loss of function can be caused by a continuous discharge activity of brain neurons. An epileptogenic focus and a continuous paroxysmal activity can lead to over-stimulation of brain neurons. Conclusion . Monitoring and analyzing EEG indicators in outpatients significantly expand the capabilities of EEG and provide new information on the brain function. In respect to the differential diagnosis between epileptic and non-epileptic seizures, prolonged monitoring allows to obtain additional information from EEG records and better identify epilepsy-associated activities.

PECULIARITIES OF HEART POSITION OF MATURE AGE PEOPLE OF VARIOUS CONSTITUTIONAL TYPES

According to WHO, cardiovascular morbidity consistently rank first place in the world, in recent decades, even has a pronounced tendency to rejuvenation. As in recent years in medicine focuses on preventive vector, it makes sense to determine the criteria that would prevent the development of cardiovascular disease. Investigation of the cardiovascular system in the clinic carried out using of methods - standard ECG, echocardiography, radiological, ELISA and biochemical methods etc. However, in interpreting results of investigations should take into account not only the general condition of the patient, his age and gender, but also constitutional, individual anthropometric data, which determine the various positions of the heart in the chest cavity. From the scientific literature it is known that to clarify the position of the heart measured the angle of its axis, the value of which ranges from 30 to 600. Depending on the angle value differentiate: oblique (43-480), vertical (49-600) and horizontal (30-420) positions of the heart. Oblique position is the most physiological, typical for normosthenics; vertical – for asthenics; horizontal – for hypersthenics. Since the displacement of cardiac axis can cause the development of various pathological conditions – horizontal position is associated with hypertension, vertical – with valves prolapses and blockade beam Hiss, determined during the patient's examination peculiarities of the heart position should be considered as additional risk factors for developement of these pathologies. That is why the aim of our work was to investigate the peculiarities of the heart positions and heart axis inclination in the mature age people different constitutional types. To perform this research is was analyzed 50 chest X-Rays in the mature age people (without complaints in the case hystory on the cardiovascular system), made in direct projection selected by randomization. It was determined the type structure of the chest and the angle of inclination of the heart axis in relation to the horizontal line drawn through the heart's apex. The study of the peculiarities of the constitutional structure of the chest made it possible to determine among all examined persons 28 normosthenics (56% of examined people), 14 asthenics (28%) and 8 (16%) hypersthenics. The result of measuring the angle of the cardiac axis inclination showed that among all examined persons oblique position of hearts met more often - in 22 cases (44% of examined people), vertical – in 16 cases (32%), horizontal – less often, in 12 cases (24%). In examined asthenics was found only two heart positions – vertical (57%) and oblique (43%); in normosthenics and hypersthenics was found all three position of the cardiac axis inclination, in both groups the most often were met oblique heart position (43% and 50% respectively for each constitutional type), less often – vertical (25%) and 12.5% respectively). Results of the study showed that different versions of the cardiac axis inclination could be detected by radiographic examination, regardless of the constitutional type, the most common heart position is the oblique position of the heart, such a position was found in the most normosthenics and hypersthenics (43% and 50% respectively).

Hyperacute And Chronic Changes In Cerebral Magnetic Resonance Images After Pvac, nmarq And Epicardial Thoracoscopic Surgical Ablation For Paroxysmal Atrial Fibrillation.

Threshold testing of cardiac rhythm devices is essential to monitoring the proper functioning of such devices (1). However, the currently method of applying multiple ECG leads to the patient is burdensome and time consuming (2). We are presenting a completely new way to perform cardiac rhythm device threshold testing using pulse oximetry. Twenty patients, with varying cardiac rhythm devices and pacing modes, were enrolled and had their atrial and ventricular thresholds tested. A comparison was made between simultaneous threshold determinations via the standard EGM based method and the new pulse oximetry based method. 75% of the ventricular threshold tested and 58% of the atrial thresholds tested were the same with the two testing methods. The remainder of the tests (25% of ventricular threshold and 42% of the atrial threshold tests) varied by +0.25 V. This study shows that pulse oximetry based testing is an accurate, reliable, and easy way to perform cardiac rhythm device threshold testing and may complement traditional methods to perform such tests in the future.

Comparison of fetal and maternal heart rate measures using electrocardiographic and cardiotocographic methods

PurposeTo determine the reliability at term of: (1) two methods of measuring fetal heart rate (HR), electrocardiographic (ECG, the ‘gold standard’) and cardiotocographic (CTG) and (2) two ECG methods of measuring maternal HR variability over relatively brief periods of time (s–min). MethodsDuring 20min of rest (N=39) and during 2min of auditory stimulation (mother's recorded voice, n=19), fetal HR data were collected using an ECG (Monica AN24) and a Hewlett-Packard Model 1351A CTG. Simultaneously, maternal HR data (n=37) were collected using the same ECG device (Monica AN24) and a second stand-alone cardiac monitor (Spacelab 514T cardiac monitor with a QRS detector). ResultsDuring 20min of maternal rest, correlations of individual fetal CTG with ECG measures of HR at each second were moderate to high (r=.57–.97) for 77% of fetuses. Correlations of HR averaged over fetuses and over each of the 20min were high (r=.93–.97); fetal HR averaged over 20min varied between devices from 0.0 to 0.8bpm. During 2min of maternal voice presentation, correlations of fetal HR over each second were moderate to high (r=.54–.99) for 95% of fetuses and high (all rs=.99) when averaged across fetuses in 30s or 2min epochs. Average fetal HR between devices over the 2min voice varied from 0.0 to 0.6bpm. Correlations and/or % agreement between the two ECG methods of measuring maternal HR were high. Average maternal HR over 10min showed 81% of pairs with a difference of ≤1bpm; correlations for HR variability measures varied from r=.89 to .97. ConclusionsGood reliability was demonstrated between individual spontaneous and auditory induced fetal CTG and ECG with high correlations when HR data were averaged over fetuses or in 30–120s epochs. High reliability of maternal HR measures was obtained using two ECG devices.

Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients: Three-Year Results From the Cryptogenic Stroke and Underlying Atrial Fibrillation Trial.

Atrial fibrillation (AF) can be a cause of previously diagnosed cryptogenic stroke. However, AF can be paroxysmal and asymptomatic, thereby making detection with routine ECG methods difficult. Oral anticoagulation is highly effective in reducing recurrent stroke in patients with AF, but its initiation is dependent on the detection of AF. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF) is the first randomized study to report the detection of AF in cryptogenic stroke patients using continuous long-term monitoring via insertable cardiac monitors (ICM). Patients with prior cryptogenic stroke were randomized to control (n=220) or ICM (n=221) and followed for ≤36 months. Cumulative AF detection rates in the ICM arm increased progressively during this period (3.7%, 8.9%, 12.4%, and 30.0% at 1, 6, 12, and 36 months, respectively), but remained low in the control arm (3.0% at 36 months). This resulted in oral anticoagulation prescription in 94.7% of ICM patients with AF detected at 6 months, 96.6% at 12 months, and 90.5% at 36 months. Among ICM patients with AF detected, the median time to AF detection was 8.4 months, 81.0% of first AF episodes were asymptomatic, and 94.9% had at least 1 day with >6 minutes of AF. Three-year monitoring by ICM in cryptogenic stroke patients demonstrated a significantly higher AF detection rate compared with routine care. Given the frequency of asymptomatic first episodes and the long median time to detection, these findings highlight the limitations of using traditional AF detection methods. The majority of patients with AF were prescribed oral anticoagulation therapy. Clinicaltrials.gov; Unique identifier: NCT00924638.

A potential pitfall of the modified 12 lead electrocardiogram (Mason-Likar modification) in catheter ablation of idiopathic ventricular arrhythmias originating from the outflow tract.

The Mason-Likar modified electrocardiogram (ML-ECG) can be interchanged with standard 12 lead ECG electrode positions (standard ECG) without affecting the diagnostic interpretation during sinus rhythm, but the morphological differences during ventricular arrhythmias have not been sufficiently evaluated. This study aimed to elucidate the morphological changes in the ML-ECG precordial leads. In 53 consecutive patients with premature ventricular contractions predicted to originate from the outflow tract (OT-PVCs), the arrhythmias were analysed by those two ECG methods. The OT-PVC origin sites, which were predicted by currently published criteria with the respective ECG methods prior to catheter ablation, were compared with the successful ablation sites. Compared with the standard-ECG, S-waves in the ML-ECG became shallower in leads V1-4 (P < 0.05 in lead V1; P < 0.001 in leads V2-4), and pseudo-R-waves in lead V1 appeared in seven patients. The precordial leads transition zone shifted counter-clockwise in 18 patients in the ML-ECG. In leads I and aVL, the negative deflection amplitudes of the ML-ECG were greater than those of the standard ECG (P < 0.001), and polarity reversals in lead I appeared in 18 patients. The R-wave amplitudes in all ML-ECG inferior leads were greater than those in the standard-ECG leads (all for P < 0.001). Those changes had an effect on the diagnostic indexes for the localization, and the specificity of the criteria for the ML-ECG was poorer than that for the standard-ECG. Great differences were found between those two ECG methods. Predicting OT-PVC origins by diagnostic criteria with the ML-ECG might result in a misdiagnosis and inefficient ablation.

Does Electrocardiogram Offer an Alternative to Radiological Imaging in the Confirmation of Tip Positioning for the Insertion of Peripherally Inserted Central Catheters; A Comparison of 120 Patients

Background:Within the Haematology and Oncology department at a London Teaching Hospital Peripherally Inserted Central Catheters (PICC) are inserted by the Nurse Practitioners (NP) and tip position is checked by radiological confirmation post procedure. Inpatients were found to be waiting on average 5 hours for a chest xray (CXR), delaying therapies. Confirming tip position post insertion also led to repeat procedures if the tip was found to be malpositioned on the CXR film.Introduction:ECG can be used to verify tip positions of central venous catheters. The technique was first introduced in the 1940s in Europe but the potential was not realised until 50 years later. The practice works by attaching the patient to a cardiac monitor, and connecting an extra lead to the PICC. Pulses from the Sinoatrial Node are detected by the PICC as it enters the Superior Vena Cava. The impulse grows stronger as the tip advances down the vein, signified by an enlarged p-wave visible on the ECG. Passing the node causes a deflection in the wave, communicating to the inserter that the tip is positioned beyond the Cava-Atrial Junction (CAJ) i.e. into the right atrium, and should be retracted. The ideal tip position for a PICC line is between the distal SVC and within one centimetre of the right atrium. This method of insertion is not suitable for all patient groups. It is well documented that obese, the young or patients with AF will not obtain a clear p-wave rise. Also the presence of a pacemaker will mean that the p-wave size is not affected by the PICC tip position.Ideal tip position of a PICC line provides reliable venous access with optimal therapeutic delivery, while minimizing short-and-long term complications. Prior to engaging in the data collection, the Nurse Practitioners completed an ECG course, participated in a company workshop and consolidated their training by visiting another trust who were also performing ECG guided PICC insertions. [Display omitted] Method:A study of 120 patients compromising of 66 females and 54 males from October 2013 – July 2014 was performed. 103 PICC lines were required for chemotherapy treatment, the remaining 17 PICC line were for supportive therapies. 36 PICC lines were inserted on the left side and 84 PICC lines inserted on the right.PICCs were placed under ECG guidance and a post-procedural CXR was performed. The NP predicted the position of the tip based on the ECG tracing, and comparison was made once the CXR was performed and the radiological report made available.ResultsOut of 120 cases, 10 patients failed to obtain a p-wave rise that the inserter deemed significant. However according to the radiological image all of these lines were found to be suitably positioned. The incidence of this phenomenon was greatly reduced once the practitioners gained experience of this technique. There was one case where the p-wave rise was deemed significantly high by both practitioners to predict a positioning of the CAJ. However following a CXR, the line was incorrectly positioned at the top of the SVC. This was of concern; however the patient was a complex case, with Budd-Chiari syndrome, causing abdominal distension and compression of the organs. In published literature, below diaphragm abnormalities can impact on the sensitivity of the technique. For this reason complicated patients, such as described will require consideration of radiological imaging.In all other cases where the P wave was appropriately elevated the chest radiograph image that followed demonstrated a definite correlation between the height (size) of the P-wave and the location of the terminal tip is within the SVC.ConclusionThe data significantly supported ECG guidance as an accurate verification for PICC tip position. Currently the department is planning on foregoing the post-insertion CXR if the ECG method has produced a positive result. The Nurse Practitioners recognise that there will always be cases that require a CXR. However use of the ECG method will reduce the time between insertion and use of the PICC line, diminish radiation exposure to our patients and lower the costs of repeated insertion due to malpositioning of lines. DisclosuresNo relevant conflicts of interest to declare.

Radioelectronic technologies in the ultrahigh resolution electrocardiography for early diagnostics of cardiopathologies

The background, features and characteristics of the ultrahigh resolution electrocardiography (UHR ECG) method and its place among the other state-of-the-art electrocardiographic methods (ECG methods) have been described. The approaches and radioelectronic technologies used in the development of devices for the primary processing of electrocardiosignals (ECS) and algorithms of their secondary processing by the UHR ECG method were considered. In addition, the technique for performing experimental investigations on test animals and registration of ECG data were also considered in the search for new diagnostic signs of cardiopathologies. The possibilities of obtaining information regarding the development of ischemic heart disease by means of ECG signals registered by the UHR ECG method were described.

PM209 Correlation Of The Ecg Changes (St Segment Depression With Or Without T Wave Inversion In Lateral Leads 1, Avl.V4-V6) With Coronary Angiographic Findings In Acs Patients

Despite being the mainstay for the initial noninvasive assessment of patients with symptomatic coronary artery disease, the 12‑lead ECG remains a suboptimal diagnostic tool for myocardial ischemia detection with only acceptable sensitivity and specificity scores. Although myocardial ischemia affects the configuration of the QRS complex and the STT waveform, current guidelines primarily focus on ST segment amplitude, which constitutes a missed opportunity and may explain the suboptimal diagnostic performance of the ECG. This possible opportunity and the low cost and ease of use of the ECG provide compelling motivation to enhance the diagnostic accuracy of the ECG to ischemia detection. This paper describes numerous computational ECG methods and approaches that have been shown to dramatically increase ECG sensitivity to ischemia detection. Briefly, these emerging approaches can be conceptually grouped into one of the following four approaches: (1) leveraging novel ECG waveform features and signatures indicative of ischemic injury other than the classical ST-T amplitude measures; (2) applying body surface potentials mapping (BSPM)-based approaches to enhance the spatial coverage of the surface ECG to detecting ischemia; (3) developing an inverse ECG solution to reconstruct anatomical models of activation and recovery pathways to detect and localize injury currents; and (4) exploring artificial intelligence (AI)-based techniques to harvest ECG waveform signatures of ischemia. We present recent advances, shortcomings, and future opportunities for each of these emerging ECG methods. Future research should focus on the prospective clinical testing of these approaches to establish clinical utility and to expedite potential translation into clinical practice.

The Intracavitary ECG Method for Positioning the Tip of Central Venous access Devices in Pediatric Patients: Results of an Italian Multicenter Study

The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients. We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices (VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (<4 years, n = 157), B (4-11 years, n = 119), and C (12-18 years, n = 31). IC-ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina. There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%. We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.

Neural Networks for Atrial Late Potentials Features Detection

The development of information technologies enables to improve tools and diagnostic methods of the cardiovascular system. The new method of electrocardiography is the method of high-resolution electrocardiography ( HR ECG), which allows to detect late potentials (LP) that are low-amplitude components of electrocardiosignal and are invisible on the standard ECG.In this paper a comprehensive method of processing HR ECG for the classification of electrocardiograms for the presence of atrial late potentials, which are markers of atrial arrhythmias, was proposed. The method is based on the combination of a neural networks algorithm and the classical methods of analysis of cardiac signals: in time domain, spectral and wavelet analysis.Also, the methods for diagnostic features formation that based on the classical methods of analysis ECG for the training samples construction for neural networks were considered.The estimation and analysis of the classification of ECG results with presence and absence of abnormalities were made.Reference 9, figures 8.