ABSTRACT
A four-tiered approach to data reduction-observer analysis, semi-automated scanning, automated scanning, and computer applications-of ambulatory electrocardiographic recordings is now possible as a result of refinements in technology. Clinical circumstances, cost, and requirements of the involved institution or laboratory will dictate to what extent more advanced technology is needed. Although computer application will increase the detection sensitivity of ectopic beats, sophisticated, costly systems are still required for the analysis of high-frequency ectopic activity tapes.
Subject(s)
Electrocardiography/instrumentation , Arrhythmias, Cardiac/diagnosis , Computers , Electrocardiography/methods , Humans , Monitoring, Physiologic/instrumentationABSTRACT
A semiautomated ventricular premature beat (VPB) detector was developed which detects VPBs based upon a logical combination of prematurity, amplitude, and width. This system utilizes technicians to define sensitivity and criteria of VPB detection and to monitor the system's performance using a unique feedback system. Technician-assisted semiautomated scanning was found superior both to the system using preselected criteria and sensitivity of the detectors, and to traditional Holter scanning for the detection of single and repetitive VPBs. Ninety percent confidence limits of VPB frequency per hour have been established for this system.
Subject(s)
Cardiac Complexes, Premature/physiopathology , Computers , Electrocardiography/methods , Monitoring, Physiologic/methods , Arrhythmias, Cardiac/physiopathology , Computers, Analog , HumansABSTRACT
Ventricular premature beats (VPBs) are present in 85% of patients with coronary heart disease (CHD). A classification of VPBs based on frequency, multiformity, repetitive pattern, and degree of prematurity promises to aid in identifying patients at high risk of sudden death. Advanced grade or repetitive forms of VPBs are observed in 41% of patients with CHD who are monitored for 24 hours while ambulatory. Exercise stress is less effective than monitoring, but when advanced grades are exposed by exercise, they are likely to be persistent for two or more hours during monitoring. Such persistent and advanced grades characterize patients with multivessel coronary artery disease. Diurnal variations occur in VPB frequency and pattern with significant reduction during sleep. This as well as other facts suggest a primary role for neural activity in the genesis of ventricular ectopy. The relevance of these observations to sudden death is considered.
