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Spaich S, Kern H, Zelniker TA, Stiepak J, Gabel M, Popp E, Katus HA, Preusch MR. Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting. Front Cardiovasc Med 2020; 7:551796. [PMID: 33195450 PMCID: PMC7581708 DOI: 10.3389/fcvm.2020.551796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background: This study explores the application of CardioSecur® (CS-ECG), a hand-held 4-electrode/22-lead ECG-device, in comparison with conventional 12-lead electrocardiogram (c12L-ECG) in patients with acute chest pain in the prehospital emergency setting. Methods: CS-ECG systems were provided for two physician-staffed emergency ambulances and parallel recordings of c12L-ECG and CS-ECG were obtained from all patients with acute chest pain. Treating emergency physicians were asked to evaluate the CS-ECG system with a standardized questionnaire. Following study completion, acquired ECGs were analyzed separately by two independent cardiologists blinded to all other medical records. Results: Over a period of 20 months a total of 203 patients were included in our study. According to a standardized questionnaire, 79% of emergency medical professionals preferred application of CS-ECG, with 87% of teams judging CS-ECG to be beneficial for patients. Morover, 79% of physicians reported a reduction in time to definitive diagnosis with implementation of CS-ECG. The majority of professional users attested user-friendliness and feasibility of CS-ECG in terms of easy general handling (94%), application (93%), and placement of electrodes (98%). During prehospital triage, both c12L-ECG and CS-ECG correctly identified 31 (91%) patients with ST-elevation myocardial infarction (STEMI). Conclusion: In this first pilot study, implementation of the CardioSecur®-ECG system in the prehospital emergency setting demonstrated feasibility and user-friendliness so that emergency teams generally preferred CS-ECG to c12L-ECG. Diagnostic yield of CS-ECG was similar to c12L-ECG recordings.
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Affiliation(s)
- Sebastian Spaich
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Hanna Kern
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jan Stiepak
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Gabel
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Erik Popp
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael R. Preusch
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
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Guldenring D, Finlay DD, Bond RR, Kennedy A, McLaughlin J, Galeotti L, Strauss DG. Computing the spatial QRS-T angle using reduced electrocardiographic lead sets. J Electrocardiol 2016; 49:794-799. [PMID: 27609012 DOI: 10.1016/j.jelectrocard.2016.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 11/25/2022]
Abstract
The 'spatial QRS-T angle' (SA) is frequently determined using linear lead transformation matrices that require the entire 12-lead electrocardiogram (ECG). While this approach is adequate when using 12-lead ECG data that is recorded in the resting supine position, it is not optimal in monitoring applications. This is because maintaining a good quality recording of the complete 12-lead ECG in monitoring applications is difficult. In this research, we assessed the differences between the 'gold standard' SA as determined using the Frank VGG and the SA as determined using different reduced lead systems (RLSs). The random error component (span of the Bland-Altman 95% limits of agreement) of the differences between the 'gold standard' SA and the SA values based upon the different RLSs was quantified. This was performed for all 62 RLSs that can be constructed from Mason-Likar (ML) limb leads I, II and all possible precordial lead subsets that contain between one and five of the precordial leads V1 to V6. The RLS with the smallest lead set size that produced SA estimates of a quality similar to what is achieved using the ML 12-lead ECG was based upon ML limb leads I, II and precordial leads V1, V3 and V6. The random error component (mean [95% confidence interval]) associated with this RLS and the ML 12-lead ECG were found to be 40.74° [35.56°-49.29°] and 39.57° [33.78°-45.70°], respectively. Our findings suggest that a RLS that is based upon the ML limb leads I and II and the three best precordial leads can yield SA estimates of a quality similar to what is achieved when using the complete ML 12-lead ECG.
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Affiliation(s)
- Daniel Guldenring
- Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland, UK.
| | - Dewar D Finlay
- Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland, UK
| | - Raymond R Bond
- Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland, UK
| | - Alan Kennedy
- Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland, UK
| | - James McLaughlin
- Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, Northern Ireland, UK
| | - Loriano Galeotti
- Office of Science and Engineering Laboratories, CDRH, US FDA, Silver Spring, MD, USA
| | - David G Strauss
- Office of Science and Engineering Laboratories, CDRH, US FDA, Silver Spring, MD, USA
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Jahrsdoerfer M, Giuliano K, Stephens D. Clinical Usefulness of the EASI 12-Lead Continuous Electrocardiographic Monitoring System. Crit Care Nurse 2005. [DOI: 10.4037/ccn2005.25.5.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary Jahrsdoerfer
- Mary Jahrsdoerfer is a clinical consultant for Philips Medical Systems in the New York–New Jersey metropolitan area
| | - Karen Giuliano
- Karen Giuliano is a clinical research specialist for Philips Medical Systems in Andover, Mass
| | - Dean Stephens
- Dean Stephens is the assistant director of nursing at North Shore University Hospital in Manhasset, NY
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Lee KW, Kligfield P, Okin PM, Dower GE. Determinants of precordial QT dispersion in normal subjects. J Electrocardiol 1999; 31 Suppl:128-33. [PMID: 9988017 DOI: 10.1016/s0022-0736(98)90305-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dispersion of precordial QT intervals has been attributed to delay in the recovery process in the myocardium under the exploring electrode, a local effect. However, the phenomenon also could be explained by different projections of the heart vector, in which case the 12-lead electrocardiogram (ECG) derived from the heart vector would show similar dispersion that could not be local in nature because the electrical activity of the heart is represented by a single dipole. Using an analog device that switched between the two, conventional and derived ECGs were obtained from 129 normal subjects. Measured as the difference between the longest and shortest precordial QT intervals, QT dispersion from the derived ECGs (mean +/- SD, 40 +/- 20 ms) was nearly identical in magnitude to that from the standard ECGs (41 +/- 18 ms, P = NS). Further analysis of the derived ECGs revealed nonuniform distributions of both the maximal and minimal QT intervals across the precordial leads. In addition, a weak correlation was found between the QT interval and the T wave amplitude in the two precordial leads with the lowest T-wave amplitudes (r = -0.303 in V1, P = .001, and r = 0.253 in V6, P = .005). While findings in patients with disease or with abnormal ECGs may differ and require separate examination, these data suggest that the observed magnitude of precordial QT dispersion in normal subjects can be explained by differences in precordial projection of the end of the T wave rather than by local effect.
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Affiliation(s)
- K W Lee
- Department of Medicine, The New York Hospital-Cornell Medical Center, New York 10021, USA
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Abstract
Rotation of the heart in relation to surface electrocardiographic (ECG) electrodes when a patient turns to one side has been reported to cause ST-segment shifts, triggering false alarms with continuous ST-segment monitoring. We prospectively analyzed ST-segment and QRS complex changes in both standard and derived ECGs in 40 subjects (18 with heart disease and 22 healthy) in supine, right- and left-lying positions. Of the 40 subjects, 6 (4 cardiac, 2 healthy) developed positional ST deviations of 1 mm or more on the standard ECG. In the derived method, five of the same six subjects showed ST-segment deviation of which most occurred in the left-lying position. Positional ST changes were most frequent for males and for cardiac patients (33%). Changes in QRS complex morphology were common on the standard (28 of 40, 70%) and less frequent on the derived ECGs (17 of 40, 43%), occurring in both healthy and cardiac subjects. QRS axis changes occurred only on the standard ECG. It was concluded that (1) right and left side-lying positions frequently induce clinically significant ECG changes; (2) positional ST-segment deviation is less frequent than previously reported and is most likely to occur in males with cardiac disease; and (3) the derived method is less prone to positional QRS changes than the standard ECG.
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Affiliation(s)
- M G Adams
- Department of Physiological Nursing, University of California, San Francisco, 94143, USA
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Drew BJ, Scheinman MM. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: practical aspects for the immediate care setting. Pacing Clin Electrophysiol 1995; 18:2194-208. [PMID: 8771133 DOI: 10.1111/j.1540-8159.1995.tb04647.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED To reevaluate ECG criteria for distinguishing supraventricular tachycardia (SVT) with aberrant conduction from ventricular tachycardia (VT), 133 wide QRS tachycardias were recorded in patients undergoing invasive electrophysiological (EP) study. Surface ECG leads (standard 12-lead and MCL leads) were compared to EP recordings to provide a standard for correct diagnosis. Criteria from six studies were pooled to select QRS morphology agreed to be highly specific for SVT or VT (specificity > 90%). Some morphological criteria were modified to simplify analysis for the immediate care setting. RESULTS Although the 12-lead ECG was useful in distinguishing aberrancy from VT, 13 tachycardias (10%) were misdiagnosed or could not be diagnosed. The MCL1 lead recorded clearly different QRS morphology than lead V1 in 40% of VT cases and was diagnostically inferior to V1. Most established criteria were highly specific for a diagnosis, but not very sensitive as individual criteria. Neither a QRS width of > 0.14 seconds nor a monophasic R wave pattern in lead V1 were valuable in diagnosing VT. CONCLUSIONS In distinguishing SVT with aberrant conduction from VT: (1) Although the 12-lead ECG is valuable, about 1 in 10 wide QRS tachycardias defy differentiation; (2) tachycardias > 190 beats/min often do not exhibit unequivocal criteria with which to make a certain diagnosis; (3) multiple leads are required for accurate assessment of QRS width, presence of AV dissociation or VA block, QRS axis, and morphological criteria; and (4) the MCL1 lead cannot be substituted for V1 in the use of morphological criteria for VT.
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Affiliation(s)
- B J Drew
- Department of Physiological Nursing, University of California San Francisco 94143-0610, USA
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