A pacemaker working status telemonitoring algorithm

Automated and manufacturer independent assessment of the battery status of implanted cardiac pacemakers by electrocardiogram analysis

According to international standards, cardiac pacemakers have to indicate the status of their batteries upon magnet application by specific stimulation patterns. The purpose of this study has been to assess whether this concept can be used as a basis for automated and manufacturer independent examination of the depletion level of pacemakers in the framework of a collaborative telemedical pacemaker follow-up system. A prototype of such a system was developed and tested in a real clinical environment. Electrocardiograms (ECGs) were recorded during magnet application and automatically processed to extract the specific stimulation patterns. The results were used to assign each signal a corresponding pacemaker status: "ok," "replace" or "undefined," based on the expected behavior of the devices as specified by the manufacturer. The outcome of this procedure was compared to the result of an expert examination, resulting in a positive predictive value of 100% for the detection of ECGs indicating pacemaker status "ok." The method can, therefore, be utilized to quickly, safely and manufacturer neutrally classify cases into the categories "ok" and "needs further checking," which - in a telemedical setting - may be used to increase the efficiency of pacemaker follow-up procedures in the future.

Real-time ECG transmission via Internet for nonclinical applications

Telemedicine is producing a great impact in the monitoring of patients located in remote nonclinical environments such as homes, elder communities, gymnasiums, schools, remote military bases, ships, and the like. A number of applications, ranging from data collection, to chronic patient surveillance, and even to the control of therapeutic procedures, are being implemented in many parts of the world. As part of this growing trend, this paper discusses the problems in electrocardiogram (ECG) real-time data acquisition, transmission, and visualization over the Internet. ECG signals are transmitted in real time from a patient in a remote nonclinical environment to the specialist in a hospital or clinic using the current capabilities and availability of the Internet. A prototype system is composed of a portable data acquisition and preprocessing module connected to the computer in the remote site via its RS-232 port, a Java-based client-server platform, and software modules to handle communication protocols between data acquisition module and the patient's personal computer, and to handle client-server communication. The purpose of the system is the provision of extended monitoring for patients under drug therapy after infarction, data collection in some particular cases, remote consultation, and low-cost ECG monitoring for the elderly.

Telecardiology and the intensive care unit

Technology continues to advance at a pace that produces a new innovation daily. To move forward, clinicians must assess these potential technological solutions adequately for their clinical, financial, and customer satisfaction efficacies. Whether the payers, the patients, or health care will find these systems acceptable has yet to be established completely. The preliminary data in the literature seem to point to physicians' trepidations as the limiting factor. More work is needed on the legal and ethical issues surrounding telemedicine. Telemedicine is progressing quickly from a strange rare subtype of medicine into something that is part and parcel of the practice of medicine in general. Cardiology and intensivist practices have been impacted directly by this technology. As it matures it will be intertwined with daily practice.