Telemetry of high-risk patients with cardiovascular diseases

Prof. Ivo Iliev, DSc – TU-Sofia Ass.prof. Krasimira Kostikova– MU-Sofia

Telemetry system architecture – WBAN conception

Target groups of patients indicative of telemetry

•Patients with left ventricular dysfunction

•Patients with symptomatic conduction dysfunctions

•Patients with Implantable Pacemakers (PM), who need of post-operative monitoring and control

•Patients with Ischemic Heart Disease or survived after Myocardial Infarction •Patients with Ischemic Heart Disease and diabetes •Patients with flutter

•Patients after transplantation

Schematic design

Data Processing at ECG Telemetry System

1. Power-line removal and base-line drift suppression

2. QRS recognition and classification

Algorithms verification MIT-BIH, AHA and European ST-T databases are used

База данни Se [%]

PPV [%]

TP beats

FN beats

FP beats

FPH beats

MIT-BIH 99.37 99.51 208701 1315 1033 21.5

AHA 99.32 99.66 322328 2205 1085 15.5

European ST-T 99.85 99.54 836750 1271 3850 20.1

Общо за трите 99.65 99.57 1367779 4791 5968 19.3

Нормални NBs Камерни екстрасистоли VBs

Коректни бр.

Грешни бр.

Sp [%]

Коректни бр.

Грешни бр.

Se [%]

•MIT-BIH

Пълна база данни 174000 1675 99.05 12454 591 95.47

Noise free 172045 180 99.9 12209 81 99.34

•AHA

Пълна база данни 310982 3584 98.86 28207 1182 95.98

Noise free 291936 1131 99.61 23475 184 99.22

Application of telemetry at hospital environment

PatRis – Software Tool Applicable in Telemetry Systems for Patients at Risk

Cardiovascular and cerebrovascular

diseases are a leading cause for death and disablement worldwide. This global epidemic affects all regions in the world.

Cardiovascular diseases (CVD) are a major cause for premature death in Europe. They are a leading cause for disablement and contribute to a large extent to growing healthcare expenses.

CVD death is often unexpected and occurs before medical help is rendered. That’s why a lot of therapeutic interventions are either inapplicable or palliative.

• CVD: • Ischemic heart disease – angina and myocardial

infarction • Cerebrovascular disease (stroke and transient

ischemic attack) • Peripheral vascular disease • Hypertension • Valvular and congenital heart disease • Rhythm and conduction disorders • Congestive heart failure

• Atrial filbrillation (AF) is the most common cardiac arrhythmia.

AF may lead to: • Death – mortality rate is twice as high in patients with AF

as compared to patients without AF • Stroke

– Every 4th stroke is caused by AF – Embolic stroke caused by AF is graver and with a worse

prognosis • Heart failure and acute coronary syndrome - greater

incidence of HF and ACS in patients with AF (N England Journal Of Medicine 2010,362:1363- 73)

• Cognitive dysfunction – asymptomatic embolic incidents accompanied by AF worsen the cognitive function (Eur Heart J 2008; 29 2125-2132)

12-lead ECG remains the gold standard for

arrhythmia detection, the major drawback of the method being the lack of early detection in asymptomatic patients.

Recent research has shown that more frequent rhythms monitoring raises the cases of AF detection. However, the appliances required are expensive and inconvenient. Due to these impediments, the National Health, Heart, Lung, and Blood Institute guidelines emphasize the need for a new method for AF detection. (Circulation 2009;119:606–618.)

Objective:

To analyze the data received from the

telemetry ECG monitoring system applied to patients with rhythm and conduction disorders

Material and methods:

We applied a telemetry ECG monitoring system to 42 patients (28female and 14male) treated in the Cardiology Department of the Clinic of Propedeutics of Internal Diseases, University Hospital Alexandrovska, Sofia, for the period of 3months (from June 2013 to September 2013). Patients in the following groups were included:

Materials and methods:

• 9 patients with ischemic heart disease and

surviving a myocardial infarction (3 female, 6 male)

• 8 patients with ischemic heart disease – without a MI (4 female and 4 male)

• 25 patients at high risk (18 female and 4 male): patients with arterial hypertension, heart failure (associated with valvular heart disease or cardiomyopathy), myopericarditis, accompanying thyreopathology and patients with accompanying electrolyte disbalance

HARDWARE

Ultraportative device called Personal Analyzer

Results:

Using the device we registered different cases of:

• Rhythm disorders – atrial (37 episodes) and ventricular (23 episodes) extrasystoles, supraventricular tachycardia (3 episodes), episodes of atrial fiblillation (10)

• Conduction disorders – AV block I degree (2) and SA block (1)

Number and type of the registered rhythm and conduction disorders:

The telemetry monitoring system showed very good efficacy and tolerability in all 42 patients. The total number of 76 episodes of rhythm and conduction disorders registered permitted a timely therapeutic intervention, especially in the cases when there was an impediment for standard holter ECG monitoring.

No serious technical failures or malfunctions

in the telemetry system were observed during the period of follow-up.

The follow-up of the patients in the Cardiology Department of the Clinic of Propedeutics of Internal Diseases “Prof. St. Kirkovich”through telemetry monitoring is on-going. The results from the system described are to be analyzed through a parallel comparison with the data from the holter ECG monitoring, the morphological echocardiogram evaluation, including the patient’s risk profile, as well as the factor time to event and possibility for intervention.

The application of the telemetry ECG monitoring system is a novel, convenient non-invasive technology for a complete 24-hour uninterrupted ECG monitoring and control of the patient outside the intensive care ward which allows for immediate emergency reanimation procedures. Its benefits for routine use in the clinical practice are doubtless.