Beat-by-beat recording of high resolution ECG: technical considerations

Nearly two decades ago, it was reported that non-invasive His-Purkinje potentials were recordable from the body surface utilizing temporal signal averaging1–3. The primary shortcoming of the technique is that this approach of signal averaging does not permit recording dynamic variations in the electrocardiogram (ECG) which may occur on a beat-by-beat basis. Attempts have been made since then by many investigators throughout the world to explore possible approaches to the recording and analysis of the microvolt level potentials on an every beat basis. The primary obstacle is the overwhelming interference such as instrumental noise, 60 Hz interference and electromyographic noise in which the signal of interest is buried. All the techniques that have been proposed are aimed at noise reduction. The most widely used method is spatial averaging4–10. This is a variation of averaging in which the ensemble of input is simultaneously from multiple surface leads rather than from sequential signals with a single lead. The technique has proved effective, although not optimal. Other techniques including finite element method11, matched filtering12, and adaptive filtering13 have been reported for beat-by-beat recording of His-Purkinje potentials.

[1]  Ouyang Jingzheng,et al.  Digital Processing of High-Resolution Electrocardiograms — Detection of His-Purkinje Activity from the Body Surface - Digitale Auswertung hochauflösender Elektrokardiogramme - Ableitung der His-Purkinje-Aktivität von der Körperoberfläche , 1988 .

[2]  J A Gomes,et al.  Late Potentials and Arrhythmogenesis * , 1985, Pacing and clinical electrophysiology : PACE.

[3]  J G Webster,et al.  60-HZ interference in electrocardiography. , 1973, IEEE transactions on bio-medical engineering.

[4]  John M. Cioffi,et al.  ECG Enhancement by Adaptive Cancellation of Electrosurgical Interference , 1983, IEEE Transactions on Biomedical Engineering.

[5]  R Lazzara,et al.  Noninvasive Technique for Detection of Electrical Activity During the P‐R Segment , 1973, Circulation.

[6]  J P Wikswo,et al.  Noninvasive magnetic detection of cardiac mechanical activity: experiments. , 1980, Medical physics.

[7]  H. Kasanuki,et al.  The Feasibility of Beat‐to‐Beat Detection of His‐Purkinje Activity by Finite Element Method , 1987, Pacing and clinical electrophysiology : PACE.

[8]  John G. Webster,et al.  Reductionl of Interference Due to Common Mode Voltage in Biopotential Amplifiers , 1983, IEEE Transactions on Biomedical Engineering.

[9]  M. J. English,et al.  A technique for real-time beat-by-beat recovery of microvolt cardiac signals , 1991, [1991] Proceedings Computers in Cardiology.

[10]  P Lander,et al.  Use of high-pass filtering to detect late potentials in the signal-averaged ECG. , 1989, Journal of electrocardiology.

[11]  L. Horan,et al.  Analysis of PR subintervals in normal subjects and early studies in patients with abnormalities of the conduction system using surface His bundle recordings. , 1983, Journal of the American College of Cardiology.

[12]  J P Wikswo,et al.  Noninvasive magnetic detection of cardiac mechanical activity: theory. , 1980, Medical physics.

[13]  Earl R. Ferrara,et al.  Fetal Electrocardiogram Enhancement by Time-Sequenced Adaptive Filtering , 1982, IEEE Transactions on Biomedical Engineering.

[14]  W Craelius,et al.  Electrophysiological Basis of Ventricular Late Potentials , 1990, Pacing and clinical electrophysiology : PACE.

[15]  V Hombach,et al.  Noninvasive beat-by-beat registration of ventricular late potentials using high resolution electrocardiography. , 1984, International journal of cardiology.

[16]  S. W. Kelly,et al.  Beat-to-beat detection of His-Purkinje system signals using adaptive filters , 2006, Medical and Biological Engineering and Computing.

[17]  J. Vandewalle,et al.  Adaptive method for cancellation of respiratory artefact in electrogastric measurements , 2006, Medical and Biological Engineering and Computing.

[18]  L. Horan,et al.  Surface Recording of His‐Purkinje Activity on an Every‐beat Basis Without Digital Averaging , 1981, Circulation.

[19]  B. Widrow,et al.  Adaptive noise cancelling: Principles and applications , 1975 .

[20]  Application of Beat‐to‐Beat Techniques , 1990, Pacing and clinical electrophysiology : PACE.

[21]  N V Thakor,et al.  Adaptive Filterng of Evoked Potentials , 1987, IEEE Transactions on Biomedical Engineering.

[22]  R.F. Santopietro.  The origin and characterization of the primary signal, noise, and interference sources in the high frequency electrocardiogram , 1977, Proceedings of the IEEE.

[23]  L. Horan,et al.  An Analysis of Beat‐By‐Beat Recording of Late Potentials and His‐Purkinje Signals in a Hospital Environment , 1990 .

[24]  E J Berbari,et al.  High-resolution electrocardiography. , 1988, Critical reviews in biomedical engineering.

[25]  L. Horan,et al.  Surface recording of electrical activity from the region of the bundle of His. , 1974, The American journal of cardiology.

[26]  S L Winters,et al.  The prognostic significance of quantitative signal-averaged variables relative to clinical variables, site of myocardial infarction, ejection fraction and ventricular premature beats: a prospective study. , 1989, Journal of the American College of Cardiology.

[27]  L. Horan,et al.  Quantitative Comparison of Temporal and Spatial High‐Resolution Recordings of Terminal QRS , 1992 .

[28]  R. Kępski,et al.  Noninvasive Recording of His‐Purkinje System (HPS) Activity in Man on Beat‐To‐Beat Basis , 1982, Pacing and clinical electrophysiology : PACE.

[29]  George R. Barnes,et al.  Multichannel Signal Processing Based on Logic Averaging , 1982, IEEE Transactions on Biomedical Engineering.

[30]  M. Simson.  Use of Signals in the Terminal QRS Complex to Identify Patients with Ventricular Tachycardia After Myocardial Infarction , 1981, Circulation.

[31]  R. Fenici,et al.  Beat to beat surface recording and averaging of His-Purkinje activity in man. , 1983, Journal of electrocardiology.

[32]  R Adamec,et al.  Beat-to-beat detection of ventricular late potentials with high-resolution electrocardiography. , 1991, American heart journal.

[33]  P. Denes,et al.  Quantitative Analsis of the High‐frequency Components of the Terminal Portion of the Body Surface QRS in Normal Subjects and in Patients with Ventricular Tachycardia , 1983, Circulation.

[34]  S. W. Kelly,et al.  Noninvasive beat-to-beat detection of ventricular late potentials , 2006, Medical and Biological Engineering and Computing.

[35]  J A Gomes,et al.  Appraisal of a Low Noise Electrocardiogram. , 1983, Journal of the American College of Cardiology.

[36]  D A Coast,et al.  Enhancement of low-level ECG components in noise with time-sequenced adaptive filtering. , 1990, Journal of electrocardiology.