Analysis: Detection and recognition of cardiac pacing artifacts [Photos]
Hint: Normally, the activity of simply implanting a pacemaker is not visible on a normal ECG map because very fast pulses are filtered out. However, those with pacing therapy can determine the presence of a pacemaker and assess its interaction with the heart by looking at the ECG curve.
1. The pacing artifact signal of the implanted pacemaker can range from 2 mV to 700 mV with a duration of 0.1 ms to 2 ms and a rise time of 15 μs to 100 μs. Since electrical noise may be several times larger than the amplitude of the pacing artifact signal, it is difficult to detect.
2. Most implantable cardiac devices use the H-field telemetry, which is an important source of noise.
3. An algorithm is embedded in the ADAS1000 ECG analog front end to help identify pacing artifacts and display them on strip ECG drawings.
If a heart patient with a pacemaker is going to have an electrocardiogram, the doctor must be able to detect the presence and function of the pacemaker. In general, no simple implanted pacemaker activity is visible on a normal ECG map because of the low display resolution bandwidth (monitor/diagnostic bandwidth of 40 Hz / 150 Hz, respectively), which filters out very fast pulses (typical The width is hundreds of microseconds). However, the signal of the pacemaker can be estimated by the morphological change of the ECG waveform. An electrocardiogram is the electrical activity of the heart recorded by the ECG lead on the surface of the skin.
It is important to detect and identify pacing artifacts as they indicate the presence of a pacemaker and can help assess its interaction with the heart. However, this artificial signal has a small amplitude, a narrow bandwidth, and the waveform is constantly changing, so it is difficult to detect, especially when there is electrical noise that may be several times its amplitude. At the same time, pacing therapy has been very advanced, with a variety of pacing methods, from single room pacing to three-compartment pacing. Pacemakers produce lead integrity pulses, minute-by-cycle (MV) pulses, telemetry signals, and other signals that can be mistaken for pacing artifacts, complicating detection.
Using real-time pacemaker telemetry, pacing artifacts can be displayed in an ECG tape that is now less important. People with experience in pacing therapy can watch this tape and sometimes guess the type of pacing therapy the patient uses and determine if the pacemaker is working properly.
In addition, all relevant medical standards require the display of pacing artifacts, but there are special requirements for capturing the height and width of the pacing signal. Applicable standards include: Association for the Advancement of Medical Instrumentation (AAMI) Specification EC11:1991/(R) 2001/(R) 2007 and EC13:2002/(R)2007, and International Electrotechnical Commission Specification IEC60601- 1ed .3.0b:2005, IEC 60601-2-25 ed.1.0b, IEC 60601-2-27 ed. 2.0:2005 and IEC 60601-2-51 ed. 1.0:2005.
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