The Implementation of Arrhythmia Analysis System
ii
LabVIEW So and Chan QRS R-R interval QRS duration Tompkins and Ahlstrom 1983 R-R interval QRS duration search back 1R-R interval 8 R-R interval ± 14 0 0 2 QRS duration 8 QRS duration ± 20 0 0 R-R interval QRS duration 2 2 iii
Abstract The main purpose of this study is to make use of digital signal analysis technique to write a program of arrhythmia analysis under LabVIEW environment. The program is divided two parts. The first part is to find the correct Q RS waves using So and Chan calculation method, and then to compute the correct R-R interval and QRS duration. The second part is to use arrhythmia algorithm of Tompkins and Ahlstrom proposed in 1983 for analyzing arrhythmia by R-R interval and QRS duration. The way of analysis is a mode of search back algorithm. According to 1if every R-R interval is between ± 14 0 0 of forward eight R-R intervals mean,and 2 if every QRS duration is between ± 20 0 0 of forward eight QRS durations mean. If the signal can satisfy these two conditions, it is classified as the heartbeat cycle of a normal person. Therefore, the physicians can get diagnostic results by the R-R interval vs. QRS duration plane. iv
ii iii Abstract iv v vii viii 1 1-1 1 1-2 1 2 2-1 2 2-1.1 2 2-1.2 2 2-1.3 3 2-1.4 4 2-2 4 2-2.1 5 2-2.2 5 2-2.3 7 2-3 8 2-3.1 9 2-3.2 10 2-3.3 11 15 v
3-1 So and Chan method R-R interval QRS duration 15 3-1.1R 15 3-1.2Q S 16 3-1.3 R-R interval QRS duration 16 3-2 16 3-2.1 16 3-2.2 16 20 4-1 20 4-2 22 4-3 23 5-1 5-2 28 vi
2.1 9 2.2 10 2.3 11 2.4 12 2.5aV 13 R av L av F 2.6 14 3.1 R-R interval QRS duration 17 4.1 20 4.2 ECG Q R S 20 4.3 R-R interval QRS duration 21 4.4 22 4.5 22 4.6 22 4.7 23 4.8 23 4.9 24 4.10 24 4.11 24 4.12 25 4.13 25 4.14 25 vii
3.1 QRS duration R-R interval ECG 18 viii
1-1 19.15 1-2 LabVIEW So and Chan QRS R-R interval QRS duration Tompkins and Ahlstrom 1983 R-R interval QRS duration 1
ECG ECG 2-1 2-1.1 coronary circulation [1] 2-1.2 cardiac cycle 2
lub-dup lub dup [1] 2-1.3 cardiac conduction system sinoateial node SA node cardiacpacemaker artrioventricular node AV node 3
[1] 2-1.4 heart muscle contraction intercalated disk [1] 2-2 SA node AV node His Bundle 4
[2] 2-2.1 [2] 2-2.2 5
[3] [3] [3] [3] 6
2-2.3 24 30 (1) (2) (3) (4) 7
WPW [2] 2-3 (ECG) (1) (2) (3) (4) (5) 8
(6) (7) (8) [4] 2-3.1 2.1 (SA node) 60 (polarized) (deporlarized) 2.2 [6] [5] 2.1 9
2-3.2 1 mv = 10 mm ( ) 25 mm/sec ( ) 2.2 P 0.12 QRS 0.11 T U Purkinje fiber PR interval 1. 2. 0.12-0.20 (3-5 ) ST segment 1. 2. ST segment ( ) 3. ± 1 mm QT interval 1. 10
2. 3. 4. 0.35 -- 0.43 2.3 P (AV node) 1/10 2.3 1/10 2.3 Q 2.3 R 2.3 T QRS T P QRS 2-3.3 2.3 (Electrocardiogram, ECG) 11
(0.05~100HZ) 1~10mV [8] 0.25mV 0.5HZ~80HZ ECG [8] ECG 12 6 2.42.56 2.6 6 12 2.4 12
av R av L 2.5 av F 13
2.6 14
So and Chan Method ECG Q R S R-R interval QRS duration Tompkins and Ahlstrom 1983 R-R interval QRS duration 2 3-1 So and Chan method R-R interval QRS duration 3-1.1 R x n ECG n ECG ( ) slope( n) = 2x( n 2) x( n 1) + x( n + 1) + 2x( n + 2) (3.1) ( threshold ) slope_threshold = threshold_parameter maxi 16 (3.2) max i = first_ maxi- maxi + maxi (3.3) filter_parameter first_ max i = Height of R point -height of QRS onset (3.4) 300 ECG the initial maxi (3.1) ECG ECG slope n slope_threshold ECG QRS ( Q point ) paper [12]threshold_ parameter 248 16 filter_parameter 248 16 threshold_ parameter = 8 filter_parameter = 16 QRS QRS ( the maximum point ) R ( ) 15
3-1.2 Q S R R ECG Q Q Q R R ECG S S S 3-1.3 R-R interval QRS duration R-R interval R QRS durations Q 3-2 3-2.1 1983 Tompkins and Ahlstrom 1983 1.R-R interval 86 0 RRn RRn 114 0 0 0 RRn R-R interval 8 R-R interval ± 14 0 0 2.QRS duration 80 0 QRSn QRSn 120 0 0 0 QRSn QRS duration 8 QRS duration ± 20 0 0 R-R interval QRS duration 2 3-2.2 QRS R QRS duration R-R interval, ECG QRS duration R-R interval,3.1 2 QRS duration R-R interval2 16
, 8 QRS, 2, region 0, Region 0 Region 0, R-R interval 0.50 QRS duration 0.05 QRS 150.00 R-R interval(seconds) 0 0.50 1.00 1.50 2.00 2.50 0 (0) 0.2s -64.00% -14.00% +14.00% +84.00% 50.00 +20.00% (2) Normal -20.00% duration (1) (3) (4) (5) (6) (ms) 200.00 3.1 R-R interval QRS duration region 1 R-R interval,,, R-R interval QRS duration, R-R interval QRS duration, 2, 1 region 3, 2 region 5, 17
, 8, 2-dimension, beat-by-beat, 3.1 ECG R-R interval QRS duration [15] 3.1 QRS duration R-R interval ECG Normal Asystole R 1.72 35 Dropped R-R interval 6 R-on-T Compensated( PVC) 2 3 5 Uncompensated( PVC) 3 Couplet( ) 3 5 Paroxysmal Bradycardia( 3 5 ) Tachycardia( ) R-R interval 120 b t / i 18
beats/min Fusion 4 QRS duration Escape( ) 5 QRS Rejected R-R interval 200ms QRS duration 60ms 19
4-1 ECG 4.1 4.1 So and Chan method R-R interval QRS duration So and Chan Method ECG Q R S 4.2 R-R interval QRS duration 4.3 4.2 ECG Q R S 20
4.3 R-R interval QRS duration Tompkins and Ahlstrom 2 1.R-R interval 86 0 RRn RRn 0 0 114 0 RRn R-R interval 8 R-R interval ± 14 0 0 2.QRS duration 80 0 QRSn QRSn 120 0 0 0 QRSn QRS duration 8 QRS duration ± 20 0 0 R-R interval QRS duration 2 4.4 21
4.4 4.4 ECG 99.32 2 0.45 0.23 Noise 100 4-2 4.5 4.6 22
4.5 4.6 noise 4-3 8 ECG 4.7 4.8 23
4.9 4.10 4.11 24
4.12 4.13 4.14 25
5-1 So and Chan method So and Chan method QRS 5-2 So and Chan method QRS PC ECG 26
[1] Berne,M and M.N.Levy,"Cardiovascular Physiology". [2] [3] by Jau-Shin WU,M.D. Arrhythmia (Posted on September 17, 1998 ) [4] DOH FN8202, DOH-83-FS-41, DOH-84-FS-11, DOH-85-FS-11, DOH-86-FS- 11 [5] 85 [6] 80 [7]Webster, J.G., Medical Instrumentation: Application and Design, John Wiley & Sons, Inc., 1998. [8] 70 12 [9] LabVIEW 2000 [10] 1997 [11] Willis J. Tompkins,Biomedical Digital Signal Processing, Chapter 12,13, A Simon Schuster Company, New Jersey, 1993. [12] H. H. So and K. L. Chan, Development of QRS Detection Method for Real-Time 27
Ambulatory Cardiac Monitor, 19 th International Conference on IEEE/EMBS Oct. 30 Nov. 2, 1997. [13]Ahlstrom M.L. and TompkinsW.J.,Automated High-Speed Analysis of Holter Tapes with Microcomputers,IEEE trans.biomed.eng.bme-30:p651-6571983. [14] 1976 [15] 28