High-resolution esophageal long-term ECG allows detailed atrial wave morphology analysis in case of atrial ectopic beats

Niederhäuser, Thomas; Marisa, Thanks; Haeberlin, Andreas; Goette, Josef; Jacoment, Marcel; Vogel, Rolf

doi:10.1007/s11517-012-0915-7

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…Hence, we restrict the BWT evaluation to binary-weighted ADCs such as the SAR ADC that offers an attractive solution in low power applications where moderate resolution and speed are required [32], [34]. For SAR ADCs, the INL has two major components [35]: the non-linearity caused by the analog preprocessing parts could be modeled with a th-order polynomial function of the code bins (12) Despite this low frequency component of the INL, the high frequency component is dominated by the binary weighted capacitor mismatches of the DAC in the feedback loop. The DAC error function is a linear combination of the distinct reference inaccuracies denoted as having as weighting coefficients the values of the single bits or 1.…”

Section: B A/d and D/a Convertermentioning

confidence: 99%

“…The resulting was superimposed with a fourth-order polynomial (according to (12)) in such a way that the maximum of was kept below , the maximal INL error. The function alternately with the linear errors and formed the non-ideal transition points of the ADC and DAC, as well.…”

Section: Simulation Setupmentioning

confidence: 99%

“…Despite the capability of being highly integrated, the signal acquisition/processing circuits have to achieve high signal-to-noise ratio (SNR) and high power-efficiency. Second, new electrode designs such as dry (textile)-based surface electrodes [9]- [11] or esophageal electrodes [12] dedicated to long-term signal acquisition have to provide distortion-free and stable interfacial contact properties. Unfortunately, dry [13] as well as esophageal electrodes [14] suffer from higher baseline wander than Ag/AgCl electrodes and are more susceptible to motion artifacts during physical activity and ingestion, respectively (an example with gelled surface electrodes, MIT/BIH record number 116 is shown in Fig.…”

Section: Introductionmentioning

confidence: 99%

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A Baseline Wander Tracking System for Artifact Rejection in Long-Term Electrocardiography

Niederhäuser

Marisa

Kohler

et al. 2016

IEEE Trans. Biomed. Circuits Syst.

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Long-term electrocardiogram (ECG) signals might suffer from relevant baseline disturbances during physical activity. Motion artifacts in particular are more pronounced with dry surface or esophageal electrodes which are dedicated to prolonged ECG recording. In this paper we present a method called baseline wander tracking (BWT) that tracks and rejects strong baseline disturbances and avoids concurrent saturation of the analog front-end. The proposed algorithm shifts the baseline level of the ECG signal to the middle of the dynamic input range. Due to the fast offset shifts, that produce much steeper signal portions than the normal ECG waves, the true ECG signal can be reconstructed offline and filtered using computationally intensive algorithms. Based on Monte Carlo simulations we observed reconstruction errors mainly caused by the non-linearity inaccuracies of the DAC. However, the signal to error ratio of the BWT is higher compared to an analog front-end featuring a dynamic input ranges above 15 mV if a synthetic ECG signal was used. The BWT is additionally able to suppress (electrode) offset potentials without introducing long transients. Due to its structural simplicity, memory efficiency and the DC coupling capability, the BWT is dedicated to high integration required in long-term and low-power ECG recording systems.

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Section: B A/d and D/a Convertermentioning

confidence: 99%

Section: Simulation Setupmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Baseline Wander Tracking System for Artifact Rejection in Long-Term Electrocardiography

Niederhäuser

Marisa

Kohler

et al. 2016

IEEE Trans. Biomed. Circuits Syst.

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“…Directed esophageal electrodes may enable plane-selective stimulation of the phrenic nerve. Esophageal electrodes also profit from a self-cleaning, stable electrochemical environment, allowing for long-term instrumentation [ 22 ] with low infection potential [ 23 , 24 ]. A simple insertion criterion [ 25 ] may be adopted from long-term transesophageal ECG recording to omit X-ray-based electrode placement in the future.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of transesophageal phrenic nerve stimulation

et al. 2023

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Background Every year, more than 2.5 million critically ill patients in the ICU are dependent on mechanical ventilation. The positive pressure in the lungs generated by the ventilator keeps the diaphragm passive, which can lead to a loss of myofibers within a short time. To prevent ventilator-induced diaphragmatic dysfunction (VIDD), phrenic nerve stimulation may be used. Objective The goal of this study is to show the feasibility of transesophageal phrenic nerve stimulation (TEPNS). We hypothesize that selective phrenic nerve stimulation can efficiently activate the diaphragm with reduced co-stimulations. Methods An in vitro study in saline solution combined with anatomical findings was performed to investigate relevant stimulation parameters such as inter-electrode spacing, range to target site, or omnidirectional vs. sectioned electrodes. Subsequently, dedicated esophageal electrodes were inserted into a pig and single stimulation pulses were delivered simultaneously with mechanical ventilation. Various stimulation sites and response parameters such as transdiaphragmatic pressure or airway flow were analyzed to establish an appropriate stimulation setting. Results Phrenic nerve stimulation with esophageal electrodes has been demonstrated. With a current amplitude of 40 mA, similar response figures of the diaphragm activation as compared to conventional stimulation with needle electrodes at 10mA were observed. Directed electrodes best aligned with the phrenic nerve resulted in up to 16.9 % higher amplitude at the target site in vitro and up to 6 cmH20 higher transdiaphragmatic pressure in vivo as compared to omnidirectional electrodes. The activation efficiency was more sensitive to the stimulation level inside the esophagus than to the inter-electrode spacing. Most effective and selective stimulation was achieved at the level of rib 1 using sectioned electrodes 40 mm apart. Conclusion Directed transesophageal phrenic nerve stimulation with single stimuli enabled diaphragm activation. In the future, this method might keep the diaphragm active during, and even support, artificial ventilation. Meanwhile, dedicated sectioned electrodes could be integrated into gastric feeding tubes.

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“…On the forefront of the field are electrocardiographic imaging (ECGI) systems, which combine multi-electrode measurements from up to 252 body surface electrodes with patient-specific anatomical information from computed tomography (CT) imaging to reconstruct epicardial depolarization sequences (Rudy, 2013;Shah, Hocini, Xhaet, et al, 2013). Alternative approaches include measurements of the heart magnetic field (Ha, Kim, Lim, Yu, & Kwon, 2015;Kim, Kim, Lee, & Ahn, 2007;Sorbo et al, 2018), the exploitation of vectorcardiograms (Castells et al, 2011;Hasan, Abbott, & Baumert, 2012;Man, Maan, Schalij, & Swenne, 2015), or the acquisition of esophageal electrocardiograms (eECGs) (Haeberlin, Niederhauser, et al, 2013;Niederhauser et al, 2012). Esophageal ECGs have interesting properties, the most notable of which is an excellent atrial signal quality.…”

Section: Introductionmentioning

confidence: 99%

Toward a novel semi‐invasive activation mapping tool for the diagnosis of supraventricular arrhythmias from the esophagus

Sweda

Wildhaber

Mortier

et al. 2019

Noninvasive Electrocardiol

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Aims: Supraventricular arrhythmia diagnosis using the surface electrocardiogram (sECG) is often cumbersome due to limited atrial signal quality. In some instances, use of esophageal electrocardiography (eECG) may facilitate the diagnosis. Here, we present a novel approach to reconstruct cardiac activation maps from eECG recordings.Methods: eECGs and sECGs were recorded from 19 individuals using standard acquisition tools. From the recordings, algorithms were developed to estimate the esophageal ECG catheter's position and to reconstruct high-resolution mappings of the cardiac electric activity projected in the esophagus over time. Results: Esophageal two-dimensional activation maps were created for five healthy individuals and 14 patients suffering from different arrhythmias. The maps are displayed as time-dependent contour plots, which not only show voltage over time as conventional ECGs, but also the location, direction, and projected propagation speed of the cardiac depolarization wavefront in the esophagus. Representative examples of sinus rhythm, atrial flutter, and ventricular pre-excitation are shown. Conclusion:The methodology presented in this report provides a high-resolution view of the cardiac electric field in the esophagus. It is the first step toward a threedimensional mapping system, which shall be able to reconstruct a three-dimensional view of the cardiac activation from recordings within the esophagus. K E Y W O R D Sbiomedical engineering, cardiac electrophysiology, cardiac mapping, esophageal ECG, noninvasive mapping

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High-resolution esophageal long-term ECG allows detailed atrial wave morphology analysis in case of atrial ectopic beats

Cited by 13 publications

References 11 publications

A Baseline Wander Tracking System for Artifact Rejection in Long-Term Electrocardiography

A Baseline Wander Tracking System for Artifact Rejection in Long-Term Electrocardiography

Feasibility of transesophageal phrenic nerve stimulation

Toward a novel semi‐invasive activation mapping tool for the diagnosis of supraventricular arrhythmias from the esophagus

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