New Holter Monitoring Analysis System-Synthesizing 12-Lead Electrocardiograms Using a Calculation of the Lead Vectors-

Abstract

novel method of synthesizing a 12-lead electrocardiogram (ECG), with practically identical waveforms to the standard 12-lead ECG (Stn-ECG), using the ECG signals from the X, Y and Z Frank leads, 1 has been developed, resulting in the synthesis of ECG waveforms closely resembling those of the Stn-ECG. 2,3 However, the individuality of the lead vector has been hindered by that synthesis. In the present study, we verified the usefulness of (1) the automatic correction of the lead vector and (2) the synthesis of the ECG from 3-channel recordings using the normal digital Holter monitoring system. Methods SubjectsThe subjects consisted of 29 individuals: 13 consecutive subjects who had had an ECG recorded with the present system (12 males, 1 female, mean age 64±10 years, range: 39-74) that included 7 with myocardial infarctions (4 anterior wall and 3 inferior wall), 5 with complete bundle branch block (BBB) (4 right BBB and 1 left BBB) and 1 with atrial fibrillation, and 16 normal volunteers (mean age Circulation ECG RecordingTo record the synthesized ECG (Syn-ECG), 5 electrodes were placed on the body surface, with the anode consisting of the V1 and V5 positions, and the point of intersection Circ J 2004; 68: 751 -756 (Received February 9, 2004; revised manuscript received April 20, 2004; accepted May 14, 2004 New Holter Monitoring Analysis System Synthesizing 12-Lead Electrocardiograms Using a Calculation of the Lead VectorsToshihiko Nanke, MD; Kiyoshi Nakazawa, MD; Tsuneharu Sakurai, MT; Naoki Matsumoto, MD*; Ryouji Kishi, MD; Akihiko Takagi, MD; Chuichi Sato, MD; Fumihiko Miyake, MD; Takashi Yamaki**; Mutsuo Kaneko** Background A new system of synthesizing a 12-lead electrocardiogram (Syn-ECG) with practically identical waveforms to the standard 12-lead ECG (Stn-ECG) from 3-channel ECGs recorded by Holter monitoring has been developed. Methods and ResultsThe study group comprised 16 healthy individuals and 13 patients with abnormal ECGs. The bipolar eV1, eV5 and eVF leads were recorded using digital Holter monitoring and nine Syn-ECGs, corresponding to each lead of the Stn-ECG, were synthesized. The 9 ECGs consisted of a theoretical Syn-ECG and 8 Syn-ECGs positioned around the theoretical Syn-ECG at 3 cm intervals on the Frank's image surface. Of the 9 ECGs, the Syn-ECG with the maximum product of the cross-correlation coefficient of the QRS wave and that of the T wave, was automatically selected as the optimal Syn-ECG. The amplitude data from the QRS wave, R wave, T wave, and ST level, and also the amplitude ratio of the R wave, T wave to the QRS wave, were significantly well correlated between the Syn-ECG and Stn-ECG. Conclusions A practically identical ECG morphology, comparable with a Stn-ECG, was successfully created using this system. (Circ J 2004; 68: 751 -756)