Real-time method for noninvasive recording of his bundle activity of the electrocardiogram

Akker, T.J. van den; Ros, H. H.; Goovaerts, H. G.; Schneider, H.

doi:10.1016/0010-4809(76)90015-x

Cited by 20 publications

(4 citation statements)

References 9 publications

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“…They converted analog ECG signals to digital signals, stored them in the buffer memory of a computer, delalyed the P-QRS segment behind the QRS complex, and averaged the P-QRS segment, using the R trigger pulse. We also used the post-trigger recording method, but we delayed the ECG signals by using an analog delay device (BBD), unlike the digital delay device used by VandenAkker et al [11]. By this method, ECG signals are amplified 1,000 times by an amplifier, delayed by the BBD behind the R trigger pulse as analog signals, and sent to the computer, by which the P-QRS segment is averaged.…”

Section: Discussionmentioning

confidence: 99%

“…The P-QRS segment in the memory is then processed for averaging by QRS trigger pulse [12,13]. VandenAkker et al [11], however, introduced the post-trigger recording method. They converted analog ECG signals to digital signals, stored them in the buffer memory of a computer, delalyed the P-QRS segment behind the QRS complex, and averaged the P-QRS segment, using the R trigger pulse.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, a noninvasive or virtually noninvasive method of recording His bundle activity was developed to overcome the limitations and complications involved in the use of the catheter technique as a routine examination [6]. The previous investigations on the noninvasive recording of His bundle activity were generally performed by the computer average response technique [7,8,[10][11][12][15][16][17][18], or by using exclusive averaging hardware [6,9,13,14,20]. For the averaging method to significantly improve the signal-to-noise ratio, the process of averaging must be driven by the trigger pulse with very accurate timing during the repeated processing.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

et al. 1995

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A simplified and clinically applicable method has been developed for real-time noninvasive recording of the electrical activity of the His bundle in the human heart. A surface electrocardiogram (ECG) was obtained from bipolar precordial leads. The electrical signal within the P-QRS segment of the ECG was amplified with a high gain amplifier and delayed with an analog delay device for QRS-triggered signal averaging. The analog delay device consisted of a bucket brigade device (BBD) with an electrical integrated circuit (IC). After filtering with a band width of 50-300 Hz, the delayed signal was processed by a microcomputer system and the signal-to-noise ratio of the signal was improved by the signal averaging technique. Surface His bundle electrocardiograms (SHE) were measured in normal subjects without conduction disorders and in patients with atrio-ventricular (A-V) block. In the same patients, each SHE was nonsimultaneously compared with an invasive His bundle electrogram (HBE) obtained by the intracardiac catheter technique. The results of this comparison confirmed that the noninvasive method of SHE recording has broad clinical applicability and high utility for the screening of patients with latent A-V block before intracardiac catheterization is performed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

et al. 1995

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“…Other reports have followed, describing further limited success in obtaining such recordings in the dog and in man. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The ability to record and to verify electrical activity in the PR segment as having arisen from the HisPurkinje system has been exciting and full of promise, yet the necessity of noise reduction and enhancement of the very low level signal with digital averaging has major shortcomings, and distinctly limits clinical usefulness of the approach. First, the averaging process excludes the ability to detect moment-tomoment changes in the true signal, and introduces errors in amplitude, duration and morphology.…”

mentioning

confidence: 99%

Surface recording of His-Purkinje activity on an every-beat basis without digital averaging.

Flowers¹,

Shvartsman²,

Kennelly³

et al. 1981

Circulation

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Efforts to record evidence of electrical activity from the body surface originating in the His bundle or bundle branches have been reported since 1973. Almost exclusively, these techniques have required digital averaging of 50-100 sequential cardiac cycles. For immediate diagnostic, therapeutic and prognostic application, recording on an every-beat basis is highly desirable. This is especially important in instances of changing atrioventricular conduction, arrhythmias or less-than-constant RR intervals. Our object has been to develop a system for more nearly optimal noise reduction, to avoid the disadvantages of serial signal averaging, and to be able to record His-Purkinje activity in man on an every-beat basis. Using multiple parallel inputs wih linear amplification, additional logarithmic amplification, some bandpass filtering, and a logic circuit that ultimately examines and accepts or rejects a deflection as "true" signal, we can record, in most instances, on a beat-by-beat basis, this very valuable component of the cardiac electrical cycle.

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The applicability of the signal averaging technique in clinical cardiology

Hombach

Braun

Höpp

et al. 1982

Clinical Cardiology

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Summary:Since 1963 the signal averaging technique has been applied to improve the signal to noise ratio in highly amplified EKG registrations. Based on the experiences from the literature and the authors own laboratory, the applications of the signal averaging technique in clinical cardiology are reviewed: extraction and analysis of the fetal EKG and P-wave variations, His bundle electrograms from the body surface (recovery rate 33-100% of cases), ventricular delayed depolarizations within the ST segment of the surface EKG (recovery rate, 40-90% of cases, depending on patient groups investigated), preatrial activity (sinus nodal potentials) from intracardiac (recovery rate, 80-90% of individuals), or surface EKGs (recovery rate, 60% of patients), analysis of frequency components of surface EKG-QRS complexes in patients with previous myocardial infarctions, and detection of low amplitude diastolic signals from surface phonocardiogram (recovery rate, 80% of cases). At present, advantages and limitations of the signal averaging technique may be appraised as follows: ( 1 ) sinus nodal potentials: S-A conduction times may be more reliable than those obtained by the extra-stimulus technique, since with averaging they are recorded during undisturbed sinus rhythm; direct recordings of changing S-A blocks may be impossible due to the summation process; validation of sinus nodal potentials in man necessary, (2) A-V nodal potentials: demonstration of true A-V nodal rhythm rather than His bundle rhythm; possibly direct identification of abnormal pathways in A-V nodal tachycardias; direct recordings of single A-V nodal blocks impossible due to summation process; (3) surface His bundle potentials: follow-up or screening of patients with A-V nodal and particularly His-Purkinje-system blocks; monitoring of antiarrhythmic drug therapy; atrial overlap in one-third of cases; direct identification of higher degree A-V nodal blocks impossible due to summation process (future developments may overcome this problem); (4) ventricular delayed depolarizations: possible identification of patients at high risk of sudden cardiac death; follow-up of therapeutic measures like antiarrhythmic drug therapy or cardiac surgery (bypass grafting, aneurysmectomy); validation of delayed depolarizations from body surface by direct intracardiac and/or epicardial mapping necessary.

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Real-time method for noninvasive recording of his bundle activity of the electrocardiogram

Cited by 20 publications

References 9 publications

Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

Surface recording of His-Purkinje activity on an every-beat basis without digital averaging.

The applicability of the signal averaging technique in clinical cardiology

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