一个 300Hz 的低通滤波器改善了远程和床边心电图上起搏器尖峰的检测。
A low-pass filter of 300 Hz improved the detection of pacemaker spike on remote and bedside electrocardiogram.
机构信息
Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
出版信息
Chin Med J (Engl). 2019 Mar 5;132(5):534-541. doi: 10.1097/CM9.0000000000000110.
BACKGROUND
The current upper-frequency cutoff of 150 Hz sometimes causes loss of pacemaker spike and misdiagnosis. We hypothesized that low-pass filter (LPF) other than 150 Hz could improve the detection of pacemaker spike. This study aimed to examine the effect of different LPF on pacemaker spike detection in remote and bedside electrocardiogram (ECG).
METHODS
Patients with permanent pacemaker implantation were included during routine follow-up. Standard 12-lead ECGs at 6 different upper-frequency cutoff (40, 100, 150, 200, 300, and 400 Hz) were collected. All ECGs were then transmitted to the remote clinic center. Ventricular and atrial pacing were analyzed by 2 independent medical practitioners.
RESULTS
A total of 88 patients' ECGs were analyzed (mean age 73.8 ± 10.2 years and 85 with dual-chamber pacemakers). About 75.3% (64/85) of patients were diagnosed as atrial pacing by pacemaker programming. Among 6 different upper-frequency cutoff, the 300 Hz turned out to perform best in detecting atrial-paced spike (area under the curve [AUC] = 0.73, 95% confidence interval [CI]: 0.61-0.84 vs. 0.56, 95% CI: 0.61-0.84 at 150 Hz; P = 0.002) on bedside ECGs. Using programming as the golden standard, the 300 Hz LPF has a sensitivity of 59.4%, specificity of 85.7%, positive predictive value of 92.7% and negative predictive value of 40.9% on bedside ECGs. As for the ventricular pacing, the 300 Hz LPF also had a higher accuracy (AUC = 0.93; 95% CI = 0.84-1.00) than that at 150 Hz (AUC = 0.86; 95% CI: 0.77-0.94; P < 0.001) in detecting ventricular-paced spike on bedside ECGs. The results of remote ECGs were similar with bedside ECGs.
CONCLUSIONS
A filter of 300 Hz cutoff may be recommended for ECG spike detection. With the recommended parameter, remote ECG can perform as well as bedside ECG.
背景
目前 150Hz 的上限频率有时会导致起搏器尖峰信号丢失和误诊。我们假设除了 150Hz 之外的低通滤波器（LPF）可以改善起搏器尖峰信号的检测。本研究旨在检查不同 LPF 对远程和床边心电图（ECG）中起搏器尖峰检测的影响。
方法
在常规随访期间纳入永久性起搏器植入患者。采集 6 种不同上限频率（40、100、150、200、300 和 400Hz）的标准 12 导联心电图。所有心电图均传输至远程诊所中心。由 2 名独立的医务人员分析心室和心房起搏。
结果
共分析了 88 例患者的心电图（平均年龄 73.8±10.2 岁，85 例为双腔起搏器）。约 75.3%（64/85）的患者通过起搏器程控诊断为心房起搏。在 6 种不同的上限频率中，300Hz 在床边 ECG 上检测到心房起搏尖峰的效果最佳（曲线下面积[AUC]：0.73，95%置信区间[CI]：0.61-0.84 与 150Hz 时的 0.56，95%CI：0.61-0.84；P=0.002）。以程控为金标准，300Hz LPF 在床边 ECG 上的灵敏度为 59.4%，特异性为 85.7%，阳性预测值为 92.7%，阴性预测值为 40.9%。对于心室起搏，300Hz LPF 在床边 ECG 上检测到心室起搏尖峰的准确性也更高（AUC：0.93；95%CI：0.84-1.00），优于 150Hz（AUC：0.86；95%CI：0.77-0.94；P<0.001）。远程 ECG 的结果与床边 ECG 相似。
结论
建议使用 300Hz 截止滤波器进行 ECG 尖峰检测。使用推荐的参数，远程 ECG 可以与床边 ECG 一样出色。
Zotero 插件