Technical Specification
ECG is recorded in the 3-channel mode, 12-channel mode or in the high-resolution mode for the artificial cardiac pacemaker. ECG can be recorded for up to 3 days. A recorder has a “Bad Feeling” Mark, a motion and position sensor, and a rheopneumographic channel. The Myocard Holter has a built-in arterial pressure monitor.


«Myocard Holter» Software Particularities


I.Artificial Intelligence


The ECG recognition algorithm is based on the artificial intelligence method. Its particularity is that an image system is automatically generated during recognition:

Р wave samples. These samples are used in diagnosing AV blocks, moments of rhythm changes, and aberrant auricular extrasystoles, and in the analysis of the cardiostimulator operation.
Samples of various (normal, ventricle, exhaust, momentary left or right bunch branch block, WPW, or cardiostimulator-imposed) QRST cardiocomplexes.
Ventricle flutter wave samples.
Waves of rhythm variability in a rhythmogram. They are needed to exclude false supraventricular extrasystoles and pauses.
The samples are formed by the software application in a fully automatic manner and requires no action on the part of the doctor. While in most other Holter monitoring systems, software outputs a few hundreds of QRS fragments because of the lack of an image forming mechanism. And the doctor has to analyze those fragments by himself spending lots of time on this.

When the «Myocard Holter» software application was tested in a test base of the Russian Society for Holter Monitoring and Non-Invasive Electrophysiology «ROHMINE», brilliant results were obtained (the best ones in Russia, way ahead of the competitors):

QRS recognition: sensitivity 99,99%, specificity 100%
Ventricle complexes recognition: sensitivity 99,57%, specificity 99,65%

II.Pulse


Minimum, medium and maximum pulse values are defined by the «Myocard Holter» software application for «the day», for «the night time» and for «the daytime», as well as per each pacemaker separately and in whole regardless of the rhythm. The software application accumulates data on tachycardia and bradycardia duration in the ranges of 150 beats per minute.


III.Types Rhythm and Asequences


Software application can distinguish the following rhythm types: the sinus rhythm, the artrial rhythm, the AV-rhythm, atrial fibrillation, pacemaker wandering, paroxysmal supraventricular tachycardia, the ventricle rhythm, ventricle flutter. The left bunch branch block, right bunch branch block and WPW are classified as temporary asequences by the software application. Interestingly, after the recognition of the temporary asequence types (from the beginning of the recording), with a fairly high probability the software application can correctly diagnose single complexes with temporary asequences and them from ventricle extrasystoles. Most other Holter monitoring systems can distinguish the rhythm types from asequences only in part.


IV.Artificial Pacemaker Analysis


To assess cardiostimulator operation, a unique technology was employed: In the artificial pacemaker mode, all the ECG is recorded with the 2000 Hz frequency, and the pacemaker recognition is performed in the computer after the reading of indications. This is due to the fact that the pacemaker recognition software programme is very large and complex and requires considerable system resources. The software application recognizes pacemakers in the range from very narrow (1 ms) to very broad (50 ms) ones, from very small (0.1 mV) to very large (5 mV) ones, from 1-phase to 3-phase ones. Recognition preciseness is close to 100% even if interfering signals of the same frequency range are present. Good results have been achieved by means of the use of artificial intelligence methods, in particular, through the automatic formation of atrium and ventricle pacemaker images. It is our pleasure to note that large medical centres that employ Holter systems from 3-4 manufacturers prefer to use our recorders for patients with artificial pacemakers.


V.Analysis of Standstills and of Noticeable Sinus Arrhythmia


Our software application can distinguish standstills not only based on sharp increases of RR intervals, but also taking into account the presence of blocked P waves and rhythm variability wave parameters in the rhythmogram. The software application can classify SA-blocks, cardiac pacer arrests, AV blocks, blocked supraventricular extrasystoles, post-extrasystole and post-tachycardia standstills, noticeable sinus arrhythmia; the application can categorize standstills by duration and the RR rate


VI.Ectopic Activity


Our software application can distinguish single, double and multiple extrasystoles, bigeminy, trigeminy, and premature extrasystoles. Unlike many other Holter monitoring systems, our software application can classify: supraventricular complexes with aberrant behaviour, parasystole and exhaust complexes; it can combine ventricle complexes into morphological groups.


VII. Segment ST and Negative Т Analysis


The Myocard Holter software application employs such “ischemic ST displacement” criteria as Rule 1х1х1 and ST / cardiac rate index. A conclusion reflects ischemic displacement types, their duration, cardiac rate, total duration, maximum ST deviations. The experience of 12-channel recorder use shows that they are more preferable in ischemic heart disease diagnostics than the 3-channel recorders. So far, no other Holter monitoring system can perform negative Т wave analysis, while such analysis turned out to be of great use.


VIII.Other Options


Rhythm variability analysis, spectrum analysis,
Сardiac rhythm turbulence,
Т wave microalternation,
Increased and reduced PQ intervals analysis,
Increased and reduced QT analysis,
Step-by-step tests.

IX.Basic Windows of Software Application Interface


ECG window. Here you can input the scope, velocity and number of leads. The cardiac rate or RR duration is displayed between 2 cardiocomplexes. PQRST layout can be shown. You can measure the ECG parameters duration and range by means of the “electronic ruler”. You can work in 2 ECG windows at the same time (in a small window with a large scale and in almost a full-screen window with a small scale).
Hystograms and tables. There are approximately 220 abnormalities and dysfunction quantity hystograms by hours. You can clearly see in which hour there were the most abnormalities and dysfunctions. By mouse-clicking the time you want in the hystogram, you can proceed at once to view ECG for that time. Hystograms can be printed out.
The abnormality tree is the main mechanism for a doctor to select abnormalities to view. It is very convenient to view and edit abnormalities by means of either detailed or general classification. For example, you can view and edit all the ventricle extrasystoles or only double or early ones, etc.
Abnormality list. The mechanism is very convenient because the abnormalities can be sorted based on any criterion, e.g. you can sort extrasystoles by pre-ectopic intervals, by RRi/RRi+1 ratios, by QRS duration, by the presence and types of Р waves, by extrasystole types, by image shapes, by interfering signal levels, by levels of similarity to the image. You might want to edit by ticking line groups in the list.
Rhythmogram. In the rhythmogram, different abnormalities are marked by different colours. Rhythm types and temporary asequences are marked separately. You can clearly see aberration regularities, for example, respiratory arrhythmia waves.
Pulse trends (charts), ST, Т, PQ, QT, etc. Here, there is a mechanism to view the most remarkable fragments (minimum and maximum pulse, maximum ST deviation, etc.) and the beginnings of types, for example, ischemic displacements.

X.Editing and Records Output


1.Examination by Sections.

Records are filed automatically and consist of 10 sections. Therefore, it is recommended to perform the whole examination also by sections. After having selected a section, it is convenient to switch between the hystograms, aberration list, ECG charts, trends, and record conclusion fragments. The convenience is that when working on some subject, for example ST, everything related to ST will be at hand.

2.Transitions.

Windows of ECG, rhythmograms, trends and lists have one and the same cursor. I.e. when surfing in the ECG, the cursor will move both in the rhythmogram and trends. If you click on any spot in the rhythmogram, trends or lists, the ECG will also move.

3.Editing Options Diversity.

The following editing options are possible at different levels:

Classification of single cardiocomplexes;
Aberration groups (for example, an entire group of ventricle extrasystoles of a certain shape can at once be sent to “supraventricular extrasystoles with an aberrant behavior”);
ECG types (rhythm, temporary blocks, ST displacement, etc.); the types can be deleted, added or changed
The text of the conclusion in the records;
It is possible to undo or redo, i.e. to cancel the latest changes.
4.A Single Abnormality List.

Wherever editing is performed, it will automatically appear elsewhere: in the conclusion, hystograms, tables, and abnormality lists. You can conveniently edit in the lists by marking line groups in the list, and further change the classification by a single command. Through various sortings, e.g. by QRS widths or interfering signal levels, you can exclude software application errors.

5.Charts Printing Out.

In the course of an ECG examination, the doctor sends examples of the ECG, trends, and rhythmogram to the printing queue. The software application will automatically prepare a comment, for example, “maximum pulse”, “double ventricle extrasystole”, etc. The doctor can correct the comments. The doctor can view the selected fragments or delete them from the queue, for example, to use a more characteristic one instead. When the doctor sends fragments to the printer after the examination has been finished, it is possible to choose page orientation (landscape or portrait one). The software application will try to make maximum use of each page by displaying several fragments on it. Charts are displayed by sections.

6.Examination Records

The records consist of chart fragments, the text of a conclusion and tables. It is possible to group the charts, text and tables by sections. The records structure can be easily defined by check marks. For example, if you don’t need the rhythm variability section or the QT section, you will just have to uncheck it.


Cost Effectiveness



In Nizhny Novgorod, most private diagnostics centres that perform daily ECG monitoring have purchased Myocard Holters sets. This indicates a profitable price-to-quality ratio. A business person will buy neither a system that is not efficacious in diagnostics or has an inconvenient interface, nor over-priced so called elite systems, which are noticeably weaker in recognition and analysis than Myocard Holter. It is also essential that in Myocard Holter all the sections of analysis are fully functional. Only telemedicine is a separate option.

Regarding elite systems. To maximize their profit, many domestic and foreign manufacturers divide their software into several levels (basic, professional, expert, and elite ones). Each level has a separate price. Thus, after having paid a large amount for a basic version, the user receives abridge analysis functions, for example, without options for the analysis of atrium fibrillation or supraventriular tachycardia or without for the proper analysis of ST segments.

For example, Rozin (USA) offers the following as only additional options:

SVT (supraventricular tachycardia).
This is incredible! ВThe basic version lacks analysis of such a serious aberration! Do they mean a doctor will have to review all the records by himself?
Allorhythmia (bigeminy, trigeminy) This is elementary diagnostics! Why is it only an additional option?
Tachycardia, bradycardia. Optional, too!!! Then what do they have in their basic version?
High-quality analysis of ST segments. Are we supposed to think the basic version is only capable of low-quality analysis?! Who needs it then?
В «Myocard Holter » software offers everything we have attained in ECG diagnostics in full, with no additional options required. Myocard Holter sets have been delivered to over 2000 medical institutions, mainly to central district hospitals, regional hospitals and private medical centre.