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MICROPROCESSOR-BASED AMBULATORY ECG MONITORING SYSTEM

P. LE-HUY, J.P. L'HUILLIER, Y. OUMERZOUK, E. YVROUD

Centre de Recherche en Automatique de Nancy - ENSEM


P.O. Box 850, 54011 NANCY Cedex, FRANCE

ABSTRACT
Ambulatory monitoring of electrocardiograms (ECGs)
was facilitated by the introduction of Holter method
in the early '60s. Since this time, many researchs
have been undertaken in order to improve the overall
performances of the recorder and analyser, two unseparated parts of this method.
The principal drawbacks of Holter method are wellknown:
. Recording of ECG is based on the assumption that
the arrhythmia of interest will be occurred in monitoring period.
. Analysis and arrhythmia detection could be processed
only after the monitoring period. This is a timeconsuming and tedious job, and subjected to human

ECG Amplif ier


First of all, the ECG signal is picked up by a bipolar
electrodes system before routing to the input of an
ECG amplifier. Depending on the nature of the ECG
signal, whether it is paced or not, the output of amplifier is sent directly to a pace-maker pulse reject
circuit or simply bypassing this latter. This fonction
is fulfilled by means of a switch.
The ECG amplifier is constructed around three low
power operational amplifiers in classical configuration, providing no isolation. All discret components
are calculated in order to have a frequency response
from 0.05 Hz to 40 Hz, this band of frequency is
judged enough for our application. Furthermore, all
artefacts of high frequency such as EMGs are greatly
attenuated by this choice.
Pace-maker pulse reject circuit
The pacing pulse is simply filtered out by a circuit
with slow rise time, passing only the slow varying
parts of ECG signal.
Signal conditioning section
This section consists of an R wave detector and
associated logic circuits, whose principal output is a
pulse presenting a R Wave. Its on-time is lengthened by a refractory period of approximately 200ms,
preventing the detector from the false triggering on
tall T waves.
The heart of R wave detector is a bandpass filter,
centering about 20 Hz, thus the frequency components
of R wave are enhanced in respect to the others.
At the same time, the slow varying base line is stabilized, this is frequently occurred in ambulatory
monitoring. A threshold circuit is then used to detect
the presence of a R wave. An accompanied logic
signal indicates the site of detected R wave, ventricular or supraventricular.
Upon the occurrence of two successive R waves,
the microprocessor uses a real-time timer to calculate the RR interval. It is the primary parameter
using by detection algorithm to classify arrhythmia.
Recording section
An analog delay circuit, FM modulation circuit and
a cassette recorder are the principal parts of this
section. The recording of arrhythmia on cassette tape
is under controlled of a logic signal coming from
microprocessor, upon the detection of arrhythmia
on ECG signal.
The ECG signal is delayed by a circuit using bucketbrigade devices, providing a delay of approximately

error.
.Process "Recording-Play-back - Analysis - Diagnosis"
takes usually many days.
In this paper, the design of a microprocessor - based
portable recorder will be described. The analysis and
classification of arrhythmia are processed immediately upon their occurrence according to a look-up table, which could be programmed to suitaparticularneed.

SYSTEM DESCRIPTION
By refering to the block diagram of this portable
recorder in figure 1, different sections may be distinguished:

FIGURE

BLOC DIGA

0195-4210/83/0000/0917$01.00 0 1983 IEEE

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5 seconds prior to an abnormal complex identified


by detection algorithm. The recording of ECG on
cassette tape is performed through FM modulation.
The free running frequency of VCO section is of
1200 Hz with a maximum deviation of 300 Hz.
Microcomputer section
This section contains a CMOS microprocessor (Motorola 146805) with timers, a program located on a
27C16 2Kx8 EPROM, IK bytes of RAM are used
as temporary registers, some I/0 ports allowing the
interface with analog world.
Other characteristics
The above described recorder offers other possibilities of use such as:
. Detection of electrode failure
. Automatic recording of ECG ordered manually
by wearer.
. Transmission of recorded ECGs over public telephone lines by using an appropriate adaptor in
conjunction with modulated output in play-back
mode.
Direct interface with electrocardiograph in playback mode using demodulated signal.
Alarm on life-threatening arrhythmia.
CONCLUSION
In this paper, the design of a portable microprocessorbased ambulatory ECG monitoring system is described. The analysis and classification of arrhythmia
are processed in real time. Therefore, the recording
of normal complexes over long periods is totally
eliminated.
Actually, the implementation of this system according
to the presented block diagram is on progress. The
experimental and clinical results will be published
as soon as available.
REFERENCES
1. BERSON, A.S. ; WOJICK, J.M.; PIPBERGER, H.V.,
Precision requirements for electrocardiographic
measurements computed automatically, IEEE Trans.
on Biomed. Eng., Vol. BME-24, N 4, July 1977,
pp. 382-385.
2. VAN DAM, R.A.A.F.; BREKELMANS, F.E.M.;
DUISTERHOUT, J.S., A high performance microprocessor-based arrhythmia monitor, Computers
in Cardiology, 1981, pp. 449-452.

3. ALAN RITTER, J. ; ARGUS/PLUS: Application


of current research to a clinical arrhythmia monitoring system, Computers in Cardiology, 1981,
pp. 527-530.
4. LE-HUY, P. ; LEBLANC, A. ; PRINCE, G. ; LAMY,
J.Y., Un simple systeme de telemetrie pour les
signaux bio-electriques, I.T.B.M. Review, Vol. 2,
n 3, 1981, pp. 366-368.

5. LAMY, J.Y. ; LEBLANC, A. ; DION, J.L.; LE-HUY,


P. ; ROY, M., Un systeme de monitoring ambulatoire
versatile comme appareil pour l'etude de l'homme
en situation, I.T.B.M., Vol. 2, N.3, 1981, pp. 356-365

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