ADVANCES IN ELECTROCARDIOGRAMS – METHODS AND ANALYSIS pptx

ADVANCES IN ELECTROCARDIOGRAMS – METHODS AND ANALYSIS Edited by Richard M. Millis Advances in Electrocardiograms – Methods and Analysis Edited by Richard M. Millis Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Petra Nenadic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published January, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advances in Electrocardiograms – Methods and Analysis, Edited by Richard M. Millis p. cm. ISBN 978-953-307-923-3 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Cardiac Structure and Function 1 Chapter 1 Cardiac Anatomy 3 Augusta Pelosi and Jack Rubinstein Part 2 ECG Technique 21 Chapter 2 Low-Frequency Response and the Skin-Electrode Interface in Dry-Electrode Electrocardiography 23 Cédric Assambo and Martin J. Burke Chapter 3 Implantation Techniques of Leads for Left Ventricular Pacing in Cardiac Resynchronization Therapy and Electrocardiographic Consequences of the Stimulation Site 53 Michael Scheffer and Berry M. van Gelder Chapter 4 Non Contact Heart Monitoring 81 Lorenzo Scalise Chapter 5 Automated Selection of Optimal ECG Lead Using Heart Instantaneous Frequency During Sleep 107 Yeon-Sik Noh, Ja-Woong Yoon and Hyung-Ro Yoon Part 3 ECG Feature Analysis 125 Chapter 6 A Novel Technique for ECG Morphology Interpretation and Arrhythmia Detection Based on Time Series Signal Extracted from Scanned ECG Record 127 Srinivasan Jayaraman, Prashanth Swamy, Vani Damodaran and N. Venkatesh Chapter 7 QT Interval and QT Variability 141 Bojan Vrtovec and Gregor Poglajen VI Contents Chapter 8 The Electrocardiogram – Waves and Intervals 149 James E. Skinner, Daniel N. Weiss and Edward F. Lundy Chapter 9 Quantification of Ventricular Repolarization Dispersion Using Digital Processing of the Surface ECG 181 Ana Cecilia Vinzio Maggio, María Paula Bonomini, Eric Laciar Leber and Pedro David Arini Chapter 10 Medicines and QT Prolongation 207 Ryuji Kato, Yoshio Ijiri and Kazuhiko Tanaka Chapter 11 Concealed Conduction 217 Hasan Ari and Kübra Doğanay Chapter 12 Recognition of Cardiac Arrhythmia by Means of Beat Clustering on ECG-Holter Recordings 225 J.L. Rodríguez-Sotelo, G. Castellanos-Domínguez and C.D. Acosta-Medina Part 4 Heart Rate Variability 251 Chapter 13 Electrocardiographic Analysis of Heart Rate Variability in Aging Heart 253 Elpidio Santillo, Monica Migale, Luca Fallavollita, Luciano Marini and Fabrizio Balestrini Chapter 14 Changes of Sympathovagal Balance Measured by Heart Rate Variability in Gastroparetic Patients Treated with Gastric Electrical Stimulation 271 Zhiyue Lin and Richard W. McCallum Chapter 15 Associations of Metabolic Variables with Electrocardiographic Measures of Sympathovagal Balance in Healthy Young Adults 283 Richard M. Millis, Mark D. Hatcher, Rachel E. Austin, Vernon Bond and Kim L. Goring Part 5 ECG Signal Processing 295 Chapter 16 An Analogue Front-End System with a Low-Power On-Chip Filter and ADC for Portable ECG Detection Devices 297 Shuenn-Yuh Lee, Jia-Hua Hong, Jin-Ching Lee and Qiang Fang Chapter 17 Electrocardiogram in an MRI Environment: Clinical Needs, Practical Considerations, Safety Implications, Technical Solutions and Future Directions 309 Thoralf Niendorf, Lukas Winter and Tobias Frauenrath Contents VII Chapter 18 Customized Heart Check System by Using Integrated Information of Electrocardiogram and Plethysmogram Outside the Driver’s Awareness from an Automobile Steering Wheel 325 Motohisa Osaka Chapter 19 Independent Component Analysis in ECG Signal Processing 349 Jarno M.A. Tanskanen and Jari J. Viik Part 6 ECG Data Management 373 Chapter 20 Broadening the Exchange of Electrocardiogram Data from Intra-Hospital to Inter-Hospital 375 Shizhong Yuan, Daming Wei and Weimin Xu Preface The human heart has a long evolutionary history. Recent developments in genetic analysis suggest that the roots of some heart diseases stem from the hearts of our invertebrate and vertebrate ancestors. Whether squids, butterflies, grasshoppers or tarantulas possess predispositions for heart disease and death from heart failure in their natural environments is unknown. However, at least some of the events occurring during embryonic organogenesis of the human heart appear to reflect the evolutionary, and phylogenetic structural adaptations that may increase susceptibility to the cardiac diseases found in humans. The basic structure and function of the vertebrate heart as a blood pump, derives from cardiac myocytes which are electrically coupled by gap junctions. Tight coupling and compact arrangement of the cardiac myocytes are characteristic of the human heart. However, a looser coupling and architecture was observed in the hearts of invertebrate and lower vertebrate animals. The loose arrangement characteristic of the human ancestral heart is adapted to a heart that functions to pump hemolymph to the tissues by a, more or less, peristaltic movement similar to that seen in the gastrointestinal tract. Such peristaltic pumping is adequate for animals possessing hearts which consist of a primitive conduit, for insuring continuous flow of nutrients to tissues under relatively constant conditions and demands. On the other hand, the hearts of mammals are designed to maintain a continuous flow of nutrients to tissues under more variable conditions than those of invertebrates and lower vertebrates, thereby requiring responsiveness to complex stimuli such as those associated with changes in metabolic, emotional, immunological and many other physiological functions. Embryonic development of the gap junctions which give rise to tight electrical coupling in the human heart appear to partly depend on the production of a proline rich repeat unit structure of a protein named Xin, derived from the Chinese word for heart, center or core. Xin proteins are known to bind to various actin, cadherin and catenin proteins which organize into zona adherens of gap junctions. When the Xin proteins, together with others involved in the gap junction morphology, are deficient in mutant zebrafish, lethal cardiomyopathies and heart failures occur. When the Xin proteins are deficient in knockout mice, there is an absence of the compactness and tight electrical coupling characteristic of the mammalian heart, resulting in morphologies more or less like fish hearts, which results in cardiomyopathies and heart failures similar to those observed in humans with lethal neonatal X Preface cardiomyopathies. Some neonatal cardiomyopathies appear to result from genetic defects in proteins associated with structuring the gap junctions for electrical coupling between neonatal cardiac myocytes. In addition to the aforementioned genetic abnormalities of gap junctions, epigenetic mechanisms which affect the electrical coupling, and signaling mechanisms of cardiac myocytes have been implicated in adaptive and maladaptive hypertrophy, remodeling and various morphological abnormalities of the heart. Such epigenetic modifications may explain congenital and acquired susceptibilities to cardiomyopathies and heart failures throughout a person’s life. Cardiac signaling has evolved based on endogenous myogenic pacemaker mechanisms for excitation and recovery by phases of depolarization and repolarization, and on exogenous visceral motor (autonomic) nerve directed mechanisms utilizing neurotransmitter release to regulate the phases of depolarization and repolarization. Invertebrate and lower vertebrate hearts, with loose electrical coupling by gap junctions, depend on the development of a pacemaker with higher rates of depolarization in the receiving areas to drive, via loose connectivity and electrical coupling, the pumping areas. These primitive hearts have thin layers of cardiac myocytes, not well organized into chambers. It seems that heart chambers with distinct layers of endothelium, and myocardium have evolved in parallel with more complex structures of Xin and other proteins organized as intercalated discs. These findings suggest that electrical coupling of cardiac myocytes has a large impact on determining heart morphology and, therefore, physiology. In this volume, Advances in Electrocardiograms - Methods and Analysis, the reader will revisit some classical concepts and will be introduced to a number of novel, innovative methods for recording and analyzing the human electrocardiogram. Being mindful of the important role of cardiac electricity in determining heart structure and function will, no doubt, lead the reader to a greater appreciation of the electrocardiogram in health and disease. Richard M. Millis, PhD Editor Dept. of Physiology & Biophysics The Howard University College of Medicine USA [...]... draining the gastrointestinal system and the portal circulation), the 4 Advances in Electrocardiograms – Methods and Analysis common cardinal veins (draining the anterior cardinal vein coming from the anterior part of the embryo), the posterior cardinal vein (from the posterior part of the embryo), and the umbilical veins (from the primitive placenta) Between day 22 and 28, the heart begins to fold and. .. vein while the right umbilical vein connects to the right vitelline vein through the ductus venosus (derived from the vitelline veins) The veins draining into the left sinus venosus (left cardianal, umbilical, and vitelline) degenerate and the left sinus venosus becomes the coronary sinus, draining only the venous circulation of the heart (Abdulla, 2004) 6 Advances in Electrocardiograms – Methods and. .. originates the contracting and the conducting tissue The origin of the sinus and atrioventricular (AV) node is not well known The cells seem to originate at the original connection of the sinus venosus with the right and left superior cardinal veins These small groups of cells follow the cardinal veins as they move to their final destination The right cardinal vein becomes the superior vena cava and. .. inferior cervical ganglion form the “stellate ganglion” giving off the inferior cardiac nerve (Snell, 2008) The cardiac plexus is a network of sympathetic and parasympathetic nerves primarily innervating the conduction system and the atria 10 Advances in Electrocardiograms – Methods and Analysis 3.1 Heart in the thoracic cavity and external anatomy The heart is located within the thoracic cavity in. .. mediastinum is the central part and contains the heart and the pericardium The posterior mediastinum is contained between the pericardium anteriorly and the anterior surfaces of the bodies of the thoracic vertebrae (T5-T12) (Snell, 2008) Superiorly the thorax narrows as it enters the neck (1st ribs, the 8 Advances in Electrocardiograms – Methods and Analysis manubrium and the 1st thoracic vertebra), and inferiorly... coronary sinus also receives the middle vein The veins, draining the posterior left and right ventricle and the interventricular septum, form the middle cardiac vein This vein runs on the posterior interventricular sulcus and it enters the coronary sinus just before the right atrium The small cardiac vein originates from the antero-lateral right ventricular wall and follows a path parallel to the marginal... trachea and esophagus The azygous vein crosses anteriorly to them and to the right The thoracic duct enters into the posterior mediastinum through the aortic hiatus and travels between the thoracic aorta and the azygous vein behind the esophagus It then drains into the left venous system close to the junction of the internal jugular and subclavian veins The superior mediastinum is crossed by the vagus and. .. superior and inferior mediastinum by the transverse thoracic plane, which extends from the sternal angle to the space between the thoracic vertebrae T4 and T5 This line divides the thoracic cavity into superior and inferior mediastinum The inferior mediastinum can be divided into an anterior, middle and posterior mediastinum (Snell, 2008) The anterior mediastium is bounded by a line crossing the thorax... left atrium (vein of Marshall), and the posterior vein of the left ventricle The oblique vein of Marshall runs superior to inferior along the posterior side of the left atrium, providing venous drainage of the area It drains into the coronary sinus next to the great vein The posterior vein ascends to the coronary sinus from the inferior portion of the left ventricle and provides drainage of the area... close to the heart becomes the coronary sinus (James, 2001) The left posterior cardinal vein degenerates, the right posterior cardinal vein becomes the azygous vein, and the left sinus horn contributes to the coronary sinus The vitelline veins also undergo several changes: the right vitelline vein becomes the inferior vena cava The course of the umbilical veins (coming from the placenta) is also modified . draining the gastrointestinal system and the portal circulation), the Advances in Electrocardiograms – Methods and Analysis 4 common cardinal veins (draining the anterior cardinal vein. ADVANCES IN ELECTROCARDIOGRAMS – METHODS AND ANALYSIS Edited by Richard M. Millis Advances in Electrocardiograms – Methods and Analysis Edited by. Xin proteins are known to bind to various actin, cadherin and catenin proteins which organize into zona adherens of gap junctions. When the Xin proteins, together with others involved in the