Window on Cardiology

Clinical Excellence in Computerized ECG Analysis
ECG and its role in modern medical care

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"The fact is, the electrocardiogram is needed to deliver modern medical care now more than ever (1)."

According to Hurst (1), there is a misconception that newer diagnostic modalities have replaced the electrocardiogram (ECG). He continues that the ECG is needed now more than ever to delivery accurate and cost-effective modern medical care. Kadish et al. (2) report that recording the resting 12-lead ECG continues to be the most commonly used laboratory procedure for the diagnosis of heart disease. They also list the advantages of the procedure: it is safe, simple, and reproducible; the ECG record lends itself to serial studies; and the relative cost is minimal.

The ECG continues to play a key role in the proper selection of the latest therapies. In the setting of an acute coronary syndrome, the ECG is used for treatment selection and expedited care (3). The ECG continues to be central in the management of arrhythmias. New advancements in electronic cardiac implants have solidified the role of the ECG in selection of appropriate target populations for such therapies as biventricular pacemakers and implantable cardioverter defibrillators (4). Even in the presence of superior diagnostic imaging methods, the ECG often provides valuable prognostic data showing that the ECG still has a significant role in determining patient care.

Quality digital waveforms drive clinical excellence

Many physicians can recall instances where a single ECG made all the difference in determining a critical diagnosis. To be the most effective and to maintain clinical excellence, it is critical that the ECG enters the digital and paperless domain. Advancements in computer technology brought digital writers and displays to the clinical environment. This allowed for the computerization (digitization) of the ECG.

Digital acquisition of the ECG signal is important to reduce noise and artifact (5). GE pioneered to introduce a digital acquisition system and lead the way in developing sophisticated signal processing programs designed to improve ECG signal (waveform) quality. This processing is vital and helps to maximize the accuracy of computerized measurements, interpretation and waveform display.

Information management for effective, broad support

GE uses industry-standard networking to connect ECG acquisition systems. All ECG types, whether it be Holter, stress, resting, signal-averaged ECG, vectorcardiogram, etc., can be sent to the MUSE® Cardiology Information System.

In addition, ECGs acquired from bedside monitors and telemetry units can also be transmitted via the Unity Network®. This network can include a secure wireless capability to provide automatic routing of the ECG to the point-of-decision. Furthermore, the network has Health Level 7 (HL7) functions for accurate administration of patient demographics, orders, test results and billing-related information.

ECG across the continuum of care

GE provides products and systems that incorporate digital ECG processing, in every patient care setting where the ECG is needed. Starting with out-of-hospital emergency care, GE's Marquette® 12SL program is implemented in ZOLL and Medtronic LIFEPAK pre-hospital defibrillators for recognition of acute coronary syndromes (6).

GE provides a complete set of diagnostic systems for resting ECG, stress testing, Holter, clinical patient monitoring, cardiac catheterization and electrophysiology (EP) testing, all of which include advanced analysis programs.

Bringing continued innovation to the ECG

As a manufacturer, GE was the pioneer to provide digital electrocardiographs that simultaneously acquired and analyzed all 10 seconds of all 12 leads of ECG waveforms. Introduced in 1982, this innovation had a profound impact on the industry (7).

Today, GE continues to deliver advanced ECG technology focused on taking clinical excellence to the next level. Introduced in 2004, the Marquette Hookup Advisor, is a signal quality analysis program which dynamically measures and indicates ECG signal status, and provides user feedback for increased ECG quality. On the same year, the CardioSoft PC-based resting ECG and exercise testing software came also available. It is a solution which provides final report results integrated into office-based electronic medical record (EMR) systems.

References:

1. Hurst JW. Current status of clinical electrocardiography with suggestions for the improvement of the interpretive process. American Journal of Cardiology 2003;92:1072-9.
2. Kadish AH, Buxton AE, Kennedy HL, Knight BP, Mason JW, Schuger CD, et al. ACC/AHA clinical competence statement on electrophysiology and ambulatory electrocardiography. Circulation 2001;104:3169-78.
3. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et.al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction – summary article: a report of the American college of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). Journal of the American College of Cardiology 2002;40:1366-74.
4. Engel G, Beckerman JG, Foelicher VF, Yamazaki T, Chen HA, Richardson K, et al. Electrocardiographic arrhythmia risk testing. Current Problems in Cardiology 2004;29:365-432.
5. Association for the Advancement of Medical Instrumentation. Diagnostic electrocardiographic devices. 2nd ed. ANSI/AAMI standard EC11:1991/(R)2001.
6. Aufderheide TP, Rowlandson I, Lawrence SW, Kuhn EM, Selker HP. Test of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) for prehospital use. Annals of Emergency Medicine 1996;27:93-8.
7. Drazen E, Mann N, Borun R, Laks M, Bersen A. Survey of computer-assisted electrocardiography in the United States. Journal of Electrocardiology 1988;21 Suppl:S98-104.

Last updated: 1 September 2005Created
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