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Klinische Wochenschrift

, Volume 60, Issue 8, pp 379–391 | Cite as

Die Bedeutung der Signalmittlungstechnik in der Kardiologie

  • V. Hombach
  • H. H. Hilger
  • V. Braun
  • H. -W. Höpp
Übersichten

Zusammenfassung

In der vorliegenden Arbeit wird eine Übersicht über Prinzip, Methodik und klinische Anwendungsmöglichkeiten der Signalmittlungstechnik gegeben. In hochverstärkten EKG-Ableitungen werden bioelektrische Signale des Herzens im Mikrovoltbereich durch das ebenfalls verstärkte Grundrauschen in aller Regel überdeckt. Durch Summation mehrerer hundert Herzzyklen und Mittelung kann das Untergrundrauschen nivelliert werden, während periodisch wiederkehrende Signale aufsummiert werden. Diese Verbesserung des Signal-Rauschverhältnisses durch die Signalmittlungstechnik hängt ab von der Zahl der gesammelten Herzzyklen und entspricht etwa der Quadratwurzel der Zahl gesammelter Herzaktionen, z.B. 10:1 bei hundert gesammelten Zyklen. Die einzelnen im Einsatz befindlichen Signalmittlungscomputer sind sehr unterschiedlich konzipiert, was die Signalaufnahme, Filterbestückung, Triggermechanismus und Verarbeitung der Daten angeht. Diese Eigenheiten müssen bei der Bewertung der gewonnenen Ergebnisse berücksichtigt werden. Die Anwendungsmöglichkeiten der Signalmittlungstechnik in der klinischen Kardiologie sind bisher folgende: 1. Oberflächen-EKG: Ableitung von Prä-P-Potentialen, von His-Bündel-Potentialen, von ventrikulären Spätpotentialen und die Frequenzanalyse des QRS-Komplexes bei Herzinfarktpatienten, 2. Intrakardiales EKG: Registrierung von Prä-P-Potentialen aus dem Vorhofelektrogramm sowie von AV-Knotenpotentialen aus dem His-Bündel-Elektrogramm, 3. Oberflächen-Phonokardiogramm: Reduktion von Untergrundrauschen, Registrierung von niedrigamplitudigen spätdiastolischen Signalen, 4. Mittelung phasischer Ventrikeldruckkurven. Die Registrierung von His-Bündel-Potentialen und ventrikulären Spätpotentialen von der Körperoberfläche scheint zur Zeit die vielversprechendste und am besten abgesicherte Anwendungsmöglichkeit zu sein. Die Bemühungen werden in der Zukunft darauf abzielen, die im Mikrovoltbereich liegenden Signale des Herzens (Sinusknotenpotentiale, His-Bündel-Potentiale, ventrikuläre Spätpotentiale) fortlaufend mit Hilfe speziell konstruierter EKG-Geräte von der Körperoberfläche sichtbar und registrierbar zu machen.

Schlüsselwörter

Signalmittlungstechnik Prä-P-Potentiale Oberflächen-His-Bündel-EKG ventrikuläre Spätpotentiale Prognose von Koronarpatienten 

The significance of the signal averaging technique in cardiology

Summary

This paper gives a survey on the principles, methodology, and clinical applications of the signalaveraging technique. Bioelectric signals of the heart at the microvolt level are overwhelmed by basal noise in high-gain amplified EKG registrations. By summation and averaging of several hundreds of cardiac cycles, basal noise can be minimized and the signal of interest accumulates. This improvement of the signal-noise ratio primarily depends on the number of cycles averaged, e.g., by 10:1 when 100 cycles are averaged (approximately, the square root of the number of averaged cycles). At present, signal-averaging computers in use are rather variable with respect to data acquisition, filter settings, trigger mechanism/stability, and data processing. These properties have to be taken into account when the results of different groups using different types of averaging computers have to be compared. At present, several applications of the signal-averaging technique in clinical cardiology have been proposed: (1) Surface EKG — registrations of pre-P potentials, of His bundle potentials, and of ventricular late potentials, as well as analysis of the frequency spectrum of the QRS complex in patients with myocardial infarction; (2) intracardiac EKG — recordings of pre-P potentials and of A-V nodal potentials; (3) surface phonocardiogram — detection of low-amplitude, late diastolic signals; (4) Intracardiac pressure analysis — recording of average phasic pressure changes. The most promising and clinically proven application of the signal-averaging technique, at present, seems to be the registration of His bundle potentials as well as of ventricular late potentials from the body surface. Future efforts will need to be made to record cardiac microvolt potentials beat by beat from the body surface by means of specially designed EKG recorders.

Key words

Signal-averaging technique Pre-P potentials Surface His bundle potentials Ventricular late potentials Prognosis of CHD patients 

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Literatur

  1. 1.
    Alanis J (1961) Propagation of impulses through the specialized tissues of the mammalian heart. In: De Carvalho, De Mello, Hoffman (eds) The specialized tissues of the heart. Elsevier, Amsterdam, p 175Google Scholar
  2. 2.
    Baschieri L, Lalagi L, Puletti M (1967) Experimental study of the pathogenesis of ventricular extrasystolia. Cardiologia 50:366Google Scholar
  3. 3.
    Berbari EJ, Lazzara R, Samet P, Scherlag BJ (1973) Noninvasive technique for detection of electrical activity during the P-R segment. Circulation 48:1005Google Scholar
  4. 4.
    Berbari EJ, Scherlag BJ, Lazzara R (1978) Recordings of AV nodal potentials during junctional rhythms utilizing signal averaging. Am J Physiol 235:110Google Scholar
  5. 5.
    Berbari EJ, Scherlag BJ, Hope RR, Lazzara R (1978) Recordings from the body surface of arrhythmogenic ventricular activity during the S-T segment. Am J Cardiol 41:697Google Scholar
  6. 6.
    Bethge KP, Bethge HC, Graf A, van den Berg E, Lichtlen P (1977) Kammerarrhythmien bei chronisch koronarer Herzkrankheit. Analyse anhand des Langzeit-Elektrogramms und der selektiven Koronararteriographie. Z Kardiol 66:1Google Scholar
  7. 7.
    Braun V, Hombach V, Höpp H-W, Gil-Sanchez D, Scholl H, Hilger HH (1981) Pre-atrial activity recorded from intracardiac and surface leads by signal averaging. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 81Google Scholar
  8. 8.
    Breithardt G, Becker R, Seipel L, Abendroth R-R, Ostermeyer J (1981) Non-invasive detection of late potentials in man — a new marker for ventricular tachycardia. Eur Heart J 2:1Google Scholar
  9. 9.
    Breithardt G, Borggrefe M, Schwarzmaier J, Karbenn U, Yeh HL, Seipel L (1981) Clinical significance of ventricular late potentials. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 219Google Scholar
  10. 10.
    Cramer M, Siegal M, Bigger JT, Hoffman BF (1977) Characteristics of extracellular potentials recorded from the sinoatrial pacemaker of the rabbit. Circ Res 41:292Google Scholar
  11. 11.
    Damato AN, Lau SH, Berkowitz WD, Rosen KM, Lisi KR (1969) Recordings of specialized conduction fibers (AV nodal, His bundle, and right bundle branch) in man using an electrode catheter technique. Circulation 39:435Google Scholar
  12. 12.
    Durrer D, Van Lier A, Buller J (1964) Epicardial and intramural excitation in chronic myocardial infarction. Am Heart J 68:765Google Scholar
  13. 13.
    El Sherif N, Scherlag BJ, Lazzara R, Hope RR (1977) Reentrant ventricular arrhythmias in the late myocardial infarction period. I. Conduction characteristics in the infarction zone. Circulation 55:686Google Scholar
  14. 14.
    El Sherif N, Scherlag BJ, Lazzara R, Hope RR (1977) Reentrant ventricular arrhythmias in the late myocardial infarction period. II. Patterns of initiation and termination of reentry. Circulation 55:702Google Scholar
  15. 15.
    Evanich MJ, Newberry O, Partridge LD (1972) Some limitations of the removal of periodic noise by averaging. J Appl Physiol 33:536Google Scholar
  16. 16.
    Fontaine G, Guiraudon G, Frank R, Vedel J, Grossogeat Y, Cabrol C, Facquet J (1977) Stimulation studies and epicardial mapping in ventricular tachycardia: Study of the mechanisms and selection for surgery. In: Kulbertus (ed) Reentrant arrhythmias. MTP Press, Lancaster, pp 334Google Scholar
  17. 17.
    Fontaine G, Pierfitte M, Tonet JL, Filette F, Frank R, Grosgogeat Y (1981) Interpretation of afterpotentials registered from epicardium, endocardium and body surface in patients with chronic ventricular tachycardia. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology. May 7.-9th, 1981, Cologne. Schattauer, Stuttgart New York, p 177Google Scholar
  18. 18.
    Flowers NC, Horan LG (1973) His bundle and bundle branch recordings from the body surface. Circulation 48:[Suppl 4] 102Google Scholar
  19. 19.
    Flowers NC, Shvartsman V, Sohi GS, Horan LG (1981) Signal averaged versus beat-by-beat recording of surface His-Purkinje potentials. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 329Google Scholar
  20. 20.
    Gebhardt U, Pop T, Bethge C, De Bakker JMT, Keusen H, Messmer BJ (1979) Sinus node potentials in man. In: Meere Cl (ed) Proceedings of the VIth World Symposion on Cardiac Pacing, Montreal, 8–6Google Scholar
  21. 21.
    Gebhardt-Seehausen U, Bethge C, Bonke FIM, Merx W (1981) Continuous recordings of sinus nodal potentials. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology. May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 41Google Scholar
  22. 22.
    Goldberger AL, Bhargava V, Froelicher V, Covell J, Martara D (1980) Effect of myocardial infarction on the peak amplitude of high frequency QRS potentials. J Electrocardiol 13:367Google Scholar
  23. 23.
    Hashimoto H, Tomita T, Kodama K, Miyata K, Shina A, Tsuchiya M, Yaginuma Y, Hosoda S (1979) Clinical significance of the pre-atrial activity obtained by averaging technique for evaluating the sino-atrial conduction. In: Meere Cl (ed) Proceedings of the VIth World Symposion on Cardiac Pacing, Montreal, 8–5Google Scholar
  24. 24.
    Hariman RJ, Krongrad E, Boxer RA, Cramer M, Bowman FO Jr, Malm JR, Hoffman BF (1978) A method for recording of extracellular sinoatrial electrograms during cardiac surgery in man. Am J Cardiol 41:375Google Scholar
  25. 25.
    Hirche H, Kebbel U, McDonald F (1981) Unveröffentlichte BefundeGoogle Scholar
  26. 26.
    Hishimoto Y, Sawayama T (1975) Non-invasive recordings of His bundle potentials in man. Br Heart J 37:635Google Scholar
  27. 27.
    Hombach V, Zanker R, Behrenbeck DW, Hilger HH (1978) Die Ableitung von Sinusknotenpotentialen beim Menschen. Z Kardiol 67:155Google Scholar
  28. 28.
    Hombach V, Scholl H, Braun V, Gil-Sanchez D, Behrenbeck DW, Tauchert M, Hilger HH (1979) The direct detection of sinus nodal potentials in man by means of the signal averaging technique. Z Kardiol 68:720Google Scholar
  29. 29.
    Hombach V, Scholl H, Braun V, Gil-Sanchez D, Behrenbeck DW, Tauchert M, Hilger HH (1979) Direct registrations of AV-nodal potentials in man with the aid of the signal averaging technique. Herz/Kreisl 11:528Google Scholar
  30. 30.
    Hombach V, Höpp H-W, Braun V, Behrenbeck DW, Tauchert M, Hilger HH (1980) Significance of post-excitation potentials within the ST segment in the surface EKG of patients with coronary heart disease. Dtsch Med Wochenschr 105:1457Google Scholar
  31. 31.
    Hombach V, Braun V, Höpp H-W, Behrenbeck DW, Tauchert M, Hilger HH (1981) Nichtinvasive Ableitung von Potentialen des Hisschen Bündels von der Körperoberfläche. Muench Med Wochenschr 123:173Google Scholar
  32. 32.
    Höpp H-W, Hombach V, Braun V, Behrenbeck DW, Tauchert M, Hilger HH (1980) Die nichtinvasive Registrierung ventrikulärer Nachpotentiale und ihre Bedeutung bei Patienten mit Koronarer Herzkrankheit. Z Kardiol 69:(Abstr) 725Google Scholar
  33. 33.
    Höpp H-W, Hombach V, Braun V, Behrenbeck DW, Tauchert M, Hilger HH (1981) Ventricular delayed depolarisations in patients with chronic stable coronary heart disease and with acute myocardial infarction. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 233Google Scholar
  34. 34.
    Hon EH, Lee ST (1963) Noise reduction in fetal electrocardiography. Am J Obst Gynecol 87:1086Google Scholar
  35. 35.
    Irnich W (1975) Einführung in die Bioelektronik. Thieme, StuttgartGoogle Scholar
  36. 36.
    Klein H, Frank G, Karp B, Kouchoukos NT, Lichtlen P, James TN, Waldo AL (1980) Intraoperative Erkennung arrhythmogener Bezirke im abnormal kontrahierenden Myokard. Z Kardiol 69:211Google Scholar
  37. 37.
    McKenna WJ, Rowland E, Mortata D, Dawson RE, Krikler DM (1979) Non invasive recording of the His bundle electrogram. In: Meere Cl (ed) Proceedings of the VIth World Symposion on Cardiac Pacing, Montreal, 11–9Google Scholar
  38. 38.
    McKenna WJ, Rowland E, Mortara D, Borggrefe M, Krikler DM (1981) Noninvasive recording of the His bundle electrogram: Evaluation of the Marquette high resolution MAC unit. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 301Google Scholar
  39. 39.
    Mackintosh AF, English MJ, Vincent R, Woolons DJ, Chamberlain DA (1979) Low voltage electrical activity preceding right atrial depolarisation in man. Br Heart J 42:117Google Scholar
  40. 40.
    Mackintosh AF, Vincent R, English MJ, Woolons DJ, Chamberlain DA (1981) Possible sinus node signals in the human right atrium recorded by signal averaging. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 53Google Scholar
  41. 41.
    Naumann-D'Alnoncourt C, Zierhut W, Lüderitz B (1981) Pathophysiology of ventricular arrhythmias with special reference to late depolarisations. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, pp 153Google Scholar
  42. 42.
    Ostermeyer J, Breithardt G, Kolvenbach R, Körfer L, Seipel L, Schulte HD, Bircks W (1979) Intraoperative electrophysiologic mapping during cardiac surgery. Thorac Cardiovasc Surg 27:260Google Scholar
  43. 43.
    Reiffel JA, Gang E, Gliklich J, Weiss M, Davis JC, Patton N, Bigger JT (1980) A transvenous catheter technique and a comparison of directly measured sinoatrial conduxtion time in adults. Circulation 62:1324Google Scholar
  44. 44.
    Ros HH, Koeleman ASM, v d Akker TJ (1981) The technique of signal averaging and its practical application in the separation of atrial and His-Purkinje activity. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 3Google Scholar
  45. 45.
    Rozanski JJ, Mortara D (1981) Delayed depolarisations in patients with recurrent ventricular tachycardia and left ventricular aneurysm. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.-9th 1981, Cologne. Schattauer, Stuttgart New York, p 205Google Scholar
  46. 46.
    Scher AM, Rodriguez MI, Hamlin RL (1961) Observations on the atrioventricular conduction and on distribution of the impulse in the ventricles of ruminants and other mammals. In: De Carvalho P, De Mello WC, Hoffman BF (eds) The specialized tissues of the heart. Elsevier, Amsterdam, p 159Google Scholar
  47. 47.
    Scherlag BJ, Berbari EJ, Lazzara R (1981) In vivo recordings of A-V nodal potentials: A review. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 109Google Scholar
  48. 48.
    Simson MB, Spielman SC, Horowitz LN, Harken AH, Josephson ME, Kastor JA (1981) Afterpotentials in man and cardiac arrhythmias. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 253Google Scholar
  49. 49.
    Stopczyk MJ, Kopec RJ, Zochowsky RJ, Pieniak M (1973) Surface recording of electrical heart activity during P-R segment in man by a computer averaging technique. Int Res Communications System (77–8) 11:21–2Google Scholar
  50. 50.
    Stopczyk MJ, Wajszczuk WJ, Zochowsky RJ, Rubenfire M (1979) Pre-P (sino-atrial node region) activity recording from the right atrial cavity by signal averaging. Pace 2:156Google Scholar
  51. 51.
    Stopczyk MJ, Walczak F, Kepski R, Plucinski Z, Pecalski K (1981) The history of noninvasive His-bundle recording. From averaging to continuous record. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 283Google Scholar
  52. 52.
    Takeda H, Kitamura K, Takanashi T, Tokuoka T, Hamamoto H, Katoh T, Niki I, Hishimoto Y (1979) Noninvasive recording of His-Purkinje activity in patients with complete atrioventricula-block. Circulation 60:421Google Scholar
  53. 53.
    Tonkin AM, Blood RJ, Riggs A, Bennett A, Heddle WF, Helfgott A (1981) Non-invasive recording of His bundle potentials: Limitations of existing signal averaging techniques. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 291Google Scholar
  54. 54.
    Uther JB, Dennett CJ, Tan A (1978) The detection of delayed activation signals of low amplitude in the vectocardiogram of patients with recurrent ventricular tachycardia by signal averaging. In Sandøe E, Julian DG, Bell JW (eds) Management of ventricular tachycardia-role of mexiletine. Excerpta Medica, Amsterdam Oxford, p 80Google Scholar
  55. 55.
    Vincent R, Stroud NP, Jener P, English MJ, Wollons DJ, Chamberlain DA (1978) Noninvasive recording of electrical activity in the PR segment in man. Br Heart J 40:124Google Scholar
  56. 56.
    Vincent R, English MJ, Mackintosh AF, Stroud N, Chamberlain DA, Wollons DJ (1980) A flexible signal-averaging system for cardiac waveforms. J Biomed Eng 2:15Google Scholar
  57. 57.
    Vincent R, English MJ, Woollons DJ, Carrol D, Werneck S, Marriott TH, Chamberlain DA (1981) Surface His bundle potentials and other low amplitude cardiac signals by signal averaging. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 351Google Scholar
  58. 58.
    Wajszczuk WJ, Palko T, Przbylski J, Stopczyk MJ, Bauld TJ, Rubenfire M (1981) External recording of sinus node region activity in animals and in man. In: Hombach V, Hilger HH (eds) Proceedings of the International Symposion on the Signal Averaging Technique in Clinical Cardiology, May 7.–9th 1981, Cologne. Schattauer, Stuttgart New York, p 65Google Scholar
  59. 59.
    Waxman HL, Sung RJ (1980) Significance of fragmented ventricular electrograms observed using intracardiac recording techniques in man. Circulation 62:1349Google Scholar

Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • V. Hombach
    • 1
  • H. H. Hilger
    • 1
  • V. Braun
    • 1
  • H. -W. Höpp
    • 1
  1. 1.Lehrstuhl Innere Medizin III und Abteilung für KardiologieMedizinische Universitätsklinik und PoliklinikKöln

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