![Page 1: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/1.jpg)
Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools
Simon Authier, D.V.M., M.B.A., Ph.D.Director of Veterinary Science and Safety PharmacologyLAB Research Inc.
![Page 2: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/2.jpg)
Background EMG artifacts interfere with automated detection Various ECG leads presented mixed results: SC leads → significant EMG artifacts IC leads → variable ECG morphology Pericardiac leads→ Invasive + lengthy recovery
![Page 3: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/3.jpg)
VentricularJunctional AV-block II
35 dB
30 dB
25 dB
20 dB
15 dB
10 dB
![Page 4: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/4.jpg)
Intravenous Biopotential Lead
Added:Rounded Bullet Tip:For easy passage through vessel.
Based on Standard DSI ECG Lead
Standard DSI ECG Lead Coil & Insulation
![Page 5: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/5.jpg)
Intravenous Biopotential Lead in a Cynomolgus monkeys
Anatomical placement is critical for stable ECG morphology
![Page 6: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/6.jpg)
ECG from Cynomolgus Monkey with IV Biopotential Leads
![Page 7: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/7.jpg)
Signal (R-wave) to noise ratio: Comparison of SC leads with IV Biopotential lead and diaphragmatic
0
100
200
300
400
500
600
700
16:01 20:49 1:37 6:25 11:13
~mV
Time
IV Biopotential leads
Subcutaneous leads
![Page 8: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/8.jpg)
Macroscopic examination
6 animals: 6 months No macroscopic
abnormality
![Page 9: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/9.jpg)
Intravenous Biopotential LeadHistopathology of vena cava of cynomolgus monkeys after 6 months
Mild thickening intima/subintima with intimal proliferation. 400x20x
![Page 10: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/10.jpg)
Comparison with Permanent IV CathetersIncidences of Catheter ization System-Related Microscopic Observations in Cynomolgus
Monkeys after 6 months (AVA Biomedical Cath-in-Cath)Finding Males (n=3) Females (n=4)
Chronic Active Inflammation 2 1Minimal 0 0Mild 0 0Moderate 1 1Marked 1 0
Intimal Proliferation 0 3Minimal - 2Mild - 1
![Page 11: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/11.jpg)
Automated arrhythmia detection using the ARR30a Module (NOTOCORD) Identified Arrhythmia:
- Sinus pause- Premature atrial complex- Junctional complex- Ventricular complex (PVC or ventricular escape complexes)- Atrio-ventricular block type II- Abnormal complex
![Page 12: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/12.jpg)
Detection of sinus pause in a Cynomolgus monkeyNOTOCORD (ARR30a)
![Page 13: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/13.jpg)
Atrial pauses
Atrial premature
contractions
Atrioventricular blocks
Junctional ventricular complexes
Ventricular arrhythmia
Monkey 1 7\7 0\0 2\0 0\0 0\0 Monkey 2 9\10 0\0 0\0 2\0 0\1 Monkey 3 39\43 8\10 1\0 180 N/A \0 Monkey 4 23\19 13\13 0\0 905\4 147\11
Incidence of arrhythmia in telemetered cynomolgus monkeys over a 48-hour period (IV Biopotential lead and diaphragmatic ECG
leads)
Automated arrhythmia detection\Confirmed arrhythmia after manual over-read
![Page 14: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/14.jpg)
Incidence of arrhythmia in telemetered beagle dogs with subcutaneous ECG leads over a 24-hour period (with and without LVP catheters) 3 months post-implant
Automated arrhythmia detection\Confirmed arrhythmia after manual over-read
Atrial pauses Atrial
premature contractions
Atrioventricular blocks
Ventricular arrhythmia
Dog 1 9\9 3\0 1\0 9\5 Dog 2 1\1 1\0 8\0 2\2 Dog 3 28\28 7\0 33\0 2\0 Dog 4 9\9 5\4 7\0 139\3 Dog 5 6\6 1\1 3\0 1\0 Dog 6 38\38 3\3 N/A \0 0\0 Dog LVP 1 1\1 0\0 4\0 2\0 Dog LVP 2 0\0 0\0 5\0 0\0 Dog LVP 3 4\4 1\1 7\0 0\0 Dog LVP 4 8\8 0\0 1\0 63\0 Dog LVP 5 0\0 0\0 1\0 0\0
![Page 15: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/15.jpg)
Automated Arrhythmia Detection• Manual over-read: 5 to 45 min per animal per 24 hours• Incidence of spontaneous arrhythmia higher than previously
reported1
• Analysis was adjusted to maximize the sensitivity as limitedspecificity was not considered to have a significant impact on interpretation after manual over-read
• Specificity of the automated arrhythmia detection wascorrelated with the quality of the ECG signal
1. Authier S, Pugsley MK, Troncy E, Curtis MJ. Arrhythmogenic liability screening in cardiovascular safety pharmacology: commonality between non-clinical safety pharmacology and clinical thorough QT (TQT) studies. J Pharmacol Toxicol Methods. 2010 Sep-Oct;62(2):83-8
![Page 16: Arrhythmia Detection: A Quest for Signal Quality and ... · Arrhythmia Detection: A Quest for Signal Quality and Computerized Tools. Simon Authier, D.V.M., M.B.A., Ph.D. Director](https://reader030.vdocument.in/reader030/viewer/2022041015/5ec6dfb62b7456770d7645d0/html5/thumbnails/16.jpg)
Conclusions– Automated arrhythmia detection significantly increased
efficiency of ECG data review with focus on data of interest
– Preliminary results suggest comparable incidence of arrhythmia with and without left ventricular catheters in dogs after complete recovery but more data needed to confirm this observation
– The quality of automated arrhythmia detection wasproportional to the quality of the ECG tracing
– Automated arrhythmia detection appears to be the new GPS of ECG data analysis!