Ambulatory Monitoring

Jlmbulatory monitoring of signals, related to cardiovascular system per­ formances, is one of the biomedical technologies of wider interest. This interest is well documented by the literature, by the number of instruments available on the market and by the increasing diffusioo of this technique at routine clinical level. The wide distribution of ambulatory monitoring is however not yet well supported by commonly accepted criteria of clinical interpretation, by an assessment of the minimal requirements for instrumentation performances, or by indications of costjbenefit figures in relation to different situations. Several European centres have a recognized expertise and are well suited to the examinatioo of the problem of defining comnon guidelines and of making recommendations so as to stimulate an improvement of the clinical usage and of the performance of the instrumentation. The Biomedical Engineering Standing Group of the Committee for Medical and Public Health Research approved the organization of this \Orksrop which had as its aims the assessment of the state-of-the-art of different aspects of ant>ulatory monitoring and the discussion within a group of experts of the feasibility and interest in promoting the coordination in Europe of these activities in the frame\Ork of a "concerted action". The \Orkshop was held in Pisa over two full days (April 11-12, 1983). The participants were physicians and engineers, experts in their fields.

Contenu

1: Transducers and Analysis Systems for Ambulatory Monitoring.- 1.1 Sensors for Electrophysiological signals monitoring.- Silicon sensors for electrophysiological signals monitoring.- Discussion.- 1.2 Transducers for long term hemodynamic signals monitoring.- Sources of error in direct and indirect blood pressure measurements.- Air-chamber sensing for blood pressure monitoring.- 1.3 Review of existing systems for ECG ambulatory monitoring.- Review of commercially available systems for ambulatory monitoring.- Review of ambulatory monitoring systems developed at research institutes.- Discussion.- 2: Clinical Applications.- 2.1 Ambulatory monitoring of arrhythmias.- The clinical use of ambulatory monitoring in arrhythmia evaluation.- Computerized arrhythmia analysis of the Holter recordings.- Clinical significance of ventricular premature beats.- Discussion.- 2.2 Ambulatory monitoring of ischemic patients.- Ambulatory ST segment monitoring: past and future.- Significance of electrocardiographic changes in acute transient myocardial ischemia.- Prevalence and magnitude of ST segment and T wave abnormalities in healthy adult subjects during continuous ambulatory electrocardiography.- Discussion.- 2.3 Ambulatory monitoring of hypertensive patients.- Clinical value of non-invasive ambulatory blood pressure measurements and comparison with other methods.- Continuous blood pressure monitoring in the clinical evaluation of hypertensive patients and in the study of neural cardiovascular control.- Combined ECG and intra-arterial blood pressure analysis for the beat to beat evaluation of the systolic time intervals in ambulatory patients.- Discussion.- 2.4 Aspects of the organization of the ambulatory monitoring.- Multilevel organization of ambulatory monitoring units.- 3: Recent Advances of Methods for the Ambulatory Monitoring of the Cardiovascular System.- 3.1 Algorithms for cardiac cycle detection.- Algorithmic approaches to QRS detection.- Performance comparison of fast QRS detection algorithms.- Discussion.- 3.2 Feature extraction for ECG waveforms characterization.- Feature extraction from ECG waveforms; techniques used by automatic analysis systems and clinical observers compared and contrasted.- Parameter extraction for automatic analysis of ECG traces.- Discussion.- 3.3 Feature extraction for hemodynamic signals characterization.- Ambulatory blood pressure signal features: identification, measurements and implications.- How shall we analyse the ambulatory blood pressure signal?.- Discussion.- 3.4 Algorithms for the classification of biological signal waveforms.- Pattern recognition in biological signals.- Algorithms for wave form classification.- Algorithms for ECG waveform analysis and classification.- Discussion.- 3.5 Portable real time processors versus playback systems.- Ambulatory Monitoring: Real time analysis versus tape scanning systems.- 3.6 Evaluation of ambulatory monitoring systems: experiences and perspectives.- Evaluation of automated arrhythmia monitors using an annotated ECG database.- Clinical experience with a system based on analysis of R-R interval patterns.- Pilot study and preliminary experiences with a data base for the evaluation of algorithms for the detection of arrhythmic and ischemic episodes.- Discussion.- 4: Further Applications of Ambulatory Monitoring and Technological Perspectives.- 4.1 Monitoring of non cardiovascular signals.- Ambulatory monitoring of neurophysiological signals, art or artefact.- Long term respiration monitoring and its relevance to cardiovascular monitoring.- Discussion.- 4.2 Emerging technologies.- The potential of VLSI in Ambulatory monitoring.- Discussion.- Appendix: Presentation and Discussion of a Proposal for a Concerted Action on Ambulatory Monitoring.- Discussion, chairman: C. Marchesi.