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HolterSoft Ultima v2.5 Manual

1. 28 4 1 2 Determining the pathologic 29 FEZ LATIS INI AS ee ih 29 2 1 22 rial Elbrillatton 30 HolterSoft Manual 16 GB 17 09 2009 Page 7 HOLTERSOFT A2 SFS a apn SPORT iii 30 22 2 To eee enel 31 2 2 9 oV 2 31 440 ar UPO RE SIS 31 4 2 CHECKING THE AUTOMATIC ECG ANALYSIS 32 4 2 1 The Examination Conclusion window 9 92 32 422 TS TOW 2 0102 CERA 33 4 2 3 Details of thedemplates i e e mb oe 34 4 2 4 Operations on the templates 88888888888 35 4 2 5 Selecting one or several templates esses nennen 36 4 2 5 1o5elecunp a template cc e hace onc tae hice 36 4 2 5 2 Selecting several neighbouring templates eese 36 4 2 5 3 Selecting several non neighbouring 37 4 2 5 4 Selectmp by using the keybOatd u uii 37 4 2 6 Relabelling or grouping templates 88 38 4 2 6 1 Usmg the right button of the Mouse italiana 38 4 2 6 2 Using the ECG detail window for 39 4 2 6 3 Grouping by keyboard short 40 CARNAGE t ES 40 4 2 7 Consulting Modifying a given
2. The artefact grey strip not labelled A is automatically relabelled N since it is moved In this example the width of the new N beat can be decreased as in the previous example The red bar is still flashing it is now necessary to definitively validate the changes with a mouse click either on the ECG Analysis button or in another window or to cancel changes if necessary by a click on the Cancel modifications button Page 62 HOLTERSOFT The ECG 5 6 Vista Complete Recording window fl Click on Complete Recording button to open this window 5 6 1 Window content This window is divided in three parts from top to bottom 9 6 1 1 s Procedures management Vista Information on complete recordin Information i Start of procedure date 26 02 2002 18 30 Pie ei and ates duration number channels an Data transmission date 28 02 2002 15 49 e gt voice message play back a click on the button are available 1n the upper part of the window Duration E D 20 22 Number of channels 5 6 1 2 Heart rate curve The centre part of the window shows the patient s Heart Rate Trend chart mean heart rate during the whole monitoring The vertical scale is in Beats per Minute The horizontal scale shows the real time during monitoring from the start up time The background colour alternates every 24 hours making clear the number of days
3. 87 OLD SCG S UICC 97 S Ampa EU 87 Dd Sb SIS Ce EG 88 02d AVCTASING periods FC eContent 86 D d 2 Deliu Mr Lee M M AL E ME a a 88 90 2 2 T Intervals thresholds 5 88 2 AC OTE CON TOL EIS aliena 88 9 5 THE RESULTS WINDOWS 89 oI Noemie conn 89 SICAV siii act 89 ERRORI OSE eae 90 D E HS ollare iii 90 9 3 5 The Averaged QT ttt ble te Eb enge ncs 91 9 340 The Procedure windo W esae e tito 92 9 3 Sue PHI E s deitate uti 92 10 DATA ADDED BY EHE eue ea oe ep Esch 93 IU We EISTS inco iude petat alii 93 10 2 MANUALLY CORRECTING QUANTITATIVE 5 94 LOZ AE MOA VIN ONO 94 10 2 2 Whole column hourly ot t somete al aes 94 iii Li 94
4. 888888 41 2 2 JT Template 41 4 2 8 Suppress one or several 42 4 20 Flashing red bar LODTOCESS lire 42 2 2 T0 MODUL COM ON atas tae ates t aaa 42 SECC EXAMINA TION EEEO ESS aN 45 S COMPDEEIB TOO 52 6 es wane 45 5 1 1 HolterSoft Ultima standard with no 888888 45 5 1 2 HolterSoft Ultima with Pack Plus 8888 45 5 1 3 HolterSoft Ultima full 888888 45 3222 PRESENTATION OF THE RESULTS oc scvascentdusvsccaduatecseuespoenbeeabeontepnedesedeatooneusuoceeeaboenbeys 46 Creal on Of VISIQPTOC CONT OS ean dietus 46 Sod Ihe Examination WIN GOW E E 46 9 2 2 Strips a d STODFONIS tu 46 NS 46 S dud A E 47 9 29 FOCINAK OT 47 endo dq 47 VIA 47 D270 Patent S ACHvVit and DOSUTOTLS s Re te es lele 47 2 9 LHE RESULTS SCREEN salle 48 ricono eo etneo SI 9291 compressed ECG
5. d e Le LLLA 5 45 48 48 LANA LULA LL ee 5 46 24 54 IZ i Start lysi toh LTL wiet il EI I ET NE I IV spear O ee SI DO ZA 15 47 00 50 Jf fp LE Le E LL E E E E E E EL E LL E E LL LE ELLE LE LLL 15 47 36 66 SS ND UE DEAR E SS CA IRE I rs Pas p ai p eS 5481272 JL LLL E E LL EL E E 2 1 1 2 c E LL Ll 5 48 48 78 RA E A e 12 01 2004 20 01 HD 17 12 2003 Analysis The analysis can be performed right after the recording has been read with a mouse click on the Start analysis button in the ECG Analysis window example with an ECG only recording If the practitioner does not want to proceed to the analysis straight away he can after having closed the ECG Analysis window either look at the whole ECG recording using the right vertical scrolling bar or use the other buttons available in the tools bar Example buttons activated after a reading of a Triolter with BP and ECG Open the Printing window 6 buttons for the ABPM Open close the OKd window HolterSoft Manual Open close t
6. ISHNE Choice of the model of report to be exported PDF DM Resolution Mean 150 dpi m Destination e PDF Generation of a report in the PDF format to store it in a disk or send it by email by using the mail client installed in the system Module d export PDF and XML export module for integration of report in a patient data management system ISHNE Export of the ECG according to the standard format ISHNE HolterSoft Manual Page 99 HOLTERSOFT Other 12 4 XML export Preferences aliis A oui gene ano F sana fio near ie es 3 PAG T SD cenae ev eae Dan de ae toe wg ademasve aliena Export ML Choice of the model of report to be exported PDF Resolution Mean 150 dpi iw Automatic export with each report print XML file with the examination summary e aPDF file containing the report This option allows to export the HolterSoft Ultima data to a Patient Management System The technical data regarding this export are available on demand 12 5 CF Card Diagnostic Q card diagnostic CF card detection Found onl VISTAL 2 CF card information 114658 KB Description OVISTA 02 Halter Recorder n VTOO07000001 Device version D1 50 03 20 WARNING To continue the test click on continue button All the data on the card will be erased Start the test again Allows to test a CF card Tests
7. lai 95 iB O4 MS DI C c 97 12 1 PROCEDURE MANAGEMENT ola 97 22PATIENERESBARCH solaio 98 98 12 3 1 Procedure management window i 99 12 3 2 Export of the ongoing examination windOW 888 99 124A E PORT AME TEE 100 CARD DIAGNOS TIC alal li inizia 100 HolterSoft Manual 16 GB 17 09 2009 Contents Page 10 HOLTERSOFT 1 NOVACOR Licence agreement HolterSoft Manual The HolterSoft software 15 sold under licence and can only be copied or used in accordance with this By installing the HolterSoft software you agree to be bound by the terms and conditions of the following licence agreement Please read this text carefully before installing the software If you do not agree to its conditions you should not under any circumstances install the software You should return it with the accompanying documents items and packaging to the place of purchase for a full refund Licence agreement Page 11 HOLTERSOFT Licence agreement 1 1 Using the software 1 2 Copies The software 1s licensed as is for use of a single terminal connected to one single computer at a time The use of HolterSoft on a multi user system 1s not covered by this licence and 1s only allowed if a written contract with NOVACOR S A has been made Renting or lending of the software 1s strictly prohibited unless a prior written contract has been made with
8. e e EO 03 23 03 24 V all Number of V 8 5 runs 1 8 Number of S Number of 5 s 8 1 8 1 Heart rate Mean 90 min 84 97 i E 4444 E gt dd 9 1A 03 25 34 10 ttt ttt R 2230 2145 00 00 00 15 00 2 0045 0100 0115 0120 0145 02 00 02 15 07 10 02 48 01 00 02 5 01 10 02 45 04 00 0415 0410 0445 05 00 0845 05 20 05 45 06 00 085 06 30 08 45 07 00 0715 07 30 07 30 02 45 03 00 03 15 03 30 03 45 04 00 04 15 04 30 04 45 RR 11 1 111 4 1 1 1 1 03 25 556565t t 55th snv onnvyTouSsS uUus5ss72T7TPmaT4X scldsgs 952 15 07 2009 16 34 DEMO Vistao2 06 04 1944 28 05 2008 In combination with the VistaO it is possible to simultaneously record ECG signal corresponding to the respiration and the oxygen saturation in the blood SpO A specific interface of HolterSoft Ultima is going to allow the analysis of these parameters in order to highlight a possible syndrome of sleep apnea HolterSoft Manual Page 76 HOLTERSOFT Sleep Apnoea 7 2 1 working window Apnoea Breathing and 5 02 EE WM loe AT TTT aa eee eee 22 30 22 45 23 00 23 15 23 30 23 45 00 00 00 15 00 30 00 45 01 00 01 15 01 30 01 45 02 00 02 15 02 30 02 45 03 00 03 15 03 30 03 45 04 00 04 15 04 30 04 45 05 00 05 15 05 30 05 4
9. 2 1 7 1 Minimum configuration for Vista series recorders PC type Pentium 400 MHz equipped with a CD Rom drive and two free USB ports 1 1 or more Windows 98 Me 2000 XP or superior 17 monitor with the capacity to have a resolution of 1280x1024x65000 colours e A video card 1280 x 1024 x 65000 colours 4 Mb RAM e A 512 MB RAM e A hard disk with at least 1 Gb free printer compatible with PC Windows 2 1 2 Recommended configuration for Vista series recorders A PC with a last generation uProcessor running at the highest possible frequency equipped with a CD Rom drive a sound card and two free USB ports 1 1 or more 19 or 21 monitor GB RAM with XP fast hard disk with high capacity e printer compatible with PC windows fast laser type with an extra tray and if possible the duplex option e A hard disk back up system WARNING Do not work directly in the files in the Ho terSoft directory as this could 33 damage the data Moving files in the HolterSoft directory renaming them or destroying them could seriously affect the data and could even destroy it permanently or prevent the software from functioning properly HolterSoft Manual Page 17 HOLTERSOFT HolterSoft Ultima 2 1 7 3 Program Installation Insert the installation CD Rom supplied with the unit If it does not start automatically launch the Novacor exe program using the Windows task ba
10. the 2 one blue strip is a N beat shifted to the right and too wide the 3 one grey strip is an artefact no A label type and can be deleted and finally on the right side beat has not been detected then it 1s possible to move the grey artefact and rename it as N These operations are performed in the same way than above described with increased accuracy thanks to the zoom They can be chained and validated at the end at once see next page HolterSoft Manual Page 61 HOLTERSOFT HolterSoft Manual The ECG Select the central N beat Point inside the selection the pointer changes to an arrow Move the frame to the left up to the correct beginning of QRS position Release the mouse button then move the pointer above the right side of the selection frame the pointer changes to an horizontal double arrow Drag the right frame edge to the left until it reaches the end of the QRS Release the mouse button Select then Drag Release then Drag then Point Point Release The red bar is flashing this allowing either to go back to the initial status or to validate now the changes already performed You can go on immediately as well Select the artefact grey strip Point inside the selection the pointer changes to an arrow Move the frame to the right up to the undetected QRS Release the mouse button Select Point Drag Release
11. This reprocessing can be done directly by clicking on the Analysis icon but will also be done automatically by opening or closing a window or by clicking an already opened window V runs threshold min threshold rnin Tachy threshold min Prema criteria RAR value for 5 min 1 Absolute pauses s Relative pauses AA Brady threshold min EE SEE ME E EE E RR x2 tolerance Start analysis IVF threshold min 1 eo n Ventricular beats which have rhythm inferior to this threshold will be classified as VR IdioVentricular Rhythm instead of VT Those which have a rhythm between this threshold and the one fixed for the VT will be classified as AIVR Accelerated IdioVentricular Rhythm Min value for SVPB min feo n A QRS which corresponds to the criteria of prematurity in will not however be classified as an extra systole if the RR that it finishes corresponds to a rhythm inferior to this threshold HolterSoft Manual Page 29 HOLTERSOFT Analysis S Tolerance adjustment enables you to incorporate or not events the borderline for the desired criteria The user must test before modifying the standard position Criteria that trigger the events with the default criteria e TV RIVA RIV succession of four consecutive QRS V ventricular e Threshold of Tachycardias a minimum of four consecutive RR N sinus that exceed 120 bpm Premacriteria the
12. This list 1s the same as the Event Information window so it gives the number of each event episodes A mouse click on the chosen event shows all the corresponding Tor 08 events in the spectrogram at their chronological location and with Sx 54 their exact duration Sul 3908 Pauses relatives A mouse click on one of them displays it in the ECG Detail window A HolterSoft Ultima Procedure Display Settings Utilities Window Help 04 04 28 1650 ms 1780ms 1310ms 2040 ms 2160 ms 2290 ms 2420 ms 2550ms 3 49 23 41 13 05 05 Seriousness Chronology o 15 57 00 00 15 57 00 00 4444 13 49 23 41 04 02 2004 14 47 FADS 04 17 08 2002 17 03 2002 680 670 525 365 290 705 705 435 850 710 430 840 585 455 825 695 715 Every occurrence of the chosen event 1s coloured in green supraventricular trigeminy in this example HolterSoft Manual Page 71 HOLTERSOFT RR variability 6 4 The Poincare diagram 6 4 1 The RR variability window Poincare diagram The Poincar diagram 15 also called Lorenz plot Opening This window shows the distribution diagram of all RR interval values versus the button Previous one The 4 possible combinations are displayed in 4 sub windows Normal RR interval preceded with a Normal one Ventricular RR interval preceded with a Normal one Ventricular RR interval preceded with a Ventricular one Normal RR interval preceded wi
13. une edes 11 71 2 1 2 78 1 2 1 3 Chanoine Derman ideati 78 1 2 1 4 INIOGIMIC ATION Of aerea 79 GE 79 oa asian 81 8 POSITION AND ACTIVITY OF THE 1 83 S POSITION ONLY ae 83 RECCO ACTS CONC 83 S a 83 8 1 2 1 All recorders in BP measurements 1 83 8 1 2 2 X Olter range BP graphs and ECG windowS iii 83 8 2 e oca e chan oM e d x Sr EE DE 84 OX Graphie diS Pla 84 62220 1CLOOVOAINS Ond COC CS 84 8 3 EXPORT RESULTS OF POSITION ACTIVITY X OLTER 85 HolterSoft Manual 16 GB 17 09 2009 Contents Page 9 HOLTERSOFT 9 OT AND QT 87 OA PRESEN DATION ille 87 D Id Purpose module iis
14. 2002 18 21 H D 3v 26 02 2002 Please note that a click in the ECG strip in which the pointer becomes a hand selects the closest QRS the ECG detail window and selects the template not the QRS itself in that template of which this QRS belongs to in the template window The identification of the selected QRS template 15 also indicated in the right lower corner of the ECG detail window 4 2 6 3 Grouping by keyboard short cuts After having selected several templates they can be grouped together by pressing the first letter of the group template N for a Normal template V for a Ventricular template A for an Artefact template If only one template is selected this can be re classified under a different morphology in the same way 4 2 6 4 Cardiac pacing HolterSoft Manual If pacing spikes detection had been activated when programming the recorder and if some are included in the procedure they can be displayed or not with a click on the corresponding item of the pop up menu right click anywhere in Templates window This action takes effect on all Templates window templates Page 40 HOLTERSOFT Analysis 4 2 7 Consulting Modifying a given template The physician can visualise all the QRS of a given family and if necessary move one or more of them to another template an N V or A already created or created automatically It 15 also possible to choose which QRS will represent the templat
15. Night time summary hourly table chonogam Printing setup with HR QT Histogram A separate report will be printed for each channel selected in the window checked boxes Print Page 92 HOLTERSOFT Data added by user 10 Data added by the user Besides general preferences and different adjustments and settings available in most HolterSoft windows the user can also add textual data for general use including them Reference Lists and numerical data concerning a specific procedure by manually correcting quantitative results 10 1 Reference lists HolterSoft Manual The Settings Reference lists menu offers to advance several lists the items of which can then be included with a single mouse click in the corresponding data fields of the Procedure window instead of keyboarding the text every time HolterS oft Ultima Procedure Display Settings Utilities Window Help Reference lists Interpreting physicians Referring physicians D Treatments Analysis qe Indications Reports Medical history Statistical thresholds 4 i Histogram groups EROE Comments Preferences Models k Printer Automatic startup of the run test In each list only type the name of the new item in the capture field then click on the Insert button to complete the existing list The His
16. Page 19 HOLTERSOFT HolterSoft Ultima 2 2 Using HolterSoft 2 2 1 Start up of the HolterSoft application A double click on the software icon from Windows desktop will open up the application HolterSoft Ultima HolterSoft version 1 HolterSoft icons 2 2 2 Opening up the software When opening the software it will display at the top of the screen a Menu Bar and a Tool Bar Only four buttons are initially activated The Display menu stays grey until a document is opened up s HolterSoft Ultima Procedure 005 settings Lies window Hell Please note that the function of each button can be checked at any time by simply moving the mouse pointer over it no click an informative tool tip appears after about one second and stays for a few seconds At the bottom of the screen an information bar gives you the date and time of your computer continuously information concerning the current operations for example the name of the opened file and of the current database or a gauge indicating the calculation progress The four initially activated buttons are 2 2 2 1 Quit button This enables you to quit the software even if some of the windows are still open 2 2 2 2 Procedure Management button File and procedure management function creating modifying or deleting a patient s file consulting up dating or deleting procedures or transferring to another database etc ni DEN 2 2 2 3 Communication butt
17. Patient research In the status bar of the main window a text field yellow background allows a quick research of a Patient file Just enter the first letters of the name of the patient to display the list of the corresponding patients HolterSoft Ultima m X 012744 c Documents and Settings All Users Documents NOYACOR HolterSoft DEMODuoSoft mdb Results 4 Hook up date S Procedure start Dur i DEMO Slow 22 05 1997 10 21 22 08 not analysed 9 8 DEMO Vistao2 28 05 2008 15 33 28 05 2008 15 33 1713 sas grave pour figure DEMO Vistao2 28 05 2008 15 33 28 05 2008 15 33 1713 sas grave pour figure 1540722009 16 45 DE 0 c Documents and Settings All Users Documents NOVACOR HolterSoft DEMOS One double click on the desired file opens it 12 3 Exports HolterSoft Manual Page 98 HOLTERSOFT Other 12 3 1 Procedure management window Export Export format Description HOLTERSOFT AR Exportation Program E TRAYAILSHOLTER AVIS TAS Vistas af SV BSE sportH A exe Destination database Browse Export data Procedures 26 Database c Documents and Settings All Usera Documents Allows to export one or several examinations from the list of Procedure by using modules of optional external exports Examples e Export of MAPA data e Export of the RR via the ExportRR module 12 3 2 Export current procedure window 12 Export current procedure PDF
18. RR N interval must be of at least 25 lower than the basal RR average of the last 8 normal RR e Relative pauses the RR N must be of at least 175 higher than the basal RR e Absolute pauses the RR N must be higher or equal to 2 5 seconds e Threshold of the Bradycardias a minimum of four consecutive RR N lower than 40 bpm 4 1 2 2 Atrial Fibrillation tab The A Fibrillation tab enables you to determine the type of event that needs to be excluded from the AF periods The phase for determining AF periods is part of the processing of the rhythm disorder However AF detection will only be performed if the with calculations of AF periods box is ticked ECG analysis It is generally undesirable to detect with calculation of AF periads supraventricular events during AF periods with OT processing gi Save These events can be suppressed by ticking the Templates Anhythmias Fibrilation sr a seri New Events not detected if AF box and selecting the events concerned the events the buttons of which are pressed down clearer colour Supra events xt x2 44 will not be included during periods labelled as Supra Biges and Triges Ta AF Ventricular events xt x2 xs 4 Ventricular Bige and T rige Brady and Tachy ela Pauses and P 2R In this example in supraventricular events only the paroxystic tachycardias and the slow Cancellation of the manual eve
19. Simple arrow line by line scrolling 1 click 1 line Double arrow automatic page by page scrolling The stop time between 2 pages can be adjusted using the bottom right cursor it is displayed 1 10 of sec during adjustment here 1 Sec Automatic scrolling stops with a mouse click anywhere in the window for example on an event which will be then selected light blue strip and displayed in the ECG Detail window HolterSoft Manual Page 51 HOLTERSOFT The ECG 5 4 The ECG detail window This window besides detailing the ECG curve offers various choices of scrolling immediate printing or addition in the final report of ECG strips selection and re labelling of QRS and also to jump to an exact time MIE D tail ECG 4444 m gt dd 3G 16 31 07 34 Template V amp 40 QRS immediate printing detail or context time at middle of strip selected QRS scrolling buttons middle of strip info template of selected ORS Any pathological event resulting from the automatic analysis can be displayed in this window using the small Event Details window on its left side see 6 4 2 Two special tools detailed in the next pages give additional capabilities of display and measurements the pop up menu right mouse click and the measurement calliper Shift key click This window allows also to insert move or rename QRS see 6 5 page 58 5 4 1 Selecting a QRS or a close event Every QRS
20. X Histogram Spectral analysis Variability Poincare chart Table of hourly events Histograms of events X Ventricular Supraventricular ALFI Slow events tachys and artefz X ST Blood pressure Activity pacemaker Compressed ECG All Partial Printing setup Mew Templates BIELLESE relative time ECG strips Beginning 00 00 End 00 00 n ii graph paper X contest Channels 1 2 3 RRinterval Page duration 20 v min HR on each line ES Using the New and Save buttons in the right part of the window new reports can be created The ECG Blood Pressure and QT tabs enable the corresponding parts of the report to be defined The Printing setup button opens a window presenting two tabs The Printing tab enables you to choose another printer and to set the general printing parameters The Heading tab enables you to insert a logo and to type the name and address of the establishment This heading is common to all the reports and will be printed in full on the first page and part at the top of the following pages of the report Page 95 HOLTERSOFT Other 12 Other 12 1 Procedure management It is from this window that you can manage your Examination databases 2 Procedure management Favorite Hook up date S Procedure stat Dur Notes Wntracor2 HA _Bases Basedemo ASUPPRIMER Xx 26 04 2006 12 09 2
21. a standard drive directly connected to a USB port will be used this does not require any additional software 2 1 6 1 Connecting the access key 2 1 6 2 HolterSoft Manual To use the HolterSoft software you will need to install the access key supplied with it on your computer This 15 a special connector which functions solely with the HolterSoft software Models for parallel and USB ports are available If the software is installed without this access key it will work as a demonstration version only Connection to parallel port Unplug the printer insert the access key the arrows should be pointed towards the computer fix it in place with its two screws and plug the printer into the access key Connection to USB port Simply plug the access key into a free USB connector access key for parallel port access key for USB port Connecting the unit to a computer It is not necessary to have a connection cable because the ECG recorders communicate directly with the computer via the memory card For the Diasys Integra use the cable supplied with the unit For the Diasys units belonging to the 200 series use the same cable you used with the previous software The cable link is usually left plugged into one of the serial ports of the computer so that connecting it to a Diasys for programming or transferring data 1s always quick and easy Page 16 HOLTERSOFT HolterSoft Ultima 2 1 Software Installation
22. and siii bean 51 SC OMI CMM E se d 51 dA THE BCODETAIEWINDOM osito ceto pretendere ie onda iaia 92 5 4 1 Selecting ORS or a close 52 ALR Cname or SUPPRESS dE das 52 Du Ihe Event Details WIA OW ibis 53 542 The dropdown list 53 5422 2 Informatio m TERTIO 1 pt dee Picea lesa 53 5 4 2 3 Watching all events of the same 53 5 4 2 4 Deleting Vents elle ideas 54 542 5 Deleting a portion ot recorded EC aaa 54 5 4 3 Basic actions in ECG Detail Wind Ow iui 54 24 3 TEC CESCEOIBE il aati 54 241 32 STIPOECONEX PANI 55 343 Jumpin tO amr ra etnie lie 59 The pop up menu eheh 56 JHOtizontal Scale eee ausit tdt iii nica elie ee 56 54 42 The 200 HZ and 400 Hz ZOOmMS nate 56 5 4 5 Intervals measurements casu o Hae aae 97 54 5 D Dura on Measure Meru ot D o t delega 57 2 425 2 Meare fale MEASTE MED tot aba dee a ted ears 57 ile aaa 57 HolterSoft Manual 16 GB 17 09 2009 Content
23. change can be applied to all the complexes belonging to the same template see application to T waves templates 5 5 5 4 page 60 In the following imaginary example standard 100 Hz horizontal scale 18 15 22 80 a QRS N is missing above the 1500 interval a must moved about 200 ms to the right and replaced by a N and the 2 N on the right of 600 is not correctly sized Insert a QRS Position the pointer hand shaped at the desired position The beginning of the new QRS will be located about in the middle of the hand middle finger Open the pop up menu with a right mouse click The left edge of its frame corresponds to the beginning of the QRS to be inserted Select Insert a ORS item Validate this choice with the mouse View spikes View spikes Insert a QRS gm Colours Colours 1500 1500 1500 Point Right Click Select Validate A 80 ms wide QRS has been inserted and you can notice that new 740 and 760 ms intervals have substituted for the initial 1500 ms interval The red bar at the bottom of the screen 1s now flashing allowing to cancel the change if necessary by a click on the Cancel modifications button to its right The insertion will be definitely validated by a mouse click either on the ECG Analysis button or in another window Page 58 HOLTERSOFT The ECG 5 5 2 Move a QRS Select the complex to be moved with a mouse click nex
24. is identified with a colour Blue for Normal beat plus a blue dot above R wave Red for Ventricular beat plus the letter V above R wave Green for Supraventricular premature N beat plus the letter S above R wave Black for Artefact plus the letter A above A mouse click inside the ECG Detail window automatically selects the closest beat put in a frame and the Ctrl Click command selects the closest event underlined 5 4 1 1 Rename or suppress a QRS When the mouse pointer comes over a selected beat it changes from a hand to an arrow Rename the QRS as M Rename the QRS as V Rename the QRS as Then a right mouse click opens a pop up menu allowing to Suppress the IS relabel or to suppress the selected part only A so suppressed Bd Og QRS 15 not relabelled into A it just disappears HolterSoft Manual Page 52 HOLTERSOFT The ECG 5 4 2 The Event Details window Event details The Event Details window is divided in 4 parts a pulldown list of all events that HolterSoft can identify a black background frame with information about the v Seriousness selected event 4 4 Chronology ll displacement keys to move between events of the same kind LO suppress button allowing to suppress either wrong events or any portion of the recorded ECG if it is very noisy for 10 24 24 08 08 27 11 94 example 5 4 2 1 The dropdown list Qi Even
25. of the Sleep Breathing Disorders e Cover page prints patient information the procedure summary and the conclusion e Detailed results page containing all the results of the analysis e Histograms graphic representing the entire analysis period with the cardiac frequency the Breathing signal 5 signal as well as the Breathing and SpO events HolterSoft Manual Page 81 HOLTERSOFT Position and Activity 8 Position and Activity of the patient 8 1 Position only When a recorder supplies position information this information 15 displayed as standard by HolterSoft Ultima 8 1 1 Recorders concerned Simple patient position is recorded by the following devices Once every BP measurement Diasys Integra range Diasys Integra Access with Position option Diasys Integra II with ECG Position or Orthostatism cable Continously X Olter range Duolter Access Triolter Quattrolter without Activity cable 9 1 2 Position display 8 1 2 1 All recorders in BP measurements window A pictogram 15 added in the Status column Diasys Integra with ECG Position cable Pictogram Diasys Integra Access Diasys Integra II with Position option with Orthostatism cable Duolter Access Triolter Quattrolter without Activity cable Standing up or Seated Standing up 8 1 2 2 X Olter range BP graphs and ECG windows A coloured strip is added below the BP Measurements graph ECG Detail and E
26. window 6 3 1 Description FARR spectrogram 15 57 03 none 21 41 37 Ventricular Bn Bo Bo Bs B Bus roms EJ 1400 ms 1780 5 1910ms 2040 ms 2160 ms 2290 ms 2420 ms 2550ms 05 40 12 87 Each RR interval 15 coded by a small coloured square or rectangle blue if ending with a normal QRS the shorter the interval the darker the blue according to a scale displayed on the left side of the window red if ending with a ventricular beat black if ending with an artefact RR intervals follow each other on horizontal lines the 1 interval of each line following the last one of the previous line and so on until the end of the recording in the bottom right corner of the window A vertical time scale helps to locate the intervals The mouse pointer looks like a reticle and it 15 zoomed in the upper left corner of the window thus allowing to detail the RR intervals that it covers all of them are clearly visible and the value of the pointed one 15 displayed Pointer The exact time of the pointed interval 1s also displayed in a 0o 00 16 00 frame at the bottom left of the window Pointer zoom HolterSoft Manual Page 69 HOLTERSOFT RR variability 6 3 2 Checking RR intervals in the ECG When displaying the RR Spectrogram window above the ECG Detail one it 1s possible to select and show any RR interval in the recording HolterSoft Ult
27. 0 22 30 00 23 30 00 Peak and End minimum mean and maximum QT and RT values raw and Number of QRS 4242 4099 3449 4738 4699 4052 3743 1605 233 522 251 409 379 3984 3221 3532 4374 4307 4113 4306 3950 4284 3931 4040 76463 595 608 560 613 528 660 67 855 779 748 882 842 553 516 513 545 671 649 569 601 671 601 623 727 RR Max 951 896 706 813 857 974 1071 1092 994 1028 980 999 968 712 875 852 903 941 874 847 892 955 938 929 Moy 801 756 615 704 749 871 932 1030 896 933 923 924 797 611 688 706 804 818 770 738 806 808 821 843 516 1092 788 SD gt Seui Min 32 28 60 22 10 29 16 20 9 24 24 24 11 14 23 23 18 17 18 18 17 13 19 21 22 21 15 26 10 21 4 4 13 50 29 25 7 40 86 5 35 0 10 11 39 10 11 18 11 22 364 373 372 376 367 365 366 373 379 377 379 369 370 389 390 369 361 362 369 361 370 368 365 365 361 SD Seui 23 20 27 26 18 2 18 16 26 19 19 2 Soonooo oon oo corrected values and Te Ta differences are displayed hour by hour for each recorded channel Alongside the number of considered QRS each hourly period is indicated as well as minimum mean maximum and standard deviation of the corresponding RR intervals 9 3 2 Trend curves The next button in the tools bar opens the OT chronogram window which dis
28. 3 and 4 are destructive for the data contained the card HolterSoft Manual Page 100 HOLTERSOFT Other HolterSoft Manual Page 101 HOLTERSOFT 0459 HolterSoft Manual Page 102
29. 4 00 ASUPPRIMER 30 08 2006 05 01 18 17 c 30 04 2006 05 16 30 04 2006 05 16 24 00 Vista Plus gt 48h rn a 20 04 2006 0616 1D 01 06 20060616 08 Gi 2SUPP 18 01 2002 15 56 01 41 Diasys Integra I Be 26 01 1998 11 15 23 56 Paroxysmal Atrial fibrillation Analysed n DEMO Slow 22 05 1997 10 20 22 39 Zone d dition libre affich e dans la fe 1 DEMO Slow 22 05 1997 10 21 22 09 not analysed Display HEBD DEMO vista 26 06 2008 15 33 28 06 2008 15 33 1713 sas grave powfgue DEMO Vistao2 28 05 2008 15 33 28 05 2008 15 33 17 13 sas grave pour figure i ie Folders amp CI n Test ACCESS sr E ALCATEL ATI bc71a46ed1b25dced78cf35449 z Documents and Settings 2 __sbs_netsetup__ 0 9 Administrateur All Users Application Data Bureau Del Documents 4 Ma musique Mes images 23 Mes vid os J microsoft 25 NOVACOR 3 E HolterS oft Import RTSoft BASE basedemotest a DEMO 1 Object 64Mb Free space on disk c 973 procedure s e Favorites section in order to rapidly access different databases Possibility to delete or add favorites To create a new database just add a Favorite pointing to the folder holding the HolterSoft database It is possible to access network bases through UNC pa
30. 5 06 00 06 15 06 30 06 45 07 00 07 15 07 30 07 45 Event duration SSESSHSEPFSSASESSIVNSMHSISSISRHEISISHaSKL SS 7 2 1 1 Description The working window is divided into three sections Whole recording enables you to set the beginning and the end of the nocturnal period In light gray the section corresponding to the displayed context Detailed context made up of three lines of 5 each In light gray the section corresponding to the displayed detail Detail One line of 2 30 In this section it 1s possible to modify the detected events add modify delete HolterSoft Manual Page 77 HOLTERSOFT Sleep Apnoea A right click on the context or the detail allows you to reject an artefacted section context rejection of a line 5 or of the entirety of the context 15 detail rejection of the entirety of the detail 2 30 Any manually rejected section can be restored with a right click then restore The artefacted sections and thus unanalyzed appear with the signal light gray 7 2 1 2 Description of the Detail section gt The data in purple correspond to the SpO e Rectangle event SpO e Curve curve of the SpO values 1 sampling per second gt The data in gray correspond to the breathing e Curve values of impedance corresponding to the breathing 10 samplings per second e Rectangle respiratory events gt The data in blue cor
31. CG Context windows and a colour coded graphic trend can be displayed in the Heart Rate and Histograms window Standing up or Seated 12 Lying down HolterSoft Manual Page 83 HOLTERSOFT Position and Activity 8 2 Activity Quattrolter only The Activity option of HolterSoft Ultima is required to make the most of recordings made by a Quattrolter with its Activity cable We then get a continuous analysis second by second of the level and type of activity walking or cycling and the position detailed between lying down seated or standing up Without the Activity option the Quattrolter recording results will look as Triolter ones even if an Activity cable was connected 8 2 1 Graphic display HolterSoft Manual In the BP measurements window pictograms are inserted in the Status column 2 2 a colour coded strip is added below measurements graph mmHqqnig ms AY y E Y WEE To the right of each pictogram a number which can vary from 0 not active 11 27 119 103 108 16 102 235 OK 11 42 130 94 106 36 91 245 to 10 maxi 11 57 101 80 87 21 982470 8K 80 41 90 2251 OK indicates the level of 79 87 Correct Incorrect Removed manually Outside specifications activity A colour coded strip 1s also added in the ECG Detail and ECG Context windows and a graphical trend supplements the Heart Rate and Histograms wind
32. Colours 0 4 4 2 The 200 Hz and 400 Hz zooms ECG detail Choosing 200 Hz horizontal scale is particularly accurate to zoom Vista signal because its sampling and storage rates are precisely 200 Hz For Unolter X olter range recorded signals the 200 Hz signal is obtained by interpolation 14444 m 200 Hz zoom on 3 channel signal In the 400 Hz zoom which 15 obtained by interpolation all detected signals are accurately demarcated in a coloured strip blue N or S beats red V or grey A see 5 5 5 5 2 page 61 The Vista dynamic range being or 6 mV instead of 1 5 before a signal which would have been saturated 1s most often entirely seen with Vista ECG detail V Channel only from the above signal vertically refocused using the cursor located in the window left margin 4444 r 23 53 07 27 HolterSoft Manual Page 56 HOLTERSOFT The ECG 5 4 5 Intervals measurements When pressing down one of the 2 keyboard Shift keys whilst the mouse pointer is inside the ECG Detail window the pointer shape changes from a hand to an arrow Maintaining then the Shift key pressed down and sliding the mouse with its left button pressed down also a measurement area black is created FE pay ES BOT BT Normal pointer Shift key Left click Sliding For each channel measurements between intersections of ECG curve and beginning and end of the black measurement a
33. HolterSoft Ultima v2 5 Manual English Software for the ECG Holter recorders UNOLTER UNOLTER DUOLTER DUOLTER ACCESS TRIOLTER QUATTROLTER VISTA VISTA ACCESS VISTA PLUS VISTAO Soft Ultima re Display Settings Utilities Window Help 052 SRO WE ELCHSmRHEHSH a RR ee CI x Apnoea Breathing and 5 02 UO RESCUE S 2 nre n B LLLLLLLLLLLLLLI a 22 30 23 00 23 30 30 01 00 01 30 100 100 RR dl d joe oe D oz 46 00 03 25 gt gt m 2 100 y 1 a to M 120 2 2 E He H p ey no B 2 4 03 33 03 34 03 35 03 38 03 37 m Event m A gt 20 duration 3 51 V all Number of V 0 es T comme Emme 70 70 74 79 89 86 84 E N a x x J 4 Mg Pe eee ass 34 2 72 03 34 03 35 DEMO Vistao2 06 04 1944 28 05 2008 NOVACOR S A 4 passage Saint Antoine 92508 Rueil Malmaison Cedex France HolterSoft Manual 1998 2009 NOVACOR SA All rights reserved HolterSoft Manual 16 GB 17 09 2009 Page 1 HolterSoft Manual 16 GB 17 09 2009 Page 2 The
34. HolterSoft Ultima software is intended to program read and exploit the results of the NOVACOR ECG Holter recorders Unolter Unolter Duolter Duolter Access Triolter Quattrolter Vista Vista Access Vista Plus HolterSoft allows the complete exploitation of Diasys Integra Diasys Access and Diasys 200 ambulatory blood pressure recorders making the use of separate specific software unnecessary It also allows direct access to the procedures recorded with the R Test Evolution NOVACOR s automatic event recorder as well as programming the unit and reading results HolterSoft Manual 16 GB 17 09 2009 Page 3 HOLTERSOFT Contents 1 NOVACOR LICENCE AGREEMENT siriani 11 2 HOLTERSOERT ULTIMA cp 15 3 HOW THE MONITORING iano 21 4 ANALYSIS OF THE 27 S ECG EXAMINA TION a aaa a aaa 45 6 HEART RATE VARIABILITY 66 7 THE SLEEP APNOEA SCREENING 22 4 44 22 00 0 74 8 POSITION AND ACTIVITY OF THE 83 87 10 DATA ADDED BY THE USER 25555600 rta 93 1L THE REPOR D gn a a 95 IZ OTHER 97 HolterSoft Manual 16 GB 17 09 2009 Page 4 HOLTERSOFT Contents HolterSoft Manual 16 GB 17 09 2009 Page 5 HOLTERSOFT Contents Summary 1 NOVACOR L
35. ICENCE AGREEMENT 11 IL USING THE SOFTWARE ste 12 IRE OBI occas ce EUREN NM 12 TS GUARANTEE isi roi 12 ERRE RR AR RA E A RR OG AN ET 13 1 GOVERNING JURISDICTION ts 13 MeO CORY RIG EES ela 13 2 252555 al 15 Zi INSTALLATION 15 2 b AAU AUS qllod 15 2 1 2 If you have never used a 15 2 1 3 If you have never used your recorder unit 15 Dias ys 200 and Didsys etos trt tate Arsia 15 LAICO 15 2 1 6 Installing the equipment lie 16 D7 26 CONNECTING the ACCESSKEY lai tata do eda Sa eae aides 16 2 16 2 the Antica ERO RANA e La vans 16 Zl PEWOPCIMSIOI QU 17 2 1 7 1 Minimum configuration for Vista series recorders 17 2 1 7 2 Recommended configuration for Vista series recorders 17 2 1 7 3 Program Installations DR Et HR HEREDI eee 18 2 41 09 id i E desto acida aer 19 IBERICA ORE 19 2 2 USI
36. NG HOLTER SOE d 20 2 2 1 Start up of the HolterSoft application a i 20 2 022 ONE WD TNC Willa 20 TO 20 2 222 Procedure ManapementDutton nitrato 20 222 3 Communicalon DUON sais 20 2 224 Chatming nl 20 3 HOW THE 525555205555 21 24 rale 21 S T USING E MANON 21 3 1 2 The Communication 21 2 THE THREE STAGES OF THE MONITORING nelle 21 PrO ramman DUNC NE 22 3 2 1 1 Programming Unolter Duolter Triolter Quattrolter n 22 252212 Vista programmino aa ess 23 35 09 09 477717 V1 1492 2 001 22 111 E 24 3 2 2 1 BP and arterial stiffness Duo Trio and Quattrolter 24 J22 AC Gr C all feCOPOGES oco 24 3 2 2 3 ECG recorded during more than 24 hours Vista range 25 312 2272 TIME UNG TO DODL iiss roan coat 25 4 ANALYSIS OF THE RECORDING 27 a NALYSIS CRITERIA lla 28
37. NOVACOR S A You may give up ownership of the CD Rom but this must be permanent and it must be accompanied by all the original documents and packaging it was delivered with Once you have given up the software you lose all rights to its use and the new owner becomes bound by the terms and conditions of this licence agreement To use the software without any restrictions you will need an Access key It may however be installed without this access key as a Demonstration Version In this instance a small database 15 available giving access to most functions although communication with a recorder is not possible Copying an original software for demonstration purposes and free distribution of these copies 15 therefore authorised as is making a backup copy Any copy made with any other aim in mind or any attempt to bypass the Access key could be considered as an offence punishable under the protection of royalties law 11 March 1957 1 3 Guarantee HolterSoft Manual NOVACOR SA guarantees that the software will perform substantially in accordance with the documentation provided with the HolterSoft package on the computers which were used for the tests NOVACOR S A cannot guarantee that the software will work properly on any specific computer NOVACOR S A guarantees the HolterSoft software and documentation for 90 days following delivery In particular NOVACOR S A promises to replace the program CD Rom free of charge
38. a i 780 1230 i 780 22 03 35 2 22 03 35 27 22 03 35 27 Select and Drag Drop Click Point a type Whole template The missing beats a type are now labelled instead of the moved T waves and the ones which were correctly detected remain unchanged In this example it is then necessary to relabel N instead of V the moved template This will be achieved the Templates window Page 60 HOLTERSOFT The ECG 5 5 5 Using 400 Hz horizontal scale zoom Previous insert move or resize QRS operations can be achieved using any horizontal scale in Detail window Nevertheless the 400 Hz horizontal scale allows increased accuracy thanks to the zoom effect and to the accurate display of all beats and artefacts these being software or user defined 5 5 5 1 Types of artefacts Most artefacts found during initial automatic analysis or labelled by the user are displayed in the Templates window They are then labelled A the ECG Detail window In some cases different types of artefacts can be created automatic search for wrong pauses manual wrong event deletion These artefacts although they can be selected in the ECG Detail window as well are not labelled A deleting them could cause problem artefacts are clearly displayed on the 400 Hz scale 0 9 9 2 Example In this example let us assume that The 1 selected item blue strip is a beat correctly defined
39. ame morphology or group together several templates with different morphologies by gathering them together in one of the three possible morphologies The chosen operation will take place two steps Select the concerned templates by clicking on each one of them whilst maintaining the Ctrl key pressed down and or by sliding the mouse if they are neighbours the backgrounds of the selected templates will become black Perform a right click on the mouse and choose the operation you need to The operation is detailed below Page 35 HOLTERSOFT Analysis 4 2 5 Selecting one or several templates 4 2 5 1 Selecting a template WI Templates 68 A simple left mouse click on one 44716 2 22101 12545 3712 of the templates will select that template only If one or several others had been previously selected they will then be deselected Simple click By maintaining the left mouse button pressed down and by sliding the mouse you can spread the selection to the neighbouring cells this enables you to select several columns and or rows 1 44716 H2 22101 If one or several others had been previously selected they will then be deselected Click slide HolterSoft Manual Page 36 HOLTERSOFT Analysis 4 2 5 3 Selecting several non neighbouring templates SI Templates 68 NI 44716 2 4 2 5 4 HolterSoft Manual 22101 Ctrl N Ctrl V Ctrl A Ctr 9 C
40. ard for status new procedure or to read a aera recorded CF or PCMCIA card give mews aN ae a Patient s sumame This Vista specific icon allows play Confi hen readi back of the voice message recorded m during start up Progam 7 3 Channels This Uno Duo Trio and Start of procedure date 1770472002 11 49 Quattrolter specific allows visualisation of the program written on a PCMCIA card 3 2 The three stages of the monitoring HolterSoft Manual Programming the unit The actual monitoring placing the recorder on the patient the start up test and the recording Reading and exploiting the results The first except Vista and third phases require the HolterSoft software you must therefore establish communication with the memory card Page 21 HOLTERSOFT How the monitoring works 3 2 1 Programming the unit 3 2 1 1 Programming Unolter Duolter Triolter Quattrolter The programming of the ECG holter and ABPM parts of the Duo and X Olter units are simultaneously implemented the memory card Therefore this enables you except for the Unolter to choose either one or the other or both possible aspects of the monitoring ECG and or BP in order to create a given program Click on the Programming the unit icon in the Holter communication window in order to reach the Programming window where you will choose the patient s name an
41. by using the Add an option item in the Utilities Menu and following the instructions 2 1 9 Password If you wish to protect the confidentiality of your data this can be done by installing a password for the access to the database The database includes a directory generally on a hard disk which contains all or part of the patients files and procedures It is possible to work with one or several databases with some of them having free access and others protected by a password This password can be different for each database if necessary The window used for creating or changing the password of each database is opened by using this button on the bottom right hand side of the Procedure Management window Chaining analysis printing Import Startup test Audio help _Addenapion The window used for creating or changing the current database password can also be accessed by using the Password command in the Utilities Menu Repair You proceed the same manner for both cases to create modify or cancel a password If no password exists yet type the word chosen into each of the two zones at the bottom of the window and click OK To change the password type it into the text zone at the top of the window and then enter the new password twice in a row into the input zones to remove use of the password leave the two text zones at the bottom of the window empty Then click OK HolterSoft Manual
42. d slide it with the left mouse button To change the duration of the analysed period bring the mouse pointer above the right edge of the black area and after its shape change horizontal double arrow slide the right edge with the left mouse button Using the keyboard First of all select with a double mouse click the beginning or ending time on the left of the heart rate trend type the desired new time on the keyboard and then press Enter key 7 1 4 3 The graphs They display for information the spectral power density of the RR interval increments during the analysed period Two different X axis are used especially to HolterSoft Manual Page 75 HOLTERSOFT Sleep Apnoea detail the very low frequency VLF part coloured blue of the total spectral density 7 1 4 4 The cursor It directly gives the result on a multicolour gauge vLFI 1 19 Yo VLFI 2 74 uncertainty orange area Yo vLFI 9 5490 VLFI gt 4 0 red area apnoea is likely For information recorded signal quality during the analysis period is indicated below the VLFE cursor as a of validated RR intervals 7 2 Apneas module Breathing 5 VoVLFI lt 2 4 green area apnoea is unlikely HolterSoft Ultima Procedure Display Settings Utilities Window Help LEETE 15 05 30 05 45 06 00 06 15 06 30 06 45 07 00 100 4
43. d the most appropriate program w Programming Patient F 2 Odette F PATIENT 1 PATIENT 1 W04 0101 1945 PATIENT 1 v4 10 11 1328 PATIENT 2 ECG Spikes PATIENT 3 BO4 12 11 1354 ECG P 12mn aff auto PATIENT 4 Julenne 0709 1921 ECG P 4mn auto 4 Hre ECG P 4mn auto 4 hre ECG P 4mn auto Aff Hre ECG P 4mn auto AF Hre ECG P 5mn auto ECG P 5mn auto Aff Al Configure Program PATIENT 1 v 4 1071171328 ELI FA 30 60 DUOLTER TRIOLTER Check if the date and time are corect on the unit If the patient is not already in your list you can create his file by clicking on the New button at the bottom of the Patient s column If no memorised program is appropriate for this new monitoring you can create a new one or simply refer to one of them once you have clicked on the Configuration button at the bottom of the program column Once you have made your choice transfer it to the memory card by clicking on the Programming icon at the bottom of the window HolterSoft Manual Page 22 HOLTERSOFT How the monitoring works 3 2 1 2 Vista programming Vista programming is easily performed on the recorder itself without any need for preparing or prior erasing of the CF card on the computer This programming 15 detailed in the Vista recorder User Manual Vista settings In a similar way as programming all Vista settings can be modified directly on the recorder itself Some a
44. ded to provide only QT intervals and T wave measurements and is not intended to produce any kind of diagnosis 9 1 2 Parameters measured The software finds on each averaged complex the points necessary to calculate the desired parameters Q wave beginning R wave peak T wave peak T wave end Intervals measured QTa QTapex Q wave beginning to T wave peak QTe QTend Q wave beginning to T wave end RTa RTapex R wave peak to T wave peak RTe RTend R wave peak to T wave end Te Ta Tend Tapex T wave peak to T wave end lt QTa j QTe gt Calculated values ex QTa are given as well as corrected values ex QTac with a choice between several formulas correcting versus heart rate 9 1 3 Impact in HolterSoft QT module adds several changes in HolterSoft ECG Analysis window 1 tab 1 check box Procedure window 2 tabs 26 02 2002 18 30 00 Default values window 1 tab Printing window 1 tab Tools bar 3 buttons on the right HolterSoft Manual Page 87 HOLTERSOFT QT module 9 2 Analysis settings QT calculations are processed together with arrhythmia so it is possible for example to modify the rejection criteria of averaging periods and then start reprocess which will take a few seconds only 9 2 1 Averaging periods rejection ECG analysis Procedure ongoing 32 500 Processing templates Processing arrhythmias and ST with calculatio
45. dge of Windows applications If not time should be taken to familiarise yourself with them by going through the guidebook which came with your computer 2 1 3 If you have never used your recorder unit This manual also assumes that you are familiar with your recorder unit 1f not you should go through the user s manual first 2 1 4 Diasys 200 and Diasys Integra HolterSoft enables you to have access to all the functions of the Diasys Integra If your Diasys belongs to the 200 series you will benefit from the increased facilities for analysing the results provided by the software but the performances of your Diasys 200 will stay the same 2 1 5 System requirements HolterSoft Manual A PC compatible computer with Windows XP complying with EN 60 950 standards see detailed configuration 9 2 7 An installation CD Rom f necessary a memory card drive installation kat An Access key Page 15 HOLTERSOFT HolterSoft Ultima 2 1 6 Installing the equipment We recommend that all cables be connected before the computer is switched on If the PCMCIA memory card reader needs to be installed on your computer we recommend you have this done by our technical service as this operation requires a minimum of technical knowledge However the Installation CD Rom which accompanies your equipment contains all the necessary instructions under Installing the equipment To read the Vista CF cards most often
46. ditional procedures will be created the Complete Recording window as described 9 5 6 page 63 Any unnecessary procedure can be deleted from the Procedures Management window 3 2 2 4 Printing the report HolterSoft Manual Right after the procedure transfer the Printing button only allows to print ABPM reports if any Page 25 HOLTERSOFT How the monitoring works HolterSoft Manual Page 26 HOLTERSOFT 4 Analysis of the recording cedure Display Settings Utilities Window Hel 1 xl 1 09 5 BOG renna TEE a eae d RR zb dediti 4 15 41 00 00 LLL 4E E E LL LL E EL Le T Ul 5 41 36 06 15 42 1212 T NASE MAAN ET VV rit de ai i ai sq i a Pei ci SR SR IO TE SEC SOS DO 15 42 4818 5 43 24 24 Jod e LL ALLEA 5 44 00 30 di ii gt Templates Arrhythmias A Fibiilation sT ar Analysis channels wv Channel 1 v Channel 2 pei 15 44 3 3 SS a iii 15 45 12 42 m Automatic grouping dCi Lt Regroup 2 or less QRS templates b s Recording with according to their type paced beats in only 1 Artefact template heben obo rob 7 e 7 rn T e
47. e 23 53 06 42 Select time with a double click and type the desired time instead respecting the same hh mm ss xx format Then press keyboard Enter key to access the new time Itis enough to type only 16 then Enter to jump to 16 00 00 00 16 30 then Enter to jump to 16 30 00 00 HolterSoft Manual Page 55 HOLTERSOFT The ECG 5 4 4 The pop up menu right click Horizontal scale A right click in the ECG Detail window shows a pop up menu which allows Vertical scale several scales or display adjustments especially Channel Grid t checked item show pacing spikes if any RR intervals with choice between milliseconds beats per minute display i choice of all or part of recorded channels View spikes with or without grid with several sizes Insert a QRS vertical scales for a choice of signal amplitude zooms Colours QRS insertion see 5 5 1 5 4 4 1 Horizontal scale After opening the pop up menu maintain the right button of the mouse pressed down and choose the 1 line Horizontal scale Horizontal scale Vertical scale 200 Hz Grid v 100 Hz Channel FU Hz BR display 33 Hz w spikes zh Hz A sub menu opens then in which you choose a value sliding the pointer Release the mouse to activate your choice Standard display uses 100 Hz frequency Insert a QRS i Insert lower rate compresses more the displayed ECG
48. e gt Channel View QRS View spikes Selected as N Selected as V Relabel SEA Place the pointer without Dee clicking on the desired area of the contextual menu relabel or group this will be enough to open a second menu Vertical scale Channel Li View GAS View spikes Selected as Still without clicking bring the pointer in this new second as V menu onto the desired morphology here Ventricular selected as 4 Finish the operation by clicking with your mouse right or left click In the case of reclassification the total number of templates indicated in the title bar of the Templates window will remain unchanged where as in the case of regrouping it will be reduced by the number of grouped templates minus 1 The above operations can be accelerated After having selected the templates for relabelling or regrouping do a right click on one of them as before and maintain pressed down the right click of the mouse Slide the pointer on to the pop up menu then still maintaining the right button pressed down slide it into the sub menu Once the desired morphology has been selected release the button Page 38 HOLTERSOFT Analysis 4 2 6 2 Using the ECG detail window for help The QRS display in each cell of the Templates window will not always identify their morphology with certitude It is thus often useful to visualise the doubtful QRS in its ECG chro
49. e chosen number of QRS will automatically be re grouped in one template only For patients with pacemaker this box must be checked in order to display spikes in ECG windows and PM button in HolterSoft tool bar Checking this box allows changes added by spikes in ECG shape if any to be taken into account These two boxes are automatically checked or unchecked by HolterSoft depending on whether the recorder program indicates or not that there is a pacemaker Page 28 HOLTERSOFT Analysis The user can change them before the analysis for example in case of erroneous recorder program or if the pacing does not impact the ECG shape very low rate of pacing or bipolar pacing etc ECG Filter O Allows the activation of a Notch filter Regalia Mitra that Hz reduces noise generated by the mains Hz This option is only available for Vista procedures Any change to this setting requires a complete analysis of the procedure 4 1 2 Determining the pathologic events 4 1 2 1 Arrhythmias tab The three tabs Arrhythmias AF and ST enable you to define the organisation of the pathologic events during a second very short stage of the analysis analysis It is necessary after each intervention to with calculation of AF periods reprocess the results in order to update all with processing tables and all the lists of events Templates Arrhythmias A Fibrillation ST ar
50. e in the printed report 4 2 7 1 Template details HolterSoft Uti ilitairi Fen tre Aide To visualise all QRS in template select that template only and LLL G 10 593 14 210 15 170 122 Group Relabel Verticalscale gt Channel v39 23 40 21 v42 18 44 7 19 1 Either Or Hold down the right click in the Click on the cross split under family drag and release the cursor on the scroller in the bottom right hand the View ORS line side of the Templates window The bottom half of the Templates window will show all the QRS in that template with a scroller if necessary One or more QRS can be selected the same way as selecting templates in the Templates window A QRS is immediately displayed in the middle of the ECG Detail window at the bottom of the screen The QRS selected if only one The first of the last group selected if more than one This selection can be extracted from the current template to form a new template right click or incorporated into any existing template drag and drop in the desired template in the Templates HolterSoft Manual window Page 41 HOLTERSOFT Analysis 4 2 8 Suppress one or seve
51. ent s activity and position No specific buttons are added to the tool bar for activity or position results These results are displayed in several BP and ECG windows HolterSoft Manual Page 47 HOLTERSOFT The ECG 5 3 The results screen BJ HolterSoft Manual After having checked the analysis made by the software close all the windows and click on one of these three buttons to display the results screen The item Arrange ECG windows in the Window menu allows fast restoration of correct window positions if they have been moved HolterSoft Ultima lef x Procedure Display Settings Utilities Window Help o 12249 SECG FE E EE Z E EN 06 GI DL ITem SYSTOLE 54 of even Number of V DIASTOLE tendancy elative pauses eriousness 09 05 0000 09 06 00 00 14444 E gt 9 amp 11 07 39 60 08 01 2004 18 51 RUELLOUX Herv 05 05 2003 This screen mainly displays The heart rate trend for the 24 hour monitoring below which the user can synchronise different histograms of events and for Duo Trio Quattrolter the blood pressure measurements Heart rate Histograms window For units with a position and or activity sensor the corresponding information 1s graphically given either as a horizontal green band along the time scale of the heart rate curve or as a specific histogram Detail
52. h courts 1 6 Copyrights HolterSoft Manual Manual HolterSoft Ultima 1998 2009 NOVACOR SA All rights reserved Unolter Duolter Vista R Test HolterSoft Ultima and their respective logos are registered Trademarks of NOVACOR Windows is registered trademark of Microsoft Corporation NOVACOR 1s an international trademark of NOVACOR SA Page 13 HOLTERSOFT Licence agreement HolterSoft Manual Page 14 HOLTERSOFT HolterSoft Ultima 2 HolterSoft Ultima HolterSoft Ultima is intended to be used by trained technicians under the direct supervision of health care practitioner 2 1 Installation 2 1 1 About this manual This HolterSoft guide deals with everything you will need to know to use the software Most of these procedures are common to the different type of recorders used with HolterSoft especially the Duolter recorder which uses most of them However the user should not take into account the procedures this manual that do not refer to the equipment in his possession particularly for the blood pressure measurements that do not apply to the ECG only recorders and certain software Access do not include all the functions 2 1 2 If you have never used a computer HolterSoft 18 user friendly and requires the same skills as for other Windows software such as using the mouse working with several windows at a time modifying text on the screen etc This manual assumes that you have working knowle
53. he 3 tables of results Closes the patient s file and all opened windows Open close button of the patient s file open with a click and close with Ctrl Click Open close button of the current procedure Measurements Hourly Means Statistics Open close the Histograms window Open close the Comparison window Page 27 HOLTERSOFT Analysis 4 1 ECG Analysis criteria open it If ECG Analysis window 18 not open click on this button of the tool bar to The ECG Analysis window enables you to define the criteria for automatic computer analysis of the ECG recording The user can establish different analysis protocols and memorise an unlimited number of them in the computer Before starting the analysis it 15 necessary to choose the desired protocol for the current procedure from the scrolling list at the top of the window If none of the listed protocols are suitable a new one can be created by clicking the New button The analysis 15 in two parts the QRS morphologies or templates first tab and the disorder and events pathologies following tabs 4 1 1 Template classification ECG analysis Procedure ongoing Standard m Close with calculation of AF periods with OT processing Templates Arrhythmias Fibrilation sr ar seri Analysis channels Channel 1 uv EH Channel 2 I v Automatic Channel 3 Boka Automatic grouping Regroup 2 or less QRS templates 2 accordi
54. ied Take note that a click in the Defined Procedure strip moves back to the previous state Procedure to be defined yellow which can be modified again 5 6 2 4 Creating the procedure A click on this button creates the procedure the new procedure will now be on listed in the Procedure Management window Creating the procedure takes a few seconds and then the software directly offers the user the possibility to start the analysis of the procedure just created If instead we go back to the Complete Recording window it appears as follows Start of procedure date 25702720021830 Data transmission date 28 02 2002 15 48 gt Duration hoaz 7 Number of channels B 06 00 Procedure to be defined Procedure not analysed Create defined procedures in Extra procedure database The recording now contains two 24 hour procedures HolterSoft Manual Page 65 HOLTERSOFT RR variability 6 Heart Rate Variability HR variability is calculated using all non premature normal RR beats It concerns frequency domain spectral analysis graph of the frequency distribution from Fast Fourier Transform e table of the spectral powers in 3 frequency bands time domain statistical analysis distribution histogram table with the main calculated parameters graphic display Poincar diagram also called Lorenz plot 35 The 2 following graphs are shown by default for the whole procedure
55. ied in the bracket 0 15 0 40Hz In order not to compute the VLFI if the pNNS0 is higher than 20 Apneas parameters definition of breathing events definition of the SpO events Click on the Start Analysis button after having chosen a protocol or having directly modified the displayed parameters A gauge in the information bar enables you to check the progress of the analysis which lasts around 2 minutes using the recommended computer configuration cf 2 1 7 2 Page 31 HOLTERSOFT Analysis 4 2 Checking the automatic ECG analysis After the analysis of a new procedure and before examining the different pathologies it is necessary to check the precision of the QRS morphology classification performed by the system The analysis algorithms generally lead not necessarily to errors in classification but to a multiplication of the number of templates Templates that appear to the user as similar may contain differences in their mathematical formulation For this reason the software may have classified these templates separately It 15 therefore necessary to group together the similar templates often you will have several dozen templates that can be grouped into one The functions of regrouping reclassifying are carried out in the Templates window 4 2 1 The Examination Conclusion window The Procedure window provides a complete summary of the analysis it gives an overall vision of the examinatio
56. ima Procedure Display Settings Utilities Window Help D502 m KI E ERR spectrogram 1557 03 pe 18 43 06 A310 mN None E Artefacts gt BUG 04 04 28 ES 630 ms E ue 07 22 09 1400ms 09 10 06 153015 1650 ms 1780 ms 10 41 48 1910 5 2040 ms 2160 ms 2290 ms 2420 ms 255045 05 40 12 87 13 05 05 Seriousness N Chronology uo weg pr 15 57 00 00 15 57 00 00 4444 gt ppp 9 05 40 12 87 04 02 2004 11 52 FAQ3 04 17 08 2002 17 03 2002 Position the mouse pointer on the desired RR interval for instance here between a red one ending with a ventricular beat and a light blue one almost white long interval could be a pause The correct position can be checked in the pointer zoom upper left corner and the exact time of the pointed RR interval is displayed in the bottom left of the RR Spectrogram window A mouse click without moving the mouse immediately displays the ECG curve at the same time in the ECG Detail window HolterSoft Manual Page 70 HOLTERSOFT RR variability 6 3 3 Displaying all occurrences of an event All episodes of any event detected by HolterSoft can be superimposed on the RR spectrogram allowing to check their distribution in the time RR spectrogram Select a type of event in the drop down list on the upper left part of the window below the pointer zoom
57. ine selects a 10 ms RR band is ens FARR histogram 11 30 09 06 34 21 Bl 11085 91192 Bl Venticular ans 205 2400 S 770 4 4 Fhronology RR SDNN 16Z ms 50 19 924 SDANN 4 ms NN50 18030 SDNNIDK 73 ms MeanNN 722 ms RMSSI 50 ms 7 200 400 600 800 1200 1400 of events 0 DTT The ECG Detail window displays the first RR interval from the beginning of the record which corresponds to the selected histogram bar 6 2 3 Searching among different intervals The displacement arrows in the table allow the display of all the intervals in a given 10 ms range or to look for exact values the extremes for instance The RR interval value arrows enable a move to the previous or PR sate 4 27 ia following RR range or a jump to the shortest or longest RR TASA cons DI The Chronology arrows enable a search in the selected range simple arrows 4 7 gt stop arrows z First last the shortest the longest Previous next immediately shorter or longer Page 68 HolterSoft Manual HOLTERSOFT RR variability 6 3 The RR spectrogram window This exclusive HolterSoft window displays the values of all the RR intervals of the recording in chronological order It is also possible to superimpose all the occurences of a chosen event at their right chronological place as well Opening s It is recommended to display this window above the ECG Detail
58. kin RR TANG a Posto oe ad sea tes ici oculo On ia ad eain Go 70 6 3 3 Displaying occurrences of an event ee tite ace he tdeo gun 71 POINCARE DIAGRAM ti 72 6 4 1 The RR variability window Poincar diagram i 72 6 4 2 oram uoo a actor rs tad Votes E ee deett uada 73 OF s netu 73 7 THE SLEEP APNOEA SCREENING 1 74 TI SCREENING FOR SAS 74 Fedd n te fcu 74 IZ OV EF TING CN 74 d do ira era 74 obo The Si 00DAPROCIWINAOW ALII RES 75 NS POPE HR et eto nce Ste et sat Sel eus 75 142 C haneine the analysis Priod 75 Ihe PAB e Vis dela The oV HI lates lele 76 1 2 APNEAS MODULE BREATHING AND SPC S Lilla 76 7 2 1 Apneas WORKIN SWING OW etta EE a fua leaned c Di BISI 00110
59. lterSoft Ultima full options Example procedure performed with a Triolter recording PM spikes 2520 IEEE E a a 1 fa es E Being a Triolter the Vista Complete recording button 15 not visible 10 supplementary buttons appear for the Sleep Apneoa option 3 for the QT option 6 for the ABPM option HolterSoft Manual Page 45 HOLTERSOFT The ECG 5 2 Presentation of the results The buttons for presenting on screen the results of the ECG recording are divided into six groups each being a group of buttons or a specific button A Vista specific button is located immediately to the left of the Printing button and to the right of the Templates button are located all the buttons corresponding to the ECG results 5 2 1 Creation of Vista procedures amp This button exclusively for Vista recordings allows view of the ief whole recording heart rate trend for any recording duration up to gt 11 days on channel From this chart it is possible to break down the complete record into several procedures lasting from 1 to 24 hours starting at any moment in the recording see 5 6 2 page 64 5 2 1 The Examination window The Examination window provides a complete summary of the analysis it gives an overall vision of the examination 5 2 2 Strips and histograms T These three buttons enable you to display the 24 hour heart rate trend synchronised
60. ly one procedure has been created from the complete recording It will be always possible to create other procedures later on by returning to this window 5 6 2 2 Procedure to be defined HolterSoft Manual A yellow strip can be moved anywhere in the complete recording by a click pointer then drag and drop Its duration can be adjusted between 1 and 24 hours sliding its right edge with the mouse pointer lt gt Previous example after moving and increasing the suggested procedure to be defined to 24 hours Start of procedure date 26 02 2002 18 30 Data transmission date 28 02 2002 15 49 Duration 20 22 the periods of a recording which are not included a procedure created or defined are labelled with a yellow strip Procedure to be defined Page 64 HOLTERSOFT The ECG 5 6 2 3 Procedure defined Once a future procedure is ready position and duration validation is simply made by a click on it Start of procedure date 26 02 2002 1830 Data transmission date 8 02 2002 1549 gt Duration ipz22 Number of channels 5 Procedure ongoing 1451 Defined procedure 06 30 Create defined procedures in i Ent BENE database ____ Procedure to be defined becomes Defined Procedure and the button allowing the creation of this procedure in the database Create Defined Procedures in Database 1s activated A Defined Procedure cannot be moved or modif
61. most often 24 hours To define a shorter duration black background in the heart rate trend above the graph please see 5 7 1 4 2 page 75 These 4 buttons in the tools bar correspond to the optional RR variability module Fa lo HRV feature is intended to provide only HRV measurements and is not intended to produce any interpretation of these measurements or any kind of diagnosis 6 1 RR spectral analysis window Click on this button to open RR spectral analysis window RR spectral analysis 11 30 09 06 34 21 PSD sec Hz Y axis Heart rate Hz Power msec Power LI N Spectral power X axis Frequency The frequency spectrum from 0 to 0 4 Hz is shared into 3 bands VLF Very Low Frequencies from 0 to 0 04 Hz LF Low Frequencies from 0 04 to 0 15 Hz et High Frequencies from 0 15 to 0 4 Hz The spectral power of each band is graphically shown with the area below the curve blue for LF and is calculated in the displayed table HolterSoft Manual Page 66 HOLTERSOFT 6 2 The RR histogram window RR variability This window besides showing the distribution histogram of all normal and ventricular RR intervals allows the display of interval samples the ECG and shows the main variability parameter values in a table It is always available in HolterSoft but if the RR variability option is not installed the variability parameters are not displa
62. n The conclusion is available from the ECG QT and Apneas tabs Procedure Duration analysed Duration Number of QRS Bradycardias Pauses AF ST pacemaker Ventricular events Total couplets bigeminy VT Number of events to be printed Motes grave pour figure HolterSoft Manual 1 09 25 81451 1 43 secondes 6 37 40 relative pauses 2 la plus longue 1 28 secondes 16 01 50 Templates Triplets Heart rate Min HA 45 E3r45 Mean 74 1 quss Max HA 127 6 14 41 127 121 Polarity Gain Channel 1 reversed 1 1 Channel 2 reversed 1 1 RR variability SONN 134 ms PNN50 852 X SDANM 107 ms MMB5 6858 SDNNIDX 64 me 59 ms RMSSD 40 me Supraventricular events Total SVPB 200 couplets Triplets SVvPT 43 a plus langue 55 QRS 81 min 6 37 50 POE n 32 HOLTERSOFT Analysis 4 2 2 The QRS templates nm First of all click on the Templates icon to display the QRS lay out according to their morphologies Templates 68 1 44716 N2 22102 12545 H4 615 Hb 3717 MID N32 9 H33 7 N35 5 N39 4 N40 2586 Yi 915 8 HolterSoft Manual Page 33 HOLTERSOFT Analysis The QRS can be classified in three categories depending on their morphology Normal N represented by blue letters and numbers Ventricular V repre
63. n of AF periods with QT processing The QT tab in the ECG Analysis Oow window allows the adjustment of Delete 4 rejection criteria for each 30 QRS number lt 10 Doe J Interval rejection mean RR Eo second averaging periods SDRR 50 insufficient number of QRS T wave amplitude lt 150 UNS Sie mean rate too high RR variability too high mean T waves amplitude too low 9 2 2 Default values This window is opened when selecting the Default values item in Settings menu Its OT tab allows configuration of two criteria w Default values x General Blood pressure ECG ar OK Correction formula Cancel Threshold values QT ac threshold Predefined QT ec threshold RT ac threshold RTec threshold 9 2 2 1 Intervals thresholds If QT or RT intervals corrected values are below pre defined thresholds the corresponding averaging periods are rejected 9 2 2 2 Correction formula For corrected QT calculations the user can choose between three formulas Bazett Fridericia and Framingham and a correction table HolterSoft Manual Page 88 HOLTERSOFT 9 3 The results windows 9 3 1 Hourly statistics QT module They can be reached the hourly table window which is opened by a mouse click on the 1 of the 3 QT buttons to the right of the tools bar Channel 2 Channel 3 Time 18 30 00 19 30 00 20 30 00 21 30 0
64. ncare diagram The above N N diagram displayed in 3D colours HolterSoft Manual Page 73 HOLTERSOFT Sleep Apnoea 7 The Sleep Apnoea Screening module 7 1 Screening for SAS The optional Sleep Apnoea module based on an innovative Heart Rate Variability analysis allows an easy screening of the sleep apnoea syndrome This option 15 not intended to produce any kind of diagnosis and shall be used by qualified personnal in evaluating the patient in conjunction with his clinical history and symptoms 7 1 1 Operating mode The analysis is based on the study of the changes between nocturnal normal RR intervals highlighted thanks to a frequency break down spectral analysis This analysis must be performed on a period of time during the night not shorter than 5 hours and after having carefully checked the automatic QRS morphology classification 7 1 2 VLFI index This index shows the relative importance of the power spectral density of the Very Low Frequency Increment band 0 01 to 0 05 Hz blue area on the graph over the total power spectral density 0 01 to 0 5 Hz This index value indicates the level of risk of obstructive sleep apnoea syndrome VLFI lt 2 4 low probability of Sleep Apnoea Syndrome or another Sleep related breathing disorder VLFI gt 4 0 high probability of sleep apnoea syndrome or another sleep related breathing disorder intermediary complementary procedures are
65. ng a 512 MB CF card HolterSoft Ultima software can analyse up to 24 hours of ECG recorded on 1 2 or 3 channels So any recording lasting more than 24 hours must be split into several 24 hour max procedures End of Vista recording download Reading a CF card recorded by a Vista will be 2 steps complete recording transfer to the database creation and storage in the database of a procedure made with the first 24 hours of the recording if the monitoring lasted 24 hours or more If the total recording lasted less than 24 hours this procedure will be created with the complete recording The procedure just created from the beginning of the complete recording becomes the active procedure Its first minutes are immediately displayed as a background behind the ECG Analysis window which allows the start of the analysis after adjusting criteria if required Create new procedures from complete recording So a procedure is created with the first 24 hours recorded this makes up for the fact that the Vista does not stop recording after a programmable amount of time Nevertheless the user can create as many additional procedures as necessary knowing that additional procedures cannot last more than 24 hours nor less than hour they can start at any time in the complete recording they can overlap or be included another existing procedure they must last an exact number of hours from their beginning These ad
66. ng to their type 4 only 1 Artefact template ECG Filter O None gt 50 Hz O 60Hz Start analysis Analysis channels Channel 1 Channel 2 Channel 3 yv vi Ep v Automatic Ee Automatic grouping Regroup 2 or less QAS templates 2 according to their type MV Coin only 1 Artefact template En Recording with paced beats Use spike information during analysis HolterSoft Manual The left tab Templates enables you to choose the channels to be used for the analysis from the present procedure ones to adjust the min level for QRS detection to indicate if the patient wears a pacemaker and if the analysis must consider it and if desired to group together the templates containing very few QRS The template calculation stage generally lasts less than two minutes with a recent computer configuration The Analysis channel frame enables you to choose which channel s must be used for the analysis for example taking into account the aspect of the patient s ECG displayed in background at the end of the procedure reading It also allows to adjust for each channel a threshold below which no QRS will be detected 0 6 mV standard The Automatic checkbox enables you to automatically determine this threshold via a quick analysis of the recorded signal the retained value appears grayed All the templates containing a maximum of th
67. ngoing event by forcing the type of each QRS to N The FA deleted events can be retrieved from the ECG Analysis window by clicking the cancellation of manual modifications button in the FA tab 5 4 2 5 Deleting a portion of recorded ECG The same button as above 15 used typing to its left the beginning time of the part to erase after a double click on the initially displayed time and to its right the ending time A right click on the button relabels then all beats the period as artefacts 5 4 3 Basic actions in ECG Detail window 0 4 3 1 ECG scrolling EIN Bicis PTS enn keys the scrolling speed being adjusted with the centre cursor These keys are activated with the mouse pointer Outer keys immediate access to begin or end of recording Simple arrow the ECG goes on scrolling as long as the button is pressed down Double arrow a click on it starts scrolling another one anywhere stops it The ECG chart can also be moved sliding the mouse pointer hand shaped while maintaining the left mouse button pressed down HolterSoft Manual Page 54 HOLTERSOFT The ECG 0 4 3 2 Strip or Context printing This button opens the User define strip window in which you can name the strip in the typing field print it immediately Print Strip button or have it printed in the final report Add button or immediately print one page of ECG Print Context button 5 4 3 3 Jumping to an exact tim
68. nological context For this the most practical presentation of the Templates window is using the maximum surface at the beginning of the regrouping in order to visualise the most templates possible at the same time whilst leaving a space for the ECG detail window at the bottom of the screen for example T In order to open the ECG detail window at the bottom of the screen click on this button in the tool bar Or double click on any template in the Templates window A HolterSoft Ultima cedure Display Settings Utilities Window Help ERE 1 N76 BEBE 1 40 1 41 1 42 1 V45 1 4 1 50 1 51 1 v52 1 53 1 54 1 528 T m Chronology 7 0 18 30 00 00 18 30 00 00 4444 A 02 49 10 19 15 05 2002 18 04 H D 3v 26 02 2002 Opening the ECG detail double clicking on a template Any click on one of the templates immediately displays the corresponding QRS in the middle of the ECG detail window more this QRS 15 selected for immediate location HolterSoft Manual Page 39 HOLTERSOFT Analysis HolterSoft Ultim rocedure Display rye Utilities Window Help 0252 Sms NEN 1 N49 1 N59 1 N69 1 N70 TIE 17 10 2 VII 2 2 17 2 18 1 1 1 Val 1 v42 1 v45 1 v47 1 50 1 v51 1 54 1 55 1800000 18 30 00 00 14444 ppp 9 A 02 49 10 19 15 05
69. nts will be taken into account during AF modifications periods 4 1 2 3 ST tab Parameters of the ST events on channel 1 and or channel 2 ST depression or elevation negative or positive values according to the slope If ST event detection 15 not required the 4 boxes must be unchecked HolterSoft Manual Page 30 HOLTERSOFT 4 1 2 4 QT tab Allows to define rejection criteria for not to be analysed periods see 9 2 1 4 1 2 5 Apneas VLFI tab ECG analysis E v Close with QT processing rejection criteria pNN5O gt 20 parameters Breathing Decrease z 50 Min duration s 10 Max duration 5 100 with calculation of amp F periods Position of the respiratory peak Save Templates Arrhythmias Fibrillation ST QT Apnoea Delete Recording with paced beats 5 02 Desaturation 4 Min duration 10 Max duration s 100 El Eb ELE Start analysis 4 1 3 Start up of the analysis After reading a procedure both parts of the analysis must be executed both boxes Start analysis HolterSoft Manual are ticked automatically E J Analysis The apneas analysis is automatically done depending on the options installed and the device used in accordance with the following displayed criteria Criteria of rejection of the VLFI In order not to compute the VLFI if the repiratory peak could not be identif
70. of any part of ECG ECG detail window plus a few minutes before and after in order to correctly situate this detail in its context ECG context window From the detail window a QRS can be relabelled individually and a wrong event can be deleted An event search small window allows you to explore the 24 hour recording event by event in each pathology by moving along either chronologically or depending on the seriousness of the events A click on the mouse in any part of the heart rate curve superimposes a vertical cursor and displays the corresponding ECG in the Detail and Context windows A right click in one of these windows will open up a pop up menu enabling you to modify their contents presentation scales etc e Frequency average of the averaged in accordance with the sampling o Complete averaged of three RR excluding the Artefacts Page 48 HOLTERSOFT The ECG o Sinus averaged of four consecutive normal RR exclusion of the Ventriculars Supra Ventriculars and Artefacts Sampling 15 30717 or 2 Displayable Histograms according to by sampling interval e Number of events Vx3 tripled ventriculars Vx2 doubled ventriculars isolated ventriculars All V all ventriculars 5 3 Sx Sxl AIS RRx2 double RR Absolute Pauses Relative Pauses Max length of events number of QRS except for the pauses TV RIVA RIV TPSV Ventricular t
71. of monitoring 5 6 1 3 Procedures created inside of the recording Horizontal strips in the lower part of the window represent the procedures included in the complete recording After download of a recording from a CF card a procedure is automatically created with the first 24 hours It is then the active procedure represented with a green strip if it has already been analysed or a white strip if not The following part of the recording is divided in as many 24 hour zones or less for the last one as allowed by the total duration of the recording These 24 hour periods are represented with yellow strips which are procedures to be defined they can be created as shown or their beginning and or ending times can be modified by the user HolterSoft Manual Page 63 HOLTERSOFT The ECG 5 6 2 Create procedures from the complete recording 9 6 2 1 Initial window Complete Recording window after download and before analysis of a Vista recording 26 02 2002 18 30 2870272002 15 49 ra Q 1D 20 22 3 The Procedure On Going strip is white which means that this procedure has not been analysed yet Once analysed it will be green In the about 40 hour recording above HolterSoft Ultima automatically created a procedure with the first 24 hours and offers by default the creation of a second one with the next 20 hours yellow strip Procedure to be defined Creating other procedures is not mandatory In this example on
72. of the red flashing bar to reproduce the procedure as it was before the bar started flashing After a cancellation the red flashing bar disappears 35 It is important to note that All modifications taken into account by a reprocess are cancelled in one go by clicking on Cancel modifications Once the recalculations have been carried out no flashing red bar cancellation is impossible HolterSoft Manual Page 42 HOLTERSOFT Analysis HolterSoft Manual Page 43 HOLTERSOFT The ECG 5 ECG examination 5 1 Complete tool bar 5 1 1 HolterSoft Ultima standard with no options Once the analysis 15 completed the tools bar presents on the right of the ECG Analysis button several other buttons allowing to watch or to reorganize the results WE EINE The windows that have been opened by these icons be closed by clicking on them again keeping the keyboard Shift key pressed down at the same time Obviously the number of icons depends upon the number of available hardware and software options installed HolterSoft Ultima offers communication module with any Novacor holter recorder data bases management ECG analysis and printing with chaining capability screen Start up test 5 1 2 HolterSoft Ultima with Pack Plus option Pack Plus option adds the following 4 optional modules Pacemaker ST segment RR variability and Archiving 5 1 3 Ho
73. olterSoft Manual Page 53 HOLTERSOFT The ECG Seriousness Re Using the video recorder style keys it is possible to move from an event to another one of the same kind according 14 4 Chronology MI either to their chronolo or if available to their seriousness gy b Y a simple arrows Previous next immediately less or more serious stop arrows x First last le less the most serious 5 4 2 4 Deleting false events When an event 15 selected its beginning and ending times are indicated on the left and right sides of the Relabel as Artefacts button A AA AAJ A right mouse click on this button relabels as Artefacts each of mi il CH the QRS included in the event then reprocesses all rhythm trouble and finally jumps to the next event of the same kind 10 24 24 08 08 2 11 34 This is equivalent to deleting the event If the keyboard Ctrl key is simultaneously held down the rhythm trouble reprocess is not perform this allowing to delete an event and jump to the next one instantaneously If this next event 15 correct you can jump to the following one using the chronological moving arrow and so on check all events in a given category deleting the wrong ones if any Finally a click on the ECG Analysis button flag will start the reprocess for updating all rhythm trouble In the case of a FA or an S event this button enables you to delete the FA or S o
74. on This enables the software to have access to the recorder or its memory card when inserted in the memory card drive in the computer You can test its condition read its contents recording of a procedure or program it for a new procedure 2 2 2 4 Chaining button Chain analysis and report chain printing functions ES E This function enables you to start up an automatic analysis of several procedures or to automatically print out several reports HolterSoft Manual Page 20 HOLTERSOFT How the monitoring works 3 How the monitoring works 3 1 Recorder computer connection 3 1 1 Using the memory card 3 1 2 The All the exchanges between the recorder and the computer are done via the memory card PCMCIA card also called PC card for Uno Duo Trio and Quattrolter Compact Flash Card also called CF card for Vista series recorders There is no cable to connect the recorder to the computer this guarantees the up most security for the patient but also stops you from sending the time from your computer to the recorder It is therefore necessary to manually set the time if you need to You only need to do this once this does not concern the Unolter which does not have an internal clock Communication window Click on the Communication icon Holter communication of the tool bar in order to open up VISTA the Holter communication window YTA02000004 from where you will be able to either program a PCMCIA c
75. ort activity 1871272003 14 19 31 Patient ACT vez Procedure 14 04 2003 16 20 00 1 Sporadic 2 Sustained Speed Time Activity code Type Speed 1 1 Systole a un Oo C CO BI Bi BO BO BO BO B BO RO RO BO bo Cn Ch Ch CR Codes 5 and 6 5 lying down 6 standing up or seated correspond to recordings with position without activity Duolter Access Triolter Quattrolter without Activity cable Codes 0 to 4 correspond to the activity recorded by a Quattrolter with its Activity cable Page 85 HOLTERSOFT Position and Activity HolterSoft Manual Page 86 HOLTERSOFT QT module 9 QT and QT variability 9 1 Presentation 9 1 1 Purpose of the QT module The purpose is mainly to calculate QT intervals on normal complexes averaged during 30 second periods averaging periods Values are calculated separately on each recorded channel Complexes must meet several conditions in order to be included in calculations i e T wave amplitude A 30 second calculation period is rejected 1f some rejection criteria are met for example a too low of complexes The user can easily access the results on screen either in tables or in graphs and print them if necessary in the final report Results also include trends on the procedure duration hourly means and QT variability versus RR intervals The QT feature is inten
76. ow in its part STE play Utilities windo 5292 ES IR 10 28 30 poe a PERR n t RA IDA UL UP 00 pum Standing up Seated Lying down Active walking Active cycling Page 84 HOLTERSOFT Position and Activity 8 3 Export results of Position Activity X Olter HolterSoft Manual When BP measurements have been recorded on a X Olter range unit two new buttons appear in the left lower corner of the BP measurements window 11 12 102 84 11 27 119 103 11 42 150 34 11 57 101 80 12 12121 60 9 97 Correct 94 250 i OK 102 235 amp OK 31 245 O K g8 247 SK 225 i Copy table Export activity Incorrect Copy table Copies the whole measurements table in the Windows clipboard same effect as the Copy table item in Procedure menu Export activity Creates an Excel file xls containing all activity values or position values if no Activity cable was connected stored at a 1 per sec rate during recording In its header the created file indicates the patient s name the date of recording and lists the used activity codes Exp
77. plays all values as graphic trends below the heart rate trend HolterSoft Manual QT chronogram These trends are available channel by channel for all parameters t 04 03 00 QT a 329ms amp QT e 373ms auto scale 01 Chronogram OT a amp OTe Channel 1 20 00 22 00 0200 0400 0600 0800 10 00 12 00 14 00 16 00 A double click in the diagram opens the Average window corresponding to the averaged period closest to the mouse pointer The buttons in the left lower corner allow access to the OT histogram and the first Averaged OT windows Page 89 HOLTERSOFT QT module 9 3 3 QT variability The last button opens the OT RR window in which each cloud of plots groups all intervals values QT by default versus the mean RR value of the averaged period As in the OT Chronogram window variability is displayed channel by channel for all parameters and the buttons in the left lower corner allow access to the OT histogram and the first Averaged OT windows 9 3 4 Histograms The OT Histogram window is opened with a mouse click on this button from OT Chronogram or QT RR windows As 1n the above windows histograms are displayed channel by channel for all parameters A double click on one of the histogram bars opens a window showing the 1 averaged QT of the procedure measuring the value on the horizontal axis A double click on an arrow above the histog
78. plex 100 ms Four markers on the averaged complex show the Q R Ta and Te points as calculated by the software The position of each marker can be adjusted in the frame Move marker in the right part of the window select the desired marker with a mouse click on its button and move it using the arrows to the right of the buttons Once a marker 1s moved a Cancel button allows the retrieval of all buttons initial position Results table in the right part of the window shows all calculated and measured values for the displayed averaged QRS T complex If a 30 second period does not meet all acceptance criteria either it 15 not displayed if not enough elements or it 1s displayed on a grey background In both cases such periods are not included statistics or in graphs The displayed averaged QT will be printed by checking Print in report check box The lowe frame lists all the averaged QT chosen for printing 1531 Channel 1 Any averaged QT can be manually deleted with a mouse click on the wastebasket which then turns red This operation can be reversed a mouse click on a red basket restores the previously deleted averaged QT Page 91 HOLTERSOFT QT module 9 3 6 The Procedure window 9 3 7 The HolterSoft Manual 7 Two tabs in the Procedure window dedicated to QT Conclusion on the right allows the entry of free text as for ECG or BP which will be
79. position its beginning and then resize it on its right side Page 59 HOLTERSOFT 5 5 4 Moving T Wave template HolterSoft Manual The ECG It happens that after completing initial automatic analysis a template is built with T waves that the software wrongly identified as V beats If all real QRS preceding these T waves had been correctly detected you only have to delete the wrong template right mouse click and Delete see 5 2 7 p 42 Nevertheless a part of or all the real QRS preceding these T waves may not have been detected Deleting the wrong template would then create as many wrong RR intervals as not detected beats relative pauses or double RR intervals The solution consists in selecting one of the T waves the preceding beat of which has not been detected and to drag and drop it to the exact beat position It can be then resized and or relabelled if necessary ur Le 210 x 177 Vi4 159 27 23 28 Em Example of a template built with T waves most real beats are not detected a type some are b type Select and point at a a type element in ECG Detail window Drag and drop it at its right place over the undetected beat Confirm Validate whole TT change Validate single QRS change whole template cha 780 980 Validate single QRS change N Validate whole template ch
80. printed the Conclusion frame on the 1 page of the final report OT tab displays global statistics for day and night periods Number of QRS 107614 Correction formula BAZETT Channel 1 Channel 2 Channel 3 General Number of analysed QRS 61522 of analysed QRS Daytime period Maximum at gt threshold OT tab in Procedure window can display 17 33 00 global statistics either 18 33 00 the day period as 19 11 30 24 gt 340 ms 1 1 opposite example 16 12 00 1 gt 440 ms PP 18 43 00 100 gt 200 ms or the night period or 16 12 00 100 gt 300 ms HA both with a mouse click on either Day or Night buttons or both on the right above the table In this window it 1s also possible to modify for the current procedure only thresholds and correcting formula automatically defined by the Default values in the Settings menu Printing window A full separated report can be printed for the QT analysis results as for ECG or BP results The OT tab in the Printing E QT std X Printing window allows Close the user to fully x Lover pae General options for QT customize final report i mew S Night time statistics X amp OTe X amp Tec New according to x Statistics 00001 RTa amp RTe RTac amp RTec 24 hr summary requirements O Delete
81. printed in italics in the final report to make easy to locate it or change it again later A manual change in a window does not impact any other window 10 2 2 Whole column in hourly table A mouse click on the header of a column selects the entire column and any value entered 1s applied to each line of the column This 16 specially useful to turn all column values to 0 10 2 3 Retrieving the initial value It is always possible and easy to retrieve the initial value automatically calculated by HolterSoft of a modified value 38 1 38 1 38 1 60 1 60 ER 1 B 58 1 1 0 10 10 0 10 10 0 Click on the value A R button appears The initial value to retrieve Click on R is back HolterSoft Manual Page 94 HOLTERSOFT The Report 11 The report HolterSoft Manual The procedure report consists of three main sections one for the ECG one for the ABPM and one for the QT Each section is entirely configurable in order to show only the data that interests you in a given monitoring The Pressure tab 1s not available in ECG only procedures neither the QT tab in a procedure where the QT analysis has not been performed They can be accessed however via the Settings Reports menu These tabs are not available if the corresponding option is not installed Click on the Print button of the tool bar Printing ECG Blood pressure Apnoea Cover page List of events HH variability
82. r Six buttons on the tool bar give you access to the ABPM results Ifno BP measurements have been taken these buttons will not show With BP measurements these buttons will be activated right after reading the recording and the results will be immediately available by clicking on them If there is no QKd measurement Duolter Access the sixth button does not appear 3 2 2 2 ECG all recorders After downloading an ECG recording three buttons will be displayed for the Vista and only two buttons will be displayed for other recorders g The 1 one exclusively for Vista recordings opens the Complete Recording i window which displays the heart rate trend for the whole monitoring up to gt 11 days and allows creation of procedures Gives access to the ECG Analysis window automatically open after a reading and which must be closed before any other action E This last button corresponds to the ECG Context window which 15 automatically open as a background after a reading After the ECG signal has been transferred to the hard disk on your computer you can start the analysis immediately cf 5 1 page 28 in order to have the overall events troubles curves and results required HolterSoft Manual Page 24 HOLTERSOFT How the monitoring works 3 2 2 3 ECG recorded during more than 24 hours Vista range Vista and Vista Plus recordings can last more than 24 hours up to 11 days usi
83. r Start Run menu Select the item HOLTERSOFT ULTIMA in the Welcome page Installing the software and follow the instructions on the screen M NOVACOR LU LL LL NOVACOR Installing the software NOVACOR Installing the software Welcome Welcome to the NOVACOR product installation CD Rom Select a product to install RTSOFT DIASYSOFT HOLTERSOFT ULTIMA hr NOVADRIVE TELEMEDECINE UTILITIES MANUALS 666 664 EME OOOOH SE The installation is in two parts firstly the index and files concerning the HolterSoft and secondly the index and files concerning the memory card drive These two installations automatically follow each other If your software indicates that you must restart your computer once you have finished the installation please do so HolterSoft Manual Page 18 HOLTERSOFT HolterSoft Ultima 2 1 8 Upgrades and options The monitoring for the ECG and ABPM are available separately or together For each one of them the basic functions are already available and if you only have one of them your software can be completed at a later date 1f you so wish This will have no effect on your existing database Processing of recordings performed with Vista recorders requires installation of corresponding option Vista option These new functions are added either with an extra CD Rom used the same way as the installation CD Rom see 2 7 3 above or
84. ral templates If one or several templates do not contain real beats it 1s possible to delete them definitively Select the template s to delete and bring the mouse pointer over a selected black one Group Relabel Open the pop up menu with a right click select the Delete item then release the mouse button Vertical scale Channel TES The beats so deleted are not relabelled into artefacts Wise gules but ignored as analysed elements 4 2 9 Flashing red bar reprocess As soon as you have regrouped or reclassified a red bar will start to flash at the bottom of the screen in the information bar This is to inform the user that due to the fact that he has made a change all the tables of the results as well as all the lists already established are now void they must be updated The user can continue regrouping or reclassifying without updating The software will automatically carry this out in certain circumstances for example a click in another window However in case you need to this update often called reprocess can be carried out at anytime by a simple click on the Analysis button chequered flag 4 2 10 Cancelling a modification It is possible to cancel any modification such as a reclassification or a regrouping of QRS templates as long as the recalculations have not been carried out Click on the Cancel modifications button to the Cancel madifications right
85. rams shows the corresponding averaged QT with the highest value 35 Please take note when the Averaged QT window is already opened a single instead of a double mouse click displays the desired graph HolterSoft Manual Page 90 HOLTERSOFT QT module 9 3 5 The Averaged QT window HolterSoft Manual 24 hour recording contains 2880 30 second periods allowing calculation of an averaged QT For each recorded channel the first one of these periods 1s reached with a click on 2T this button in the left lower corner of the OT chronogram or OT RR windows A click in the trend curve OT Chronogran Stronogiem amp Te Channel 1 window allows then to display the averaged Q1 which is the closest to the pointer You can also move to the previous next one with the displacement arrows OX x 1537 Channel Channel2 Charnia 1115 window Averaged Results Maa Shows the QT representing the poe 30 second period labelled by its min max mess chronological number and its T wave amplitude 152 ata 4 3 5 ga 329 beginning time in the right A 389 344 ms 4 347 ms RTacHJ 300 ms upper corner A anms 363 m en Emo It also positioned in Ly ta recording with a vertical marker a Bol gt on the heart rate trend displayec Print in report 1 nv above the averaged com
86. re general settings choice of language and display formats date and time adjustments Other settings allow you to customize the device contrast adjustment hook up operation displays and buttons actions during monitoring Warning Due to the fact that the time on the computer cannot be transferred to the recorders it is necessary to check it and or set it directly on the unit by pressing simultaneously both buttons on the X OLTER range units Duolter Triolter Quattrolter on screen for the Vista range units Nevertheless in case of a wrong date or time a correction can be made at any moment in the Procedure window HolterSoft Manual Page 23 HOLTERSOFT How the monitoring works 3 2 2 Reading a recording In the Holter communication window the Read the procedure from a device button is activated only if the card contains data Click on this button in the Holter communication window to transfer the recordings obtained during the monitoring to the hard disk of your computer After the transfer and the assignment to the corresponding file the file concerning the new procedure 15 created the ECG Analysis window opens if the recording contained ECG with the first minutes of patient ECG in the background order to make easier the choice of channels for analysis and the tool bar 1s completed with several buttons 3 2 2 1 arterial stiffness Duo Trio and Quattrolte
87. rea are displayed the right lower corner of the ECG Detail window 5 4 5 1 Duration measurement Interval of time between beginning and end of the measurement area For example here t 0 255 s represents a QT interval of 255 ms t 0 2598 2 5 4 5 2 Heart rate measurement If the measurement area corresponds to one or several RR intervals the mean heart rate of the selected period is indicated after its duration 4 RR 3 61 s HR 66 5 min 18 34 00 38 t 3 610s 65 5min 1 0 3 Dy2 0 1m Dy3 0 1m 5 4 5 3 ST shift measurement HolterSoft Manual The vertical shift between beginning and end of measurement area is then given for each channel Locating the beginning of measurement area on the base line before the QRS and the end on the ST segment you get the ST shift on all channels Example channel 1 ST shift Dy1 0 and channel 2 ST shift Dy2 0 4 mV 1 4 mm Page 57 HOLTERSOFT The ECG 5 5 Insert move resize QRS 9 9 1 HolterSoft Manual These operations are possible in ECG Detail window under any horizontal scale Nevertheless 200 Hz and 400 Hz zoom scales allow a better accuracy More the 400 Hz zoom shows all QRS and artefacts positions and dimensions simultaneously by including them in a vertical strip in the corresponding colour blue for N red for V and grey for A When a complex is moved or resized the same
88. required to conclude 7 1 3 Rejection criteria HolterSoft Manual Two criteria can be activated to improve the results Position of the respiratory peak in order not to compute the VLFI if the respiratory peak could not be identified in the bracket 0 15 0 40Hz The estimated respiratory peak appears in red on the curve pNN50 20 in order not to compute the VLFI if the pNNS0 is higher than 20 Page 74 HOLTERSOFT Sleep Apnoea 7 1 4 The Sleep Apnoea window re Click on this button in the right part of the buttons bar to open the window Sleep Apnea Syndrome Screening cog 23 42 00 6 39 01 Locked 4 93 Y axis Spectral Power 24 4 valid RR 96 9 SCREENING TEST RESULTS High probability for the patient of having a sleep Apnea Syndrome or another Sleep Related Breathing X axis Frequency 7 1 4 1 Upper part HR Trend The heart rate trend 15 displayed for the whole holter recording duration 22 53 58 06 59 59 The hatched area represents the night period period between getting up time and bedtime defined in the procedure window The back area represents the apnoea analysed period By default the software analyses during the whole night period 7 1 4 2 Changing the analysis period Using the mouse To move the analysed period without modifying its duration bring the mouse pointer in the black area an
89. respond to the ECG The scale is displayed on the right of the window switching ms lt gt bpm by simple click e Blue scale corresponding to each RR interval e In red ventricular QRS e In black Artefacts Length Evt under Event _ MEM _ Evt Spo the pointer duration aa 90 Curve SpO2 00 38 Breathing curve IPA Respiratory event SPO Breathing 57 n 40 Values SpO2 97 E gp lt RR 120 cm RR bprm 7 2 1 3 Changing beginning end The beginning and ending time of the analysis are set from the getup time bedtime set in the default values and used again in the General tab of the procedure window HolterSoft Manual Page 78 HOLTERSOFT Sleep Apnoea It is possible to modify the analysis period e directly changing the time displayed next to the green arrow e By moving the vertical green bars 7 2 1 4 Modification of events gt Add Make a right click on the horizontal gray strip corresponding to the desired type SpO or Breathing then add an event gt Delete Make a right click on the event to be deleted then delete event gt Modify e Shifting click on the event with the left button and move the mouse e Reduction Expansion click with the left button on the border of the event and move the mouse gt Cancelling Any deleted or modified event appears in the form of an empty rectangle phantom
90. rigeminy Ventricular bigeminy Supra ventricular trigeminy Supra ventricular bigeminy Bradycardia Tachycardia Auricular fibrillation ST channel 1 events according to the criteria defined in the analysis ST channel 2 events according to the criteria defined in the analysis Pauses length of the pause Number of beats TV RIVA RIV TPSV Ventricular trigeminy Ventricular bigeminy Supra ventricular trigeminy Supra ventricular bigeminy Bradycardia Tachycardia Auricular fibrillation ST channel 1 ST channel 2 e Other histograms HolterSoft Manual Page 49 HOLTERSOFT The ECG Artefacts Tendency ST voie I display of the average of the shift and of the slope Tendency ST voie 2 display of the average of the shift and of the slope Diastole Systole Tendency Activity HolterSoft Manual Page 50 HOLTERSOFT The ECG 5 3 The ECG Context window This window located by default the right part of the results screen allows to visualise one page of several minute compressed ECG 5 3 1 compressed ECG and RR intervals 11 21350 11 21 47 11 22 03 11 22 20 11 22 36 11 22 53 11 23 09 11 23 26 x The bottom part shows the successive RR intervals In both parts ECG and RR intervals a right click allows to modify horizontal and vertical scales anda light blue strip locates the content of the ECG Detail window 5 3 2 ECG scrolling
91. s Page 8 HOLTERSOFT 9 5 INSERT MOVE ORS idee disse aetate ten i vetus lata 58 La EIN 58 IIL HM VOU OR S ee 59 DIRLO ee 59 JIA MOVING a T Waoye sii 60 5 5 5 Using 400 Hz horizontal scale 88888888 61 5 5 de Types ORI 61 61 5 6 VISTA COMPLETE RECORDING WINDOW 63 CON CI Ds 63 56 11 Imformabtion n completerecordme iii Li li 63 RR RE E I 63 5 6 1 3 Procedures created inside of the recording 63 5 6 2 Create procedures from the complete 59588829 64 9562221 c 64 302 2 Proceduresto De COMMA iis ilaele aa 64 5 02 93 Procedure Ce ICG 65 25 02 2 Create the DEOCOQUEG si 65 6 HEART RATE VARIABILITY ET S v esa sien Va ESTRETES 66 6 1 THE RR SPECTRAL ANALYSIS WINDOW trainare 66 6 22 THE RR HISTOGRAM WINDOW 2 E ca 67 0 2 1 RR vari bility parameters ici 67 0 2 2 S JDISDIOY RE MINO iii iaia 68 6 2 3 Searching among different 68 6 9 THEREB SPECTROGRAM WINDOW allaccio lana 69 VAT ND OI TII PT 69 b32 Chee
92. s s 3415 Nocturnal Breath rate Tm ECG Correlation Inl DIFF event SONN 119ms 123ms Ventricular 30 Correlation beetwen Bradycardias ECG and Breathing Pauses Sp Correlation Apoeas with desaturation 433 Parameters Breathing Decrease 50 min 10s max 100s Sp Desaturation 4 min 12s max 1008 E Notes sas grave pour figure The two tabs Breathing and will provide specific information for each parameter as well as an analysis relative to the other parameters Respiration vs SpO Respiration vs ECG SpO vs ECG Breathing tab Breathina 5 02 Mean duration of events s 441s Nocturnal Breath rate D min ECG Correlation In DEF event SDMM 113ms 123ms Ventricular 3 0 Correlation beetwen Bradycardiaz ECG and Breathing Pauses 00 SpO2 Correlation with desaturation 433 80 HOLTERSOFT Sleep Apnoea SpO tab Breathing Sp02 Mean 02 saturation gn a Diurnal 02 A X saturation 30 0 Standard Deviation For 02 saturation 5 Saturation lt 90 Duration 02 49 35 Desaturatians Mean Mean duration 44 25 max Descent mean duration 32 18 ECG Correlation Inl DIFF event vomer Ventricular 4 0 Bradycardias 070 Pauses 0 0 7 2 3 Apneas Report Printing ECG Apnoea x x Cover page x Detailed Results x Histograms x Printing setup It is possible to print a specific report on the analysis
93. sented by red letters and numbers and Artefacts A represented by black letters and numbers The templates are grouped together categories from the largest to the smallest template 4 2 3 Details of the templates window Number of QRS in the template Morphology N blue Normal V red Ventricular A black Artefact Total number of templates Template number The blue arrows left right for the exploration of the family a click last QRS following QRS A maintained click continuous scrolling Click Ctrl pressed down Superimposed continuous scrolling Position and width of the QRS determined by the software Grey Blue strip Position in the recording of the displayed QRS Green cursor Some templates show a grid with nine beats it s in fact templates that contain beats of the same type but with different shapes These templates can be found in two cases grouping of the least numerous templates grouping of some beats found during episodes of VT v 323 13 i gt 22 SS 5 gt gt 2 2 gt Template not homogeneous Those templates cannot be printed HolterSoft Manual Page 34 HOLTERSOFT Analysis 4 2 4 Operations on the templates HolterSoft Manual The software enables you to simultaneously either reclassify one or several templates consult modify the contents of a given template group together several templates with the s
94. shape In order to cancel a deletion or a modification make a right click on the former position of the event then restore event Example of a moved and resized event Note the events that appear in the form of an empty rectangle are not used for the analysis Note 2 the modifications on the events are automatically taken into account for the results of the analysis 7 2 2 Apnea results HolterSoft Manual A complete summary of the analysis is accessible from the Examination window Apnea tab Three index are represented on a colored background Breathing Spo Duration of valid signal Quality 06 51 33 06 53 83 35 8 Mumber of events 467 407 index Mi 4 93 79 HOLTERSOFT HolterSoft Manual Sleep Apnoea Breathing corresponds to an apnea hypopnea index AHI In green AHI lt 10 low probability In orange 10 lt AHI lt 30 In red AHI gt 30 high probability SpO corresponds to an oxygen desaturation index ODI In green ODI lt 10 low probability In orange 10 lt ODI lt 30 In red ODI 30 high probability VLFI takes again the information of the VLFI see 87 1 lt gt Procedure Analysis period 23 42 gt 06 39 05 57 Duration Breathing 5 02 ZYLFI Duration of valid signal Quality 06 51 83 06 53 82 96 9 Number of events 467 407 index 4 93 Breathing 5 02 Mean duration of event
95. should it be found illegible After this period of time a set fee will be charged for a replacement The software and their accompanying manuals are sold as they are without any guarantee as to their quality their performance their accuracy or their ability to reply to a specific need In consequence the use of the results and the diagnosis established according to these results are the entire responsibility of the physician No loss or alteration of the data or any damage either direct or indirect caused by the use of the software may be attributed to NOVACOR S A or its distributors Page 12 HOLTERSOFT 1 4 Manual Licence agreement Information contained in this manual is given only as an indication and does not engage the responsibility of NOVACOR S A NOVACOR S A accepts no responsibility for any errors or inaccuracies which may be found its manuals The examples measurements and charts shown in this manual are fictitious and shown only for the purpose of illustrating the use of the HolterSoft software They have no scientific or medical value and cannot be used for any purposes other than the teaching purposes of this manual NOVACOR S A may change the functions of the software and the manual which explains them without prior notice 1 5 Governing jurisdiction This agreement 15 governed by French law and the only jurisdiction which applies in the event of a dispute 1s the exclusive jurisdiction of the Frenc
96. t details A click on its arrow pulls the list down this displaying all the events searched by HolterSoft Ma selection il The number of detected events of each kind is indicated between parenthesis In this example there are 2 ventricular doublets 9 isolated ventricular beats no ventricular bigeminy or trigeminy events 1 supraventricular tachycardia etc A click on a line of the list results in displaying the 1 event of this kind in the ECG Detail window 10 24 24 08 10 24 24 08 In addition to the standard events it 15 possible to access specific episodes All V S A access to QRS according to their type e Volunteers access to symptomatic episodes e Patient Journal vocal messages recorded by the patient e Spikes for the stimulated patients access to the recorded stimulations e Artefacted periods areas with over zones de plus de 2 unanalyzed 5 4 2 2 Information frame Qi Event details Atrial fibrillation 1 Complementary information about the selected event if any is displayed the black frame below the name of the event In this example are indicated the number of QRS the event 4 4 Chronology y duration and its mean rate A AA LN d Please note that mouse clicks in this frame toggle beginning 10 24 24 08 08 27 11 94 and end of event displayed in ECG Detail window 5 4 2 3 Watching all events of the same kind H
97. t to it Point inside the selection frame The shape of the pointer changes when passing over the frame and becomes an arrow inside Hold down left mouse button Drag the selection to the desired location Release mouse button Select Point Drag Drop You still have to relabel the moved QRS into N using the right mouse click see 6 4 1 1 page 52 and to finally validate the change with a mouse click either on the ECG Analysis button or in another window A QRS can be moved between the previous one and the following one 5 5 3 Resize a QRS HolterSoft Manual Select the complex to be resized with a mouse click next to it Bring the pointer above the concerned QRS edge The shape of the pointer changes and becomes an horizontal double arrow Press and hold down left mouse button Drag the QRS edge to the correct location Release the mouse button x Validate single QAS change Validate whole template change 600 850 600 850 Select Point Drag Drop This QRS belonging to a template containing several complexes in general a pop up menu automatically opens to specify if the resizing applies to this QRS only or to all QRS from the same template Click the correct choice to finish In this example we could proceed same way with the beginning of the QRS It would have been also possible first to move the QRS to precisely
98. th a Ventricular one HS RR variability Poincare diagram Y axis Duration of interval ms X axis Duration of interval ms It is possible to adjust the relative size of each subwindow by pointing with the mouse at the corner common to the 4 The pointer becomes a move cross that can be slided for example to the lower right corner of the window in order to better show the N N part which 15 the most useful The 3 other subwindows are generally not used Every plot of the diagram represents all RR intervals of same duration The clearer the plot the higher the number of intervals it represents according to a scale in the bottom left of each subwindow HolterSoft Manual Page 72 HOLTERSOFT RR variability 6 4 2 The Normal Normal diagram Zi RR variability Poincare diagram On this diagram are superimposed an angular sector the apex of which is located on the axis origin covering about 90 of the RR intervals aregression ellipse also covering about 90 of the RR intervals the dimensional characteristics of the ellipse LI length of the ellipse ms Lb width of the ellipse ms Lsd distance between ellipse and mass centres ms of points included in the ellipse 6 4 3 3D display PECTEN By default display is made in 2D A right mouse click allows to choose 3D display either in tones or in colours A RR variability Poi
99. ths like WMMachine path e Index Section Allows to browse the tree of mapped discs starting with a letter only e Procedure list list of the examinations contained in the current database with the possibility to filter by the first letter of the patient name vertical section on the left of the list with buttons and a possibility to sort by column Icons signification Fh ECG MAPA examination XOlter type unprinted VISTA examination uncreated VISTA examination created and analyzed unprinted MAPA examination unprinted ECG examination analyzed non VISTA and printed ECG examination unanalyzed non VISTA unprinted 5 2 examination analyzed and printed Patient without procedure In order to copy one or several procedure in another database a Drag amp Drop of the examination must be done on the name of the destination database in the Favorites or Folders section HolterSoft Manual Page 97 HOLTERSOFT Other If the Drop 15 done on a folder not containing any HolterSoft database without the red dot on the file the software will recreate a new database the chosen directory by asking for its name 35 To open the Procedure window faster it 1s advised to reduce the Folders section by clicking the button E Allows to assign or modify a password on the current database To erase a password it must be modified and leave the field New password empty 12 2
100. togram groups list allows to join several event histograms together so its becomes easy to display them all after a right mouse click in the results window Heart Rate Histograms see 6 3 p 48 Procedure General ECG Indications and treatments Conclusion ECG Indications mm Updating indications Updating treatments To add an item in the Procedure window pull the list down either directly family names or after a mouse click in the capture field to make it appear indications or treatments and click on the desired item Treatments If the desired item 15 not included in the dropped down reference list it can be typed directly in the data field After validation with Enter key it will be offered to add the new item in the reference list only if that one was kept dropped down Page 93 HOLTERSOFT Data added by user 10 2 Manually correcting quantitative results Procedure ECG tab and Hourly Events Table windows display quantitative results that can be printed in the final report When necessary the numerical values displayed in these tables can be modified for example in case of erroneous results when correct values are obvious and updating using relabelling and reprocessing by the software would take too much time 10 2 1 Modifying a value Click on the number Type the new value Press Enter key to be changed Once a value has been changed it is displayed in red and will be
101. trl 8 Ctrl 7 Ctrl 6 Ctrl 5 Ctrl 4 Ctrl 3 Ctrl 2 Ctrl 1 You can select several templates that do not neighbour one another by using the precedent methods whilst maintaining the control key pressed down This will keep all the parts which you have already selected If the new selection 15 applied to one or several already selected templates they will become deselected Ctrl click and or Ctrl click and slide Selecting by using the keyboard Particular selections can be obtained by combining the control key and other buttons on the keyboard Selects all the Normal templates Selects all the Ventricular templates Selects all the Artefact templates Selects all the templates with 9 QRS or less Selects all the templates with 8 QRS or less Selects all the templates with 7 QRS or less Selects all the templates with 6 QRS or less Selects all the templates with 5 QRS or less Selects all the templates with 4 QRS or less Selects all the templates with 3 QRS or less Selects all the templates with 2 QRS or less Selects all the templates with 1 QRS Page 37 HOLTERSOFT Analysis 4 2 6 Relabelling or grouping templates together 4 2 6 1 Using the right button of the mouse HolterSoft Manual After having selected the concerned templates place the pointer on one of the selected templates any one and click on the right button of the mouse Templates 42 Relabel Delete Vertical scal
102. with the histograms and the BP measurements if any and the ECG strip Detail below and Context on the right jg If no window 15 opened a click on one of these three buttons will be the same as clicking on all of them at the same time this shows the results screen and will therefore display the results with three main windows and a small Event information window 5 2 3 Lists The next three buttons enable you to display on the screen the table of hourly events the complete list of events and finally the list of events to be printed the final report HolterSoft Manual Page 46 HOLTERSOFT 5 2 4 RR variability 5 2 5 Pacemaker The ECG This group of buttons concerns the RR variability This displays the spectral transform Fourier the RR intervals histogram the RR intervals spectrogram or the Poincar Lorentz charts The Pacemaker window with various results and graphics relative to the pacemaker functions such as pacing mode and percentage 5 2 6 Sleep Apnea analysis The Screening for SAS window helps to diagnose obstructive sleep apnoea syndrome by displaying a specific index Vo VLFT The Apneas window gives access to the Breathing and SpO parameters as well as to the results of the analysis The 3 buttons corresponding to the QT module allow to display the hourly means table the QT trend graph the variability graph 5 2 8 Pati
103. yed Click on this button to open the RR histogram window RR Y axis Bl 21152 Number of a Ventricular QRS 205 RR versus RR ala durati on 4 Chronology RR variability SDNN 162ms 50 19 92 SDANN 147 ms 50 18030 SDNNIDX 73 ms MeanNN 722 ms RMSSD 50 ms X axe Duration RR 1200 ms 6 2 1 RR variability parameters SDNN also referred to as CLV Cycle Length Variability or SDRR Standard Deviation of all Normal RR intervals in the entire 24 h ECG recording PNN50 Percent of differences gt 50 ms between adjacent Normal RR intervals in the entire 24 h ECG recording SDANN Standard Deviation of the mean of Normal RR intervals for each 5 min period of a 24 h ECG recording NN50 Number of differences gt 50 ms between adjacent Normal RR intervals in the entire 24 h ECG recording SDNNIDX Mean of the Standard Deviation of all Normal RR intervals for all 5 min periods of a 24 h ECG recording MeanNN Average NN interval for the entire 24 h ECG recording RMSSD Root Mean Square Successive Difference The square root of the mean of the sum of the squares of differences between adjacent Normal RR intervals over the entire 24 h ECG recording HolterSoft Manual Page 67 RR variability HOLTERSOFT 6 2 2 Display of RR intervals A mouse click in the histogram displays a reticle centered on the top of the histogram bar under the pointer Its vertical l

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