IEEE TRANSACTIONS ON BIO-MEDICAL ENGINEERING, APRIL 1968

128

Short Communications
Preprocessing Program for
Real-Time ECG Rhythm Analysis

AZTEC,

Abstract-A preprocessing program developed for real-time

monitoring of the electrocardiogram by digital computer has proved
useful for rhythm analysis. The program suppresses low amplitude
signals, reduces the data rate by a factor of about 10, and codes the
result in a form convenient for analysis.

Digital computers are able to provide the biological

scientist witlh extensive comlputational capacity. However, a common difficulty that biologists encounter is
the transformation of the observed analog signals into
a form that can be easily processed by a digital computer. This poses a significant problem for those who
wish to use a small computer for on-line or real-time
interaction with their experiments. Our problem is the
real-time analysis of electrocardiographic rhythm and
we have developed a scheme to assist this analysis called
AZTEC

(amplitude-zone-timie-epoch-coding).

The electrocardiogram is composed of low frequency

components (P and T waves, ST segments) and medium
frequency components (QRS complexes). We have
chosen to ignore higher frequency components in the
QRS.1 The signal amplitude is 0.1 to 1 mV, and frequently contains undesired signals of similar amplitude
ranging from very lowA frequencies (respiration at about
0.2 Hz) to high frequencies (muscle noise up to about
200 Hz). Power line interference at 60 Hz is also cornmon. For accurate quantification of the duration and
amlplitude of the rapidly changing QRS we have chosen
to sample the electrocardiogram at a rate of 500 samples
per second.2 For anything but a trivial continuous realtime analysis, this data rate would overwxhelm most
computers. The memory size of the LINC3 employed in
this work, 2048 twelve-bit words, made the need for
data reduction even greater. In addition, some form of
preprocessing was desirable to filter unavoidable noise
recorded with the ECG signal.
Our AZTEC preprocessing program is activated by a
real-time interrupt that converts a sample of the input
voltage to digital form every 2 milliseconds. The first
sample v0 (see Appendix for notation and a compact
Manuscript received September 25, 1967; revised November 5,
1967. This work was supported by the Division of Research Facilities
and Resources, National Institutes of Health, Bethesda, Md., under
Grant FR-00161.
I P. H. Langer, Jr., D. B. Geselowitz, and F. T. Mansure, "Highfrequency components in the electrocardiograms of normal subjects
and of patients with coronary heart disease," Am. Heart J., vol. 62,
pp. 746-755, July-December 1961.
2 C. A. Steinberg and L. WV. Paine, "Methods and techniques of
data conversion," Ann. N. Y. A cad. Sci., vol. 115, pp. 614-626, July
31, 1967.
3 V. A. Clark and C. E. Molnar, "A description of the LINC," in
Computers in Biomedical Research, vol. 2, Stacy and Waxman, Eds.
New York: Academic Press, 1965, pp. 35-66.

description of the processing algorithm) sets initial conditions on tWo Iimits: Vmax=Vmin=VO. Samples obtained
at subsequent interrupts are compared to these limits.
If exceeded, a limit is replaced by the voltage just
samlpled. As long as the difference betweein the limiiits,
(V,m,ax - Viin), does not exceed an experimentally determined threshold, the fluctuating voltage is considered
to be adequately represented by a constant voltage, or
"line,'" midway between the limnits. When finally a sample would necessitate separating the limits by more than
the threshold, the preceding average of the two limits is
stored in the miiemory of the computer and called the
value of the line. The time since the limits were initialized is stored as the duration of the line. In order to
avoid long delays in the presentation of data to the
ECG analysis program, a long line is terminated after
126 nis. In our program, the duration of a line occupies
six bits of the first of a pair of twelve-bit wvords and its
value occupies the second word.
When the difference between the voltage limits exceeds the threshold and a pair of data words is recorded,
the process is restarted by setting Vrnax and Vmin equal to
the latest sample voltage. When a signal of higher frequency and amplitude such as the QRS begins, the
voltage samples will change rapidly, and lines of short
duration will be formed. A series of lines, each containing
four samples or less, is considered to be adequately represented by a constant rate of voltage change, or slope,
as long as the voltage difference between adjacent lines
does not change sign. The slope is terminated by a line
longer than four samples or a change in signs. The slope
duration and the voltage betweein the lines bounding
the slope are then stored as the next pair of data words.
In order that this pair may be recognized subsequently
as a slope, the duration wvord is marked by setting its
sign bit.
Fig. 1 illustrates an ECG signal and its resulting
AZTEC representation. The data reduction is from a rate
of 500 samples per second to an average of 25 word pairs
(50 words) per second, or about 10 to 1. The high frequency but low amplitude noise is interpreted simply as
a line as long as the peak-to-peak amplitude does not
exceed the threshold. The QRS consists of seven AZTEC
word pairs, four of which are slopes.
The AZTEC algorithm can be easily followed by additional digital processing, since the calculation time per
sample is considerably less than the time between sanmples for most digital nmachines. For example, we are cLrrently using it as input to a program that evaluates the
signal noise level and, where possible, detects QRS comi1plexes, measures their width, and codes their shape in
terms of their sloping segments. Our implementation of
this detection algorithm is quite fast and can identify

SHORT COMMUNICATIONS

129

line Li is said to be a 'plateau" if r(Li)> T. We call Li

an "extremum" if { (Li+i) -v(Li) } {V(Li) -P(Li1) } <0.
The line Li is a "bound" if Li is a plateau or an extremum. A set of AZTEC lines
is said to be a
"slope" S if no Li is a bound and Lo and Lm are bounds.
The slope S is completely specified by its value, v(S)
=V(Lm)-(Lo), and its duration,

fLi}7`

m-1

r(S) = E T(Li).
i=1

Fig. 1. ECG sampled at 500 samples per second (top) and resulting
AZTEC representation (bottom) as reproduced by a digital plotter.
The horizontal line at the upper left indicates 100 ms and the
vertical line indicates one eighth of full scale, in this case 400 ,V.

QRS complexes of widely varying shape. The AZTEC

algorithm itself could probably be implemented with a
comiplex analog system but our plans call for a series of
digital data reduction steps of which AZTEC iS the first.
Observation of the AZTEC representation of a wide
variety of pathological ECG signals has shown that
AZTEC may be a useful preprocessing procedure for realtime ECG rhythm analysis, as required for continuous
monitoring of patients in intensive care units. The
AZTEC procedure offers the advantages of on-line smoothing, data reduction, and coding. In this monitoring
application noise is relatively low in amplitude and
is therefore smoothed, whereas signal elements are relatively larger in amiplitude and are retained. Since after
such processing the bulk of the ECG consists of steady
voltages, considerable data reduction is achieved by
storage of onlyN a pair of numbers (duration and value)
for a steady voltage up to 126 ms in duration. In addition, the line-slope coding permits rapid searching of the
stored data to locate the higher frequency QRS event.
APPENDIX

The complete AZTEC transformation then consists of an

ordered set of bounds and slopes.
J. R. Cox
F. MI. NOLLE
Biomiedical Computer Lab.
Washington University
St. Louis, Mol. 63110
HI. A. FOZZARD
Dept. of Medicine
University of Chicago
Chicago, Ill. 60637
G. C. OLIVER, JR.
Dept. of Medicine
Washington University
St. Louis, Mo. 63110

Depth Gauge for Microelectrodes

In single-unit studies of the nervous system, design
of the microelectrode drive is one of the engineering
problems encountered. A hydraulic drive system is appropriate in auditory neurophysiology since it allows
remiote, smootlh mlovemiient of the microelectrode from
a position external to the soundproof experimental
chamber. In the system described here, a micrometer
drive is used to exert either positive or negative force on
a piston electrode drive with an assisting spring return.
That portion of the system which is immediatelyr related to the electrode is shown in Fig. 1. The major
problems with this system are dead zone and hysteresis,
due to expansion of the tubing and friction in the piston
drive. Since these nonlinearities depend on when and
how fast the electrode was last moved, accurate knowledge of electrode position cannot be obtained by reading the micrometer drive.
To solve these problems we have developed a method
to accurately measure the electrode position, independent of the hydraulic drive. The basic component of our
system is a linear variable differential transformer.'

The AZTEC transformation may be described as follows. Let v, be the ith sample following an initial samiiple vO. Let Vriiax and v.in be the maximum and minimum
values, respectively, of the set vi } o' where i ranges from
0 to m. If Vin5ax-Vnin.K for the set
(v}il" and
is
Vmax-Vmin>K for the set v}i then the set
said to form an AZTEC "line" L. The line L is completely
specified by its value, v(L) -(Vn,+Vrnmin), and its duration, r(L) = n times the sampling interval. Let v,, now be
the new v0 and repeat the process. This much of the
transformation is called a zero-order linear interpolator
Manuscript received April 28, 1967; revised November 19, 1967.
with aperture K/2.4 It has the property that, if L conThis
work was supported in part by the National Institutes of Health
tains the sample vi, then v(L) -v| <.K/2.
under Grant NB-05143, and by the U. S. Air Force Office of Scientific
under Contract AF-49(638)-1386.
Let Li be the ith AZTEC line following a line Lo. The Research
I Transformers were chosen on the basis of weight, size,
operating

{v,}In

C. M. Kortmani, "Redundancy reduction-a practical method

of data compression," Proc. IEEE, vol. 55, pp. 253-263, March 1967.
I

frequency, and linearity. Those used here were manufactured by

Schaevitz Engineering Co., Model 100 M-L, and Sanborn Co.,
Model 595T-100.