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Cardiac Conduction System (1)

ECG
(Electrocardiogram)
Achmad Rizal
BioSPIN

ARL-EL4703-Instrumentasi Biomedis

Cardiac Conduction System (2)

ARL-EL4703-Instrumentasi Biomedis

The ECG (1)

The ECG (1)

ARL-EL4703-Instrumentasi Biomedis

The ECG (1)


Electrocardiography
1. Standard clinical ECG (12 leads)
2. VCG (3 orthogonal leads)
3. Monitoring ECG (1 or 2 leads)

ARL-EL4703-Instrumentasi Biomedis

ARL-EL4703-Instrumentasi Biomedis

Modern ECG

Figures above show how the


earliest ECGs were recorded by
Einthoven at 1900.
Vats of salt water provided the
electrical connection to the body.
The string galvanometer served as
the measurement instrument for
ARL-EL4703-Instrumentasi Biomedis
recording the ECG.

Electrocardiograph

Holter Monitor

ARL-EL4703-Instrumentasi Biomedis

ARL-EL4703-Instrumentasi Biomedis

Dipole Model

Standard Location ?

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ECG Lead Configurations


A pair of electrodes, or a combination of several electrodes
through a resistive network that gives an equivalent pair is
called a lead.
A vector that connects a lead electrode pair is the lead vector.
If the cardiac vector M is known, the voltage generated at any
lead can be easily computed.

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Frontal Plane Bipolar Leads


EinthovenTriangle

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The Einthoven Triangle

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Lead I

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Lead II

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Cardiac Vector Through the Cardiac Cycle


As Seen By Leads I, II and III

Lead III

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Cardiac Vector
Through the
Cardiac Cycle As
Seen By Leads I,
II and III

ARL-EL4703-Instrumentasi Biomedis

Cardiac Vector
Through the Cardiac
Cycle As Seen By
Leads I, II and III

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UnipolarMeasurements:
Wilson Central Terminal
Cardiac Vector Through
the Cardiac Cycle As
Seen By Leads I, II and
III

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Wilsons Central Terminal

Three additional leads are used for frontal plane


measurements.
These are the measurements at the specific electrode, with
respect to a reference electrode
One commonly used reference electrode is the Wilson
Central Terminal, obtained through a resistive network,
combining limb electrodes
The new set of leads obtained by combining the standard
limb electrodes to the Wilson terminal form the augmented
leads
These leads provide additional vector views of cardiac
depolarization in the frontal plane. Unlike leads I, II, III, the
augmented leads utilize WCT, a central negative terminal.
This virtual "electrode" is calculated by the EKG computer
to measure vectors originating roughly at the center of the
heart.
ARL-EL4703-Instrumentasi Biomedis

Note that the voltage at Wilsons terminal is zero (why?)

Augmented Leads: aVR

aVR= V1

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VIII
2

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Augmented Leads: aVL


aVL = V1

ARL-EL4703-Instrumentasi Biomedis

Augmented Leads: aVF


VII
2

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All Frontal Leads

ARL-EL4703-Instrumentasi Biomedis

aVF=VII

VI
2

ARL-EL4703-Instrumentasi Biomedis

Frontal Lead

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12 Leads
ECG
Recording

Transversal Lead

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ECG Intrumentation
Single Channel ECG

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ARL-EL4703-Instrumentasi Biomedis

ECG Intrumentation

ECG Intrumentation

Electrode Transducer

ECG Amplifier schematics

Right leg driven loop


- noise reducing
- patient protection
- Reduce Common Mode
Voltage

Characteristic :

acquiring signal with


amplitude between
0.01mV 3mV
anticipate impedance till
> 5 M
small current leakages
< 1 -A
response frequency
0.05 150 Hz

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ARL-EL4703-Instrumentasi Biomedis

ECG Intrumentation

ECG Intrumentation

Instrumentation Amplifier

AD620 single chip instrumentation


amplifier

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ECG Intrumentation
High Pass Filter

ECG Intrumentation

Second Amplifier

Low Pass Filter 20 Hz


Clamper

Low Pass Filter 40 Hz

Analog subsystem
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ECG Intrumentation

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Some Problems in ECG


Noise & interferences

Display Unit
Galvanometer
Osciloskop
CRT
LCD
PC + Monitor
Paper chart
PDA/HP display
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Digital Subsystem

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Some Problems in ECG


Another ECG System

Souces of interference in an ECG trace


base line wander : patient movement, electrode
reposition, dry electrode, static buildup around
patient
AC noise (50 Hz) : powerline/common mode
interfrence
intermittent signal : lead connection not tight
and secured, dry electrode, damage cable or
lead wire
Other Electrical interference (EI)
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Glossary of Terms
AED :

Automated External Defibrillator Auto diagnosis with voice


directed treatment.
EKG/ECG: ElectroCardioGram skin surface, heart monitor
Holter Monitor: Portable device for continuously monitoring the electrical
activity of the heart for at least 24 hours. Can be external
or implantable.
Defibrillation : Delivering a therapeutic dose of electrical energy to the heart.
T-wave alterans : A change in the shape of the heartbeat signal on an every
other beat basis that is not apparent to the naked eye.
Right Leg Drive : An operational amplifier deriving common mode voltage is
used to invert the common-mode signal and drive it back into the
patient through the right leg.
RFI :
Radio Frequency Interference
ESD :
Electro Static Discharge

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ECG Markets

ECG

Professional Healthcare

Consumer

battery

line

line

battery

AED
Home Products

Commercial
Fitness Equipment

Above Diagnostic

Defibrillators

Diagnostic

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ARL-EL4703-Instrumentasi
Holter Monitor
Biomedis

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Diagnostic ECG

Diagnostic ECG (Clinical Use)

In-amp + Right Leg Drive


Instrumentation
Amplifier
G=14

Additional Channels

Additional Channels

Instrumentation
Amplifier
G=14

High Pass Filter 0.033Hz

Low Pass 5th Order Filter at 157Hz

G=50

1.18k

57.6k

14k

14k

19.3k

33nF

14.5k

68nF

47nF
B

15k
2.2pF
10k
10pF

-5V

4.7F

24.9k
+5V
24.9k

AD8618

AD8618

+5V

14.5k

+5V

AD8618

AD7980

10nF

15k

+5V
10k
10pF

33

AD8618

AD8220

220pF
4.12k

10k
2.2pF

19.3k

+5V

+5V

+5V

2.2pF

ADum240X

ADC

+5V

iCoupler

REF/2
A

-5V

-5V

switch
ADG601

+5V
OP2177
C

REF
+5V

1M
1.15k
33nF

From Lead I
REF/2
From Lead II
From Lead III

-5V
op amps
68pF

12.7k

REF/2

10k
2.2pF

Reference
ADR435

22nF

4.99k
REF/2

22F

Pacing Artifact
Detection Circuitry

220pF
4.12k

-5V

-5V

OP2177

ADum240X

12.7k

BlackFin
Lead Detection

-5V

AD8220
switch
ADG601

+5V

ADG620
866k

4.7F

24.9k
+5V
24.9k

REF/2

DSP
866k
499k +5V
OP2177

+5V

-5V

From Lead I
REF/2
From Lead II
From Lead III

-5V
op amps

50kHz

12.7k

68pF

12.7k

866k
499k +5V
OP2177

ADG620
866k

-5V

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Diagnostic ECG

Diagnostic ECG

Filters + Pace Detection

ADC + Isolation + Processing


Additional Channels

High Pass Filter 0.033Hz


1.18k

Additional Channels

Low Pass 5th Order Filter at 157Hz

G=50
57.6k

14k

19.3k

14k

33nF

14.5k

68nF

REF/2
47nF

iCoupler
+5V

+5V
4.7F

19.3k

AD8618

AD8618

+5V

14.5k

+5V
AD8618

AD8618

33

ADum240X

ADC

10nF

220pF

33
switch
ADG601

1M

REF/2
From Lead II
From Lead III

10nF

1.15k
33nF
REF/2

22nF

4.99k
REF/2

Pacing Artifact
Detection Circuitry

AD7980
REF
+5V

REF/2

22F

Reference
ADR435

12.7k

ADG620
866k

ADum240X

Lead Detection

DSP

50kHz

BlackFin

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Low Power, Low Cost,


Wireless ECG

Low Cost, Low Power AED

(Holter Monitor)
108pF

AD623
G=10.6

RA
Electrode
RL
Electrode

475

AD8641

Patient
Pads

Additional
Digital Filter

AD8220/4

Single pole
anti-alias
filter

Digital Filtering
LCD Display

ADR365

AD8606

Filter
and
Protection
Network

Total Gain ~ 220

5.23k

AD7685

ADuC70xx
or
Blackfin

ADF702x*

Blanking

499k

ESD
Defib
Protect

ADuC7022

Level Shift
Anti-Alias

681k
5.23k
5pF

Anti-alias Filter
-3dB, 1592 Hz

G = 22.05

0.47F

ESD
Defibrillation
Protection

RL
Electrode

10k

High-Pass Pole
0.5Hz

AD8605

Dependent on Frequency Band Used (WMTS or ISM)

High
Voltage
Discharge

AD8603

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Power
Control

ADP1712

ARL-EL4703-Instrumentasi Biomedis

Li Ion
Battery

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Exercise Heart Rate Monitor


(Example: treadmill with heart
rate monitor)
+5V
40 Hz Low Pass Filter
Input
Protection

AD8553

AD8692

AD8692

REF

REF

ADuC70xx

REF

AD8691
REF
High Pass Filter

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