ECGLAB HOLTER SYSTEM 12.

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CONTENT

PREFACE ........................................................................................................ 3

CONSIDERATION OF SAFETY AND EFFICIENCY........................................ 4

FUNCTIONS AND FEATURES (FOR 12-LEAD RECORDER) ....................... 5

ECGLAB HOLTER 12.0 PLUS INSTALLATION AND SET UP ....................... 6

System Requirement...................................................................................6

Software Environment Setting.................................................................... 6

Load the ECGLAB HOLTER 12 .PLUS Software ...................................... 7

OPERATION OF ECGLAB HOLTER 12 .PLUS.............................................. 9

MAIN MENU ................................................................................................ 9

SYSTEM SETTINGS .................................................................................. 11

LEADS ........................................................................................................ 15

ENROLL A PATIENT .................................................................................. 17

PROCESS A HOLTER RECORDING ......................................................... 21

SET ST AND QT ......................................................................................... 23

SET ST AND QT-12 Lead ........................................................................ 23

SET ST AND QT-3 Lead .......................................................................... 25

EDIT ST-QT ............................................................................................. 26

DATE ACCESS CHOICES............................................................................. 28

EDIT BEATS ............................................................................................... 31

VIEW ECG STRIPS ................................................................................. 40

REVIEW OF ABNORMAL ECG EVENTS ................................................ 48

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PAGE SCAN ...............................................................................................53

MEGA SCAN .............................................................................................. 57

QT VALIDATION ......................................................................................... 61

A-FIB/FLUTTER .........................................................................................68

HEART RATE VARABILITY ...................................................................... 72

ST SCAN ................................................................................................... 80

FCG............................................................................................................ 92

ECG STRIP .............................................................................................. ..97

HOURLY MODE........................................................................................ 101

SAECG & VCG ......................................................................................... 103

SAECG .................................................................................................. 104

VCG ....................................................................................................... 110

REPORT MENU........................................................................................ 114

12-Lead Data ......................................................................................... 114

3 Leads Data.......................................................................................... 128

HOLTER REANALYSIS ............................................................................ 131

PRIOR HOLTER ....................................................................................... 132

PACEMAKER ANALYSIS ............................................................................ 142

PACEMAKER SETUP ................................................................................. 144

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PREFACE
Welcome to use ECGLAB Dynamic Electro-cardio Analysis System (HOLTER
12.0 PLUS).
ECGLAB Dynamic Electro-cardio Analysis System is an electro-cardio
monitoring system with long time holographic information, which can
consecutively monitor the electro-cardio changes in 24~72 hours using
portable dynamic electro-cardio recorder. The electrocardiogram (ECG) data
can be analyzed, transferred and printed out in this system.
ECGLAB Dynamic Electro-cardio Analysis System (Version 12.0 Plus)
automatically supports the 3-Lead and 12-Lead recorder.
Dynamic Electrocardiogram can monitor the electrocardioinformation in
thousand fold or ten thousand fold compared with those of traditional ECG
without the interference of distance, the restriction of body position and activity,
especially in the capture of transient arrhythmia and diagnosis of transient
myocardial ischemia.
The recorder reading system of the dynamic Electrocardiogram can not only
display the total beats, maximum heart rates, minimum heart rates, average
heart rates and average heart rates per hour but also analyze and monitor the
times, degree, configuration and duration of SVE (supraventricular premature
beat), VE (ventricular premature beat), SV-RUN (atrial tachycardia) and V-tach
(ventricular tachycardia) per hour; the trend graph and full disclosure of P-R
interval, QRS waves and ST-T changes, etc. As the useful data for clinical
medicine, the results can be shown in various manners.
WINDOWS 98/2000/XP platform based ECGLAB HOLTER 12.0 Plus will give
you a totally new feeling，which will help you work swiftly, diagnose accurately
and get to a new high of your career.
This book will introduce you the functions and applications of ECGLAB
HOLTER 12.0 Plus and let you be able to master the system quickly.

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CONSIDERATION OF SAFETY AND EFFICIENCY

The following safety and efficiency should be considered before using

this product.

The safety protecting type of Holter recorder is in the scope of internally

powered equipment B model with BF application.
The Holter 12.0 Plus system should be used under physician’s instruction and
guidance.
The dependability of using this device depends on the proper operation in
accordance with this operation manual and maintenance guidance.
The measurement results and the automatic diagnostic analysis of this
system are the reference for physician. The final diagnosis is made by
physician.
Thoroughly read this user’s manual before using Holter 12.0 Plus system.

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FUNCTIONS AND FEATURES (For 12-Lead Recorder)

ECGLAB 12.0 Plus System can record 24～72 hours electrocardioinformation

applicable to the heart disease analysis for medical treatment institution.

ﾲ Using the international standard 12-Lead system, identical to that of

traditional ECG.

ﾲ Comprehensive 12-Lead automatic diagnosis function.

ﾲ Multiple channels analysis of arrhythmia, increasing the diagnosis

accuracy.

ﾲ Unique 12-Lead ST 3D trend graph and contract scan to entirely master

the changes of 12-Lead ST segment and to accurately locate the position
of myocardial ischemia.

ﾲ Accurately measure QT dispersion, a useful tool of non-invasive detecting

cardiac muscle repolarization.

ﾲ Offer the function to analyze Sleep Apnea.

ﾲ High quality pacemaker analysis with PAS technique to evaluate the

installation of pacemaker.

ﾲ Artful CF card personate designed can be conveniently used.

ﾲ Fully support print preview function.

ﾲ Advanced report saving function increases the storage volume of case

history in many times.

ﾲ Batch print function enables you to print out different patient’s reports in
batches.

ﾲ Colorful print makes the report more realistic. (Need to install color printer)

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ﾲ Fully support the special time recording and editing of the hardware.

ﾲ Electronically registering the recorder before wearing will thoroughly

prevent the possible confusion in the process of back recording.

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ECGLAB HOLTER 12.0 PLUS INSTALLATION AND SET UP

System Requirement
1． Microprocessor: Pentium PIII or Celeron 500; RAM: 128M; CANON LBP
810 or other compatible printer (The RAM of laser print is at least 2M);
SanDisk ImageMate External Reader (little goldfish type);
2． Installation CD of Windows 98 and Internet Explorer 4.0 or above version;
3． CANON LBP 810 Installation CD;
4． ECGLAB HOLTER 12.0 Plus Installation CD (include USB security key
driver);
5． Installation CD of SanDisk (little goldfish type) driver;
6． ECGLAB HOLTER 12.0 Plus USB Rainbow Security Key connected to
computer’s USB port.

Software Environment Setting

ﾲ WINDOWS Setting

1. Windows 98/2000/XP and Internet Explorer4.0 or above version;

NOTE: In this manual, all screen displays about the operation of
ECGLAB Holter 12.0 Plus are come from Windows XP.
2. To setup the screen display, click on MY COMPUTER. Click on
CONTROL PANEL. Click on DISPLAY. Click on the SETTINGS tab.
Scroll down to High Color (16 bit). Go to Screen area and slid the boar to
1024 x 768 pixels. Click on APPLY. Click on OKAY;
3. Click on the START menu button. Click on SETTINGS. Click on
TASKBAR & START MENU…. Click on SHOW SMALL ICONS IN START
MENU and SHOW CLOCK (There should be a check mark next to each
of these lines). The first two lines, ALWAYS ON TOP and AUTO HIDE
should not have a check mark next to them. Click on APPLY. Click on OK.

ﾲ Set up Printer

Please see the accompanying technical manual.

NOTE: Use only the software driver supplied by the printer manufacturer.

ﾲ Load the ImageMate Driver

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1. Insert the drive CD of SanDisk ImageMate into CD-ROM;

2. Double click on MY COMPUTER;
3. Double click on the drive;
4. Double click on Setup;
5. Inatallation according to the prompt, take out the CD after finished;
6. The computer will restart.

ﾲ Load the USB Security Key

1. Before installation of security key, be sure that the USB security key is not
connected with computer. Run EzUsb.exe in the directory of usb driver of
the installation CD. The following steps accord to the prompts of the
program.
2. After installation is completed, then connect USB security key with USB
port of computer. This security key driver is applied in Win98, Win2000 and
Winxp.

Note:

1. Inserting or pulling out the USB security key when the

computer is resetting may lead the security key unrecognized
by computer;
2. When you pull out the security key, to insert the security, it is
requirement to restart the computer.
If the USB security keys damaged, please contact our company in time.

Load the ECGLAB HOLTER 12 .0 PLUS Software

1. Insert the drive CD of ECGLAB HOLTER 12 .0 Plus into CD-ROM;
2. Double click on MY COMPUTER;
3. Double click on the drive;
4. Double click on Setup.exe in the directory of setup of the installation CD;
all the passwords are "0”;
5. Inatallation according to the prompt;
6. Double click on Hldrv32.exe in the directory of hardlock of the installation
CD;
7. Inatallation according to the prompt;

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8. Copy the 3 files from update folder in the directory of setup of the
installation CD to the software installation directory；
9. Take out the CD after finished;
10. After the file is loaded, restart your computer.

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OPERATION OF ECGLAB HOLTER 12 .0 Plus

MAIN MENU

This is the ECGLAB HOLTER 12.0 Plus Main Screen Display.

The following functions can be operated in the screen of ECG Holter 12.0 Plus:

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Leads Placement：Display lead placement recommended by this program.

Enrollment: Enroll patient information to the compact flash card used for
recording patient’s data.

New Patient: Process a new Holter record.

Database: Store or take out prior Holter records from database.

Setting: Modify the default parameter.

Exit: Return to the Windows desktop.

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SYSTEM SETTINGS
To view and edit the default settings and enter the facility information, move
the mouse arrow to SETTING and click.
Use System Setting function to modify the default parameter. System Settings
can be divided into three pages: Basic Parameter, Facility Information and
Other.
BASIC PARAMETER TAB

Move the mouse arrow to any default setting and activate with a click.
Selecting the desired setting with the mouse arrow and performing a click will
change each setting.
Basic Parameter has the following contents:
HOLTER SCAN TIME: Allows you to input the amount of hours recorded. This function can
be only applicable if the patient’s actual recording time is known i.e. 12 hours or 18 hours.

AUTO REPORT: A selection of YES tells the program to automatically print out an unedited

Holter Report. The print items of auto report are the same as those of last patient.

MANUAL SET ST: Selecting YES allows you to manually set the Baseline Reference,
J-Point and ST-Point for each channel of recorded data. The NO selection has the
program automatically make these selections. YES selection is recommended.

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SVE PREMATURE %: Sets the percentage for program to determine the SVE. This
percentage is the prematurity rate of SVE relative to the normal beat. You can select the
prematurity rate (from 15 – 50) for an SVE. The OFF selection disables this part of analysis.

PAUSE TIME: Sets the length of time for program to determine the pause of beat. Allow
you to select the length of a pause from 1.5 – 3.0 seconds.

AUTO SAVE PRINT: A selection of YES tells the program to automatically store the initial
Holter 24-Hour ECG edited file into the appointed directory.

FD WITH ANALYSIS: Tells the program to automatically print out a full disclosure for
selected leads while carrying out auto print report.

ST MODE: You can select the mode to analyze ST. There are two modes: Absolute ST and
Relative ST. Delta ST is the standard method for ST measurements. Delta ST measures
the difference in ST changes. Absolute ST always measures from the 0-reference baseline,
and does not consider the patient’s normal ST level for each individual ECG lead.

FD HOUR PER PAGE: Selects one of four print formats (30 minutes, 1 Hour, 2 Hour or 4
Hour) to print full disclosure ECG data on each page.

RAW DATA DIRECTORY: Sets the directory location for database.

ID CREATE: Manual allows you to enter any ID# for the cover sheet of your Holter report.
Auto ID commands the computer to enter an ID number automatically in the order of priority
of patient.

DATE STYLE: Lets you select your date format, either month-day-year or day-month-year.

LANGUAGE: Gives you the option of running the program in one of the listed languages.
There are eight languages such as English, Chinese, Germany, French, Spanish, Italian,
Portuguese and Hungarian for your selection. Passwords are required for all languages
except English. The password of Chinese is ‘Chinese’. Please distinguish the capital letter
or small letter. After selecting language and exit this system, then again enter WINDOWS
desktop and re-enter this system. Your language version has been changed accordingly.

WEIGHT: Lets you select between pounds and kilograms.

HEIGHT: Lets you select between inches and centimeters.

MINIMUM HEART RATE: Allows you to select the numbers of R-R interval to calculate the
minimum heart rate. You may select from 1 interval, 2 intervals, 3 intervals, 4 intervals or 5
intervals. It is usually the 4 intervals.

MAXIMUM HEART RATE: Allows you to select the numbers of R-R interval to calculate
the maximum heart rate. You may select from 1 interval, 2 intervals, 3 intervals, 4 intervals
or 5 intervals. It is usually the 4 intervals.

FILTER: A yes will turn on a filter to help clean up recordings with a lot of artifact. A no will
leave the recording as it is.

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ST ANALYSIS: There are two methods to analyze ST: J point analysis method and ST
point analysis method.

DEFAULT ECG STRIP: The ‘ON’ selection is for the automatic saving of the default ECG
event.

CONCLUSION PRINT: Selects the print format of the first page.

FACILITY INFORMATION TAB

FACILITY NAME: Enter the facility’s name as you want on the heading of the report.

FACILITY PHONE: Enter the phone number of the facility.

FACILITY FAX: Enter the facility’s fax number.

FACILITY ADDRESS: Enter the address of the facility.

When all of the data is entered, click on OK.

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OTHER

Change the colors as you want to mark VE, SVE, NORMAL, PAUSE, ST Text.
The default colors is displayed as above screen.
The ON selection in the pull down menu of ECG Antialiasing will make the ECG
wave more smoothly in this system. To adjust the gain of 12-Lead ECG strip
and 12-Lead PagePrint, click on the down arrow of the pull down menu to
select the desired gain, the amplitude of ECG wave in this system will be
changing accordingly.
When all of the data is entered, click on OK.

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LEADS

This program provides six sketch maps to instruct the electrode lead
placements for Holter ECG monitoring. Place your mouse over the hookup you
desire and click. The picture to the right will automatically change the hookup
you have selected. There is a written description of each hookup that will be
found on the lower left of the screen.
On this screen you will find different hookups located under Lead Systems as
follows:
Standard Lead A (7 Leads): Shows the electrode lead placement of V1, V3, V5
simulated by 7 wire leads.

Standard Lead B (7 Leads): Shows the electrode lead placement of V1, V5, aVF
simulated by 7 wire leads.

Standard Lead C (5 Leads): Shows the electrode lead placement of V1, V3, V5 ,
(approximate) simulated by 5 wire leads.

Standard Lead D (4 Leads): Shows the electrode lead placement of V1, V3, V5,
(approximate) simulated by 4 wire leads.

Standard Lead E (10 Leads): shows the international standard 12 lead connection
method with 10 wire leads.

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Orthogonal Lead (7 Leads): Shows the electrode lead placement of Orthogonal Lead X, Y,
Z simulated by 7 wire leads. You can transform the data of X, Y, Z leads to the wave of
standard 12 lead with the method of Vijen and print it out.

Electrodes placements may be various with different manufactures. Please

refer to the user’s operation manual for Holter recorders.
Note: The most important factor in electrode application is good skin
preparation. Most users clean the electrode sights vigorously and slightly
abrade the skin at only the small area where the electrode gel makes contact
with the skin. Only the physician can decide on the methodology for electrode
skin preparations for his or her patients.
To exit this screen, click on the CLOSE button at the bottom of the screen.

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ENROLL A PATIENT

The purpose of the Enroll setting is to label the flash card with the patient’s data.
Once the patient returns with the flash card, the data will be automatically
entered into the New Patient Information.
To “Enroll” the patient information, follow these steps:
1. From the ECGLAB HOLTER 12.0 Plus main menu, click on the ENROLL
icon at the top of the screen.
2. Using your keyboard, enter all the patient information. To move between
the fields, you may either press the TAB key or click on a field with your
mouse.
3. After entering the information, insert the SANDISK compact flash card into
the ImageMate reader, click on ‘Next’, the patient data will be enrolled on
the flash card.
Start Time: Enter the time with the 24 hours format when doctor wear the Holter recording
box for patient. The software will automatically input the current time of computer that may
be inconsistent with the time when doctor wear the Holter recording box for patient. You
can change it manually as requirement.

Record Date (M/D/Y): The software will automatically input the current date of computer.
You can change it manually.

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Supervising Physician & Referring Physician: These two items will kept unchanged
unless you select another doctor name in the pull down menu. If you want to add or modify
doctor name, click on the right E bar. If this is first time the software work, a message
‘Could you want to create a new file?’ will appear on the screen as following.

Click on the ‘Yes’ button, a new file with the name of ‘Super.txt’ will be created. Then enter
the doctor name, press the ENTER key and save the file. The next time you open the
ENROLL, the doctor name you entered or modified last time will appear in the Physician
pull down menu.

NOTE: Every time after you add a new doctor name or edit the doctor name, please press
the ENTER key. Otherwise, The next time opening the ENROLL, you will find the last letter
of the doctor name you entered or modified last time is disappear in the pull down menu.

Using your keyboard, enter all the patient information. To move between the
fields, you may either press the TAB key or click on a field with your mouse.
After entering all the information, click on the ‘Edit’ button at the right side of
the screen, a txt file will come up as following.

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This screen allows you to enter individualized patient instructions in your

Patient Diary.
To erase the patient instructions that are already entered, simply highlight the
instructions with the mouse by right clicking the mouse and dragging the
mouse over the instructions. This will leave a black highlight bar over all of the
instructions. Press the backspace key on the keyboard. This will erase all of the
patient instructions on the screen.
To enter new instructions, simply type in the instructions. Make sure to type in
good, clear instructions so it is easy for the patient to follow them. After you
have entered all of the instructions, click on File and then click on Save. This
will save the instructions you have just entered. These new instructions will
now be the default patient instructions, to change them, you must repeat the
above steps. Click on File again and then click on Close. You will return to the
Patient Information screen.
Click on the ‘Print’ button, it will print out the Holter Activity Card for patient to
fill in information, such as personal data, where he is, the activity done, and
how he feels.
Click on ‘Next’ button to load the patient information to the disk. You will be
returned to the Main ECGLAB HOLTER 12.0 Plus screen.
Remove the SANDISK compact flash card from the ImageMate reader.

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Insert the SANDISK compact flash card into the patient’s digital Holter
recorder.

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PROCESS A HOLTER RECORDING

Processing a Holter recording of patient, you need to transfer the data from
the compact flash card to the hard disk of the computer. Insert the SANDISK
compact flash card into the ImageMate reader, and then click on the NEW icon
at the ECGLAB Holter 12.0 Plus main screen, the screen dispaly of Patient
Date will appear.

PATIENT DATA

If you have used the ENROLL feature, after you click on the NEW icon, any
patient data that was entered during the ENROLL process on this compact flash
card will come up in the Patient Data screen automatically as the interface of
Patient Date in last page.
NOTE: If you click on the NEW icon, and then insert the SANDISK compact
flash card into the ImageMate reader, the data entered on this compact flash
card using the ENROLL feature will not appear on the screen. You must insert
the SANDISK compact flash card into the reader before clicking on the NEW
icon.

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If you have not used the ENROLL feature, after you click on the NEW icon at
the ECGLAB Holter 12.Plus main screen, there will be no any patient data on
the screen of Patient Date. You have to enter the patient data manually.
In this menu there are five (5) fields that must be filled with data in order to
proceed. They are Start Time, Record Date, Recorder, Pacemaker and
Patient Name.
Recorder: Allows you to select a Flash Card (Digital) Holter recording or a DEMO practice
file. The selection of DEMO will let the software to transfer the patient date ever saved in
the hard disk. It is the 2 hours date.

Pacemaker: Pacemaker processing requires a YES in the “Pacemaker” field. If you are
using a pacemaker recorder that has a different data format compared with common
recorder (software will automatically recognize whether it is a pacemaker recorder or not
during the course of transferring data), all the subsequent analysis shall be carried out by
the pacemaker mode.

SAECG: A check mark in the SAECG box will allow you to edit SAECG data and create a
report. The recorder shall have the function of recording SAECG. Before having 24 hours
Holter recording, recorder will record 10 minutes high frequency Orthogonal data of 3
channel. Usually orthogonal lead placement shall be used for SAECG sampling. Of course
you can also get reliable data by applying other lead placement mode.

DOB: Date of birth. The number of age will be changed accordingly with the DOB.

Clicking on CLOSE will return you to the main menu.

After you input all the patient data (if you already make enrollment, all the
above information shall be automatically input), click on Next, a message will
appear on the screen as following.
”Please insert PCMCIA card if you did not do so, and then press enter key.
Please do not take out the PCMCIA card when transferring data.”
Click on OK, the data of the compact flash card will now be transferred to the
hard disk of the computer. The 24 hours date of the Holter recording is now
being transferred. This screen is for visual information only. There are no
operator functions to be performed with this screen display.
It will take about3 minutes to transfer 24 hours data.
After the date is transferred, the following screen will appear.

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SET ST AND QT
The screen of set ST and QT has some difference between 12 lead and 3 lead.

SET ST AND QT-12 Lead

If you have selected yes for Manual Set ST in SETING, then the Set ST and QT
screen display will appear after the Holter ECG data has been completely
transferred to the computer’s hard disk. Otherwise, the next screen display will
be Analyze ECG Data.
Operator should adjust the ST orientation cursor manually to identify the three
vertical lines (the short lines on the electrograph at the left of the screen) to be
set to the correct position. The first vertical line represents the position of Q
point located at the beginning point of ORS wave. The second vertical line
represents the position of J point. The third vertical line should be set at the
beginning point of T wave.
1. There is a rectangular box in the 1-minute ECG strip at the top of the display.
You can move this box (thereby selecting a new beat) by placing your cursor
on a different beat and clicking your mouse. To select a different minute,
press the Page Up or Page Down button on your keyboard OR click on the
Page Up or Page Down icons at the bottom of the screen.

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2. To select a beat from the enlarged eight-second strip, simply click your
mouse within the blue box on the enlarged eight-second strip. Drag and
center the box to the beat you desire.
3. The ST Analysis & QT Analysis box on the bottom left of the screen shows
you which channels are being analyzed. To delete a channel, move your
mouse to the desired box and click. A check mark next to a channel indicates
that ST & QT Analysis will be done for that channel. In many cases,
physicians will not want to analyze the ST for a negative going QRS.
4. The Arrhythmia Analysis box at the bottom of the screen allows you to
select which channels will be analyzed for arrhythmias. To change
channels, simply click on the box next to different channels until the
desired channels are displayed.
5. The ST Analysis box at the bottom middle of the screen has two pulldown
menus in it. The first pulldown menu indicates which type of Point (J Point or
ST Point) is to be used for ST analysis. The second pulldown menu indicates
which type of ST analysis is being performed. The Delta ST is the standard
method for ST measurements. Delta ST measures the difference in ST
changes. Absolute ST always measures from the 0-reference baseline, and
does not consider the patient’s normal ST level for each individual ECG lead.
6. The Gain Adjust box at the bottom of the screen allows you to adjust the
gain for each channel individually. Click on the number of the channel you
wish to adjust. Then click on the + box if you want to increase the gain.
Clicking on the – box decreases the gain. After you have adjusted the gain
for one channel, you may adjust it for the other channels, if needed. As you
increase the gain, you will notice the beats on the screen of the channel
you are adjusting get larger. If you decrease the gain, the beats on the
screen for the channel you are adjusting will become smaller.
7. The Full Disclosure box under the Gain Adjust box allows you to select the
channel that will be printed out in the Full Disclosure. To select a different
channel, move your mouse to the desired channel and click.
8. If any of the ECG channels has a reversed polarity because of improper
electrode placement, click on the Reverse icon at the bottom of the screen
before setting the markers on the beat. The polarity of the beat will be
reversed.

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SET ST AND QT-3 Lead

The screen of Set ST and QT-3 Lead is approximately same as that of 12

Lead except points as following indicated.
1. There are only three channels to select in every box on the screen
compared with twelve channels in the screen of 12 Lead.
2. The Full Disclosure box is at the different place compared with that of 12
Lead. To select a different channel, move your mouse to the desired
channel and click. The black dot indicates which channel will be printed.

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EDIT ST-QT

First using ↑or ↓Key, PageUp or PageDn Key or directly hold on mouse to move
blue area and choose a suitable QRS wave, the QRS to be set will be located at the
left said of the screen.
1. Select the beat you wish to do your ST and QT measurements. To do this,
point and click your mouse on the beat in the 1-minute strip at the top of your
screen. The enlarged eight-second strip appears on the screen. If you desire
another beat within this strip, point and click your mouse within the blue box on
the enlarged eight-second strip. Drag and center the box over the beat you
desire.
2. The green vertical marker is the active marker. The first vertical marker is for
placement between the P wave and R wave. It should be set at the beginning
of the Q wave. Use your right and left arrow keys on the keyboard to set this
marker in place. Once in place, press the TAB key on your keyboard or mouse
click on the Toggle icon at the bottom of the screen. If the marker is not at
the beginning of the Q wave, then all QT measurements will be inaccurate.
The computer program uses the first marker at the beginning of the Q wave to
search prior to the first marker for a baseline PR location for the ST
measurements.
3. The second vertical marker is for setting the J-Point. Find a spot where the
QRS returns to the baseline and then press the right arrow key once.

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Once in place, press the TAB key on your keyboard or mouse click on the
Toggle icon at the bottom of the screen.
4. The third vertical marker is for setting the ST Point. Using your right and left
arrow keys on your keyboard, move the marker to the right to set the
sample point. Do not allow this marker to be at the beginning or the
upslope of the T-wave. If necessary, keep moving left to avoid the T-wave,
especially on the negative going QRS complexes.
5. After all the markers are placed in their desired locations, click on the Accept
icon at the bottom of the screen OR press the F10 key on the keyboard.
This will take you to the next Channel. Repeat the above process and do
the same for other Channels. After pressing the F10 key on the last
Channel or clicking on the Accept icon on the last Channel, this display will
disappear and analysis will begin. The analysis needs 3 minutes or so.
After the analysis is complete, a message ‘ You may take out the flash card or
cassette tape now.’ will appear on the screen. Click on OK, the program will
take you to the Date Access Choices main menu.
NOTE: If you make an error on your ST setup of 3 Lead and would like to go
back and reset the markers, simply click on the 1, 2, or 3 in the Gain Adjust box.
This will move the cursor to the appropriate channel (such as clicking on the 1
will give you the active cursors on Channel 1). If you want to reset the
markers of 12 Lead, you have to click on ‘Re Analysis‘ button at the screen of
Date Access Choices.

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DATE ACCESS CHOICES

After setting the ST and QT, program will automatically enter Date Access
Choices main menu. This menu allows you to review, edit and process your
Holter reports. To access one of these choices, point and click with your
mouse on the icon of the desired function as following.

Edit: Identify, modify or delete 20 arrhythmia templates or 20

abnormal events.

Page Scan: Dynamically scan full period ECG waves to learn

Holter records in a macroscopic view. It contains
conventional page scan and artifact page scan.

Mega Scan: Display 24 hours Heart Rate Variability trend (HRV),

ST segment trend, QT (QTc) trend, SDNN of
Heart Rate Variability, ST spectral graph. VE,

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V-Run, SVE, SV-Run and Pause column shape

trends per hour.

QT Validation: Display QT interval and QTc validation analysis

data.

A-Fib/Flu: Edit and identify Atrial Fibrillation and Atrial flutter.

HRV: Display HRV poincare plots, Spectral Frequency graph, R-R

histogram and 3 dimensional spectral.

ST Scan: This function is used to review and compare 12 lead ST

segment trend graph. (Applicable in 12 lead data)

FCG: Frequency Domain

ECG Strip: Review initial ECG waves at any period. Input patient
diary and mark important ECG strips.

Hourly: Display hourly ST segment and some kinds of

arrhythmia.

SAECG: Analyze SAECG dime domain and frequency, which is

applicable with 3 lead data.

Report: Select reports for printing out Holter reports.

Re Analysis: Re-analyze Holter data of current patient.

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Note: Using this function will erase all the data you have edited
manually and restore the Holter analysis result to the
initial data automatically completed by software.

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EDIT BEATS

The purpose of the Edit Beats display is for you to review and edit the various
arrhythmia templates for VE (ventricular premature beat), SVE
(supraventricular premature beat), aberrant and Normal beats.
According to the wave shape, there are twenty templates programmed for your
review. They are VE Template 1, VE Template 2, VE Template 3, VE Template
4, VE Template 5, VE Template 6, VE shadiness 1, VE shadiness 2, VE
shadiness 3, Normal shadiness 1, Normal shadiness 2, Normal shadiness 3,
Aberrant 1, Aberrant 2, Aberrant 3, SVE Template 1, SVE Template 2, SVE
Template 3, SVE Template 4, Normal.
At the bottom of the Edit Beats screen display, there are eighteen ECG events.
They are Pause, ST segment, SV-RUN (atrial tachycardia), VE-Pair
(ventricular premature beat in Pair), V-tach (ventricular tachycardia),
SV-Bigeminy (supraventricular bigeminy), SV-Trigeminy (supraventricular
trigeminy), V-Bigeminy (ventricular bigeminy), V-Trigeminy (ventricular
trigeminy), Aberrant Runs, Sinus R-R > 1.5s, Block, VE, SVE, R on T (R wave
is overlapping with the last T wave), Longest R-R, Minimum HR (heart rate),
Maximum HR.
Click your mouse to one of the 20 arrhythmia templates, you will enter the
screen display of arrhythmia template to edit the data of Holter record. If there
is a red letter “None” in the template, it indicates there is no content in this

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template. If there is a green letter “None”, it indicates the content has been
deleted manually in the template. You can enter into this template to review or
edit its content.
Point and click your mouse to the first template with ECG data in its box. In
the above example, it would be VE Template 1. This will prompt a new screen
display that shows all the beats assigned to that particular template.
NOTE: Pressing the F1 key at any place in the program will automatically print
out a page screen.

For the pacemaker patient, 20 arrhythmia templates are:

VE Template 1, VE Template 2, VE Template 3, VE Template 4, VE
Template 5, VE Template 6, VE shadiness 1, VE shadiness 2, VE
shadiness 3, Normal shadiness 1, Normal shadiness 2, Normal shadiness
3, Paced Beat, Failure to Capture, Failure to Sense, SVE Template 1, SVE
Template 2, SVE Template 3, SVE Template 4, Normal.
As for the eighteen ECG events, there are two events different from that of no
pacemaker patient. They are ‘HR > 120’ and ‘HR < 60’ instead of ‘ R on T’
and ‘Longest R-R’. The number of HR can be changed as you need. The
default number is 120 and 60 respectively. NOTE: If these two numbers are
changed, the number of other events will also change accordingly.

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What is the arrangement on the screen display of Arrhythmia Template?

Take the Arrhythmia Template-VE for example:

The beats are divided into two parts on the screen display.
The beats at the lower part of this screen represent all kinds of beats
recognized as VE by the program. The green number on every type of beats
represents how many beats belong to this type. You can see these concrete
beats at the upper part of this screen. The white number at the left of this part
indicates how many rows of beat types are considered as VE by the program.
Denominator represents total rows displayed here. Numerator represents the
number of current row. If there are too many rows of beat types, you can use
the scroll bar at the right of this part to see the rows you cannot see now. If
many consecutive beats in the same row are artifact beat, you can edit them at
a time. The steps is as following: Point and click the first artifact beat in this
row; a white rectangular box will highlight the beat; don’t release the left key of
your mouse and drag the white box to the last artifact beat in this row; click on
the ALL button on the bottom of the screen and click F button in the ‘Color
Panel’.
The beats at the upper part of this screen represent the kind of all beats
marked by the white highlight box at the lower part. On the left side of this part,
you see a column of ECG strips. These strips correlate to the column of beats
on the right side of this part. As you move the beat box (either by mouse or by

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arrow key) across the different columns of beats, the strips will change
accordingly.
The white number at the top right of the right side shows the channels
displayed here. Clicking the left key of your mouse on it, you can change the
channels you want.
The time on the bottom left of the screen indicates the time of beats currently
edited.
Each beat is color coded per the ‘Color Panel’ description at the bottom left of
the screen. The Label Code and Color Code for the beats are as follows:
LABEL CODE COLOR CODE DESCRIPTION
V Green Ventricular Ectopy
S Magenta Supra-Ventricular Ectopy
T Light Blue Aberrant
N White Normal
F Yellow Artifact
D Deep Blue Paced Beat
C Brownish read Failure to Capture
E Ponceau Failure to Sense
The letters on each button are also the hotkey corresponding with the letters
on keyboard except the letter C.
NOTE: The D, C, E bar are applicable for pacemaker patient.
Clicking on the button, the corresponding arrhythmia terms will display in the
edit rectangular box above the button.
The buttons on the bottom middle of the screen represent swift editing
combination key with corresponding hotkey as following:
Beat (Alt+B) – single beat
Row (Alt+R) – a row of beat
Page (Alt+P) – one page of beat
Column (Alt+C) – a column of beat
All (Alt+A) – all beats

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How to edit a beat?

The first step is to edit the beats at the lower part of the screen. Using mouse or
Tab key to select the desired beats marked by the white rectangular box, click
on the appropriate label code (V, S, T, N, or F) at the bottom of the screen for
the beats OR you may press the corresponding letter from the label code on
your keyboard. As you edit the beats at the lower part, the beats at the upper
part will change accordingly.
To edit concrete beats is at the upper part of this screen as follows:
To edit a beat individually, move the green beat box to the beat, using the
mouse or arrow key. If you use the arrow key, move the cursor to the beat box.
Using the mouse, point and click on the beat desired. Click on the appropriate
label code (V, S, T, N, or F) at the bottom of the screen for the beat OR you may
press the corresponding letter from the label code on your keyboard.
To edit a column of beats at one time, click on the COL button at the bottom of
the screen. A rectangular box going the length of the column will appear. You
may move the column cursor using the right and left arrow keys on the
keyboard. Click on the appropriate label code (V, S, T, N, or F) at the bottom of
the screen for the column of beats OR you may press the corresponding letter
from the label code on your keyboard.
To edit a row of beats at one time, click on the ROW button at the bottom of the
screen. A rectangular box going the length of the row will appear. You may

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move the column cursor using the right and left arrow keys on the keyboard.
Click on the appropriate label code (V, S, T, N or F) at the bottom of the screen
for the row of beats OR you may press the corresponding letter from the label
code on your keyboard.
To edit a page of beats at one time, click on the PAGE button at the bottom of
the screen. A rectangular box will surround all of the beats on the screen.
Click on the appropriate label code (V, S, T, N or F) at the bottom of the screen
for the row of beats OR you may press the corresponding letter from the label
code on your keyboard.
To edit all of the beats in a template at one time, click on the ALL button on the
bottom of the screen. Then click on the appropriate label code (V, S, T, N, or F)
at the bottom of the screen OR you may press the corresponding letter from
the label code on your keyboard.
An additional aid to editing an individual beat is to point and click your mouse
on the desired beat. This will move the rectangular box around the desired beat.
Right click with your mouse and a Dropdown List will appear with various beat
labels. Move the mouse arrow to the desired label and click. The beat will be
labeled and edited.
If you have numerous pages of beats in your template, you may click on the
Page Up or Page Down icons at the bottom of the screen OR press the Page
Up or Page Down keys on your keyboard. If you look at the top left of the upper
part, you will see how many pages of beats are in the template. When you edit
all beats, program will automatically return back to the first page after the edit
is complete.
To sequence through each beat in a template, point and click on the
SEQUENCE icon at the bottom of the screen. The following screen will appear.

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The first beat in the arrhythmia template will be shown to you in an enlarged
eight-second strip. The beat with the blue box around it is the beat in the
arrhythmia template.
Point and click your mouse on the appropriate label code for the beat in the
blue box OR type the corresponding letter on your keyboard for the appropriate
label code. After labeling the beat, the system will take you to the next beat in
the template and it will be shown to you in the enlarged eight-second format.
Continue labeling the beats until you have sequenced through all of the beats
in the template. When you have finished sequencing through the beats, you
will be returned to the Arrhythmia Template screen as follows.

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When you have completed editing all of the beats in the template, clicking on
the CLOSE icon at the bottom of the screen or pressing ESC key in keyboard,
you can return to the screen of Edit Beats.
To view a beat in an enlarged eight-second strip, there are 3 different ways to
enlarge an individual beat.
1. Double click on the beat.
2. Move the beat box to the desired beat with the arrow key and press the
ENTER key on your keyboard.
3. Point and click with your mouse on the desired beat. Click on the ZOOM IN
icon at the bottom of your screen
The eight-second strip with the beat you are viewing will appear on the screen
as follows.

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The beat with the red mark above it indicates the beat that is being edited in
this template.
To immediately print the strip, click on the PRINT icon at the bottom of the
screen.
To save the strip to print out later with the report, click on the SAVE STRIP
icon at the bottom of the screen.
To edit a beat in the eight-second strip, please refer to page 65 for instructions.
To return to the Arrhythmia Template screen display, click on the CLOSE icon at
the bottom of the screen.

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VIEW ECG STRIPS

In the screen of View ECG Strip, the initial ECG data can be reviewed, sorted,
measured, labeled and printed, including 12-lead data and 3-lead data.

12-lead data

The enlarged ECG wave showed in this screen is the 8-second strip. The small
ECG wave at the top of the screen is 1-minute data. The abnormal beats
have been marked with corresponding colors. The number in the box at the
bottom middle of the screen shows the length of ECG strip marked by the
yellow rectangular box. Clicking on Change ECGstrip length button under
this box will change the length of ECG strip at the top of the screen.
You can change the gain of ECG wave from Gain pull down menu under the
small ECG wave. There are five selections in the pull down menu, including
2.5mm/mV, 5mm/mV, 10mm/mV, 10mm/Mv (2 pages) and 10mm/Mv (4
pages). The selection of “10mm/Mv (2 pages)” or “10mm/mV (4 pages)” will
make the 12 lead ECG wave displayed in 2 pages or 4 pages. You can click on
“1”, “2”, “3”, “4” button at the right side of Gain menu to switch ECG wave
display pages. Use← , →, ↑ , ↓ or PgUp and PgUp on the keyboard, you can
select desired ECG strips at top of the screen according to the time and wave
type. Then you can carry out the following operations.

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Save: Save the current selected ECG strips which are divided into 8-second,
16-second, 24-second. If ECG strips are labeled (refer to next page), the
labels will be also saved. Saved ECG strips can be printed out in report. If R-R
interval and heart rate of selected ECG strips are not displayed in the screen,
it will not be saved. This situation appears in following two conditions:
1. The initial 2-minute recording will not be saved because it is square wave
and will not be analyzed by program.
2. The current 8-second ECG strips are all artifact.
Print: Instant print current selected ECG strips. If ECG strips are labeled, the
labels will also be printed. In the same way, the function of print cannot be
carried out, if R-R interval and heart rate of selected ECG strips are not
displayed in the screen.

Label: Add an additional illuminate phase for current ECG (8-second ECG,
16-second ECG, 24-second ECG) at the pull down menu as above. We call
these illuminate phases Lable. Label can be input directly or can be selected
from the pull down menu.
To clear current label, click on CLEAR button at the right side of the Label
menu.
To add new label, click on EDIT button next to the Label menu. The Label
Database will appear in the screen.

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Label database is used for saving common medical glossary, which can be
added by physician to enrich the label. Enter the medical glossary into the input
area; click on Add To List button; the new glossary will appear at the field under
the input area. To add another label repeat above steps again. Label database
also provides the function to delete the existing label, which can be done as
following:
Move the mouse arrow to any labels and activate with a click OR use↑ or ↓on
keyboard to select the label to be deleted, and then the selected label will be
highlighted by a blue bar. Click on Delete From List button; the label will
disappear from the menu.
Clicking on Close button after adding or deleting label, the alteration will be
saved and can be seen in the label menu from then on. Clicking on Cancel
button after adding or deleting, the alteration will not be saved.

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EDIT: If you notice a beat on the strip is mislabeled, you may edit it at this time.
To start the edit mode, simply move the mouse to the beat you wish to edit and
right click or click the EDIT icon at the bottom of the screen. A rectangular box
will appear on the strip. Use the arrow keys on the keyboard to move this box to
the beat you wish to edit. Click on the label code on the bottom of the screen to
re-label the beat OR you may press the appropriate letter from the label code
on the keyboard.
If the rectangular box skips over the desired beat, it is because the beat was
rejected by the analysis. Use the arrow keys to move the box before the desired
beat location. Click on the ADD BEAT icon at the bottom of the screen. Use the
arrow keys on the keyboard to move the marker to the R-wave of the beat. With
your mouse, click on the appropriate label from the label code at the bottom of
the screen OR press the appropriate letter from the label code on the
keyboard.
To delete a beat from the Holter file, move the rectangular beat box to the beat
and click on the DEL BEAT icon at the bottom of the screen.
The Editing function is unavailable for the initial 2-minute Holter recording.

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QTd: Q-T dispersion (QTd) is the difference between the maximum QT

interval and the minimum QT interval in the standard 12-Lead ECG, which is
used to evaluate the synchronization degree of ventricular repolarization. Click
on the OTd icon at the bottom middle of the screen, the program will calculate
the QTd value and display it in the pull down menu box next to the EDIT button
at the top left of the screen.
There are three lines in every sequential 3 waves of the current ECG strips
displayed in screen. The first line is at the start point of QRS wave (Q point).
The other two lines are at the end point of T wave to marked the maximum and
the minimum QT interval in the standard 12-Lead ECG. The green line is the
current active line, which can be switched with TAB key on keyboard. You can
manually adjust the position of green line with ← and → Key on the keyboard.
The QTd value will also changed accordingly. Click on Save or Print icon, then
the program will save or print the current ECG strips labeled with QTd.

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Ruler: Ruler is used to measure the interval time between any two points in
current ECG wave, such as R-R interval, P-R interval. There are five buttons
RR, PR, QT, HR and PP on the top middle of the enlarged ECG strips,
indicating R-R interval, P-R interval, Q-T interval, heart rate and P-P interval
respectively. Point and click on Ruler icon; the mouse pointer will turn into a
small ruler with a little red cross, then you can select the items you want to
measure by clicking on the five buttons on the top of ECG strips. Place the red
cross at start point; press the left key of mouse and drag the mouse to the end
point, and then leave the left key go of. The measurement values will be shown
in the label box next to the EDIT button. Click on Save strips icon, the content in
this box will be the label of this ECG strips at the result. After the measurement
is complete, you must click on Ruler icon again to restore mouse to the
normal state. When you measure the PP interval or R-R interval, there will
appear 5 vertical equidistant lines for you to refer to.

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3-lead data

On the top of screen, it displays 1-minute ECG wave of three leads or

1.5-minute ECG wave of one lead. The abnormal beats have been marked
with corresponding color. You can select all three leads or any one of three
leads by clicking on All Channel or “1”, “2”, “3” button at the bottom middle of
the screen. The content in the box next to “1”, “2”, “3” button shows the length
of ECG strip marked by the yellow rectangular box. Clicking on Change
ECGstrip length button under this box will change the length of ECG strip at
the top of the screen.
The other functions of 3 lead data are same as those of 12 lead data except
QTd.

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After editing the first template, click on the next template and follow the
previous procedures until all of the templates are edited.
Once all of the templates have been edited, click on the UPDATE TEMPLATE
button on the lower right side of the screen. This will save all of the changes
you have made while editing.

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REVIEW OF ABNORMAL ECG EVENTS

The categories for Abnormal ECG Events are Pause, ST segment, SV-RUN
(atrial tachycardia), VE-Pair (ventricular premature beat in Pair), V-tach
(ventricular tachycardia), SV-Bigeminy (supraventricular bigeminy),
SV-Trigeminy (supraventricular trigeminy), V-Bigeminy (ventricular bigeminy),
V-Trigeminy (ventricular trigeminy), Aberrant Runs, Sinus R-R > 1.5s, Block,
VE, SVE, R on T (R wave is overlapping with the last T wave), Longest R-R,
Minimum HR (heart rate), Maximum HR.
The number at the left side of Minimum HR and Max HR rectangular button
represent the heart rate value. The number “0” next to some abnormal ECG
events rectangular button indicates there is no data in the template. The Button
turns into gray with no function now. To edit an Abnormal ECG Event, click on
the category bar. The following screen will appear.

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This screen will show you up to 16 ECG Events. There may be several pages of
events, as indicated by the page count on the lower left of the screen. In this
example, there is two pages. To view other pages of events in this category,
click on the PGUP or PGDN icon on the bottom of the screen OR you may
press the Page Up or Page Down key on the keyboard.
All of the events displayed have been accepted. To reject an ECG event, move
the mouse to the appropriate ECG event strip and click. The strip will lighten to
gray. Click on the REJECT icon at the bottom of the screen.
To view this strip in an enlarged eight-second strip, click on the ENLARGE
icon at the bottom of the screen or double click on the ECG rectangular box.
To save this strip to be printed with the report, click on the SAVE STRIP icon at
the bottom of the screen.
To reject an entire page of events, click on the REJECT PAGE icon at the
bottom of the screen.
To accept an entire page of events, click on the ACCEPT PAGE icon at the
bottom of the screen.
To go to the next Abnormal ECG Event category, click on the CLOSE icon on
the bottom of the screen or press ESC key on the keyboard.

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Select the next Abnormal ECG Event category you choose to edit and click on
the category bar. Repeat the aforementioned editing techniques for the
remaining categories. The editing for the Minimum Heart Rate and Maximum
Heart Rate categories is different.

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EDITING MINIMUM AND MAXIMUM HEART RATE

Only one event is accepted as the Minimum Heart Rate and Maximum Heart
Rate.
The green vertical markers at the top of each strip should be located above
successive R-waves. If this is the case for the first selected event, click on the
CLOSE icon at the bottom of the screen. You will be taken to the Edit Beats
screen.
NOTE: In the Settings Menu, you chose how many intervals would be counted
to determine your minimum and maximum heart rate, either 1 interval, 2
intervals, 3 intervals, 4 intervals or 5 intervals. The interval count determines
how many consecutive R-waves should be counted.
If the green markers are not located above successive R-waves, click on the
first heart rate strip that has successive R-waves marked and click on the
ACCEPT icon. The word Accept will appear in the lower right corner of the
selected ECG Event strip.
NOTE: There may be more than one ECG Event strip with the same Heart
Rate with the intervals being counted correctly. In an instance like this, it is
always preferable to choose the ECG Event strip with the least amount of
artifact.
If there are no Minimum Heart Rates with green markers above successive
R-waves, click on the PGDN icon at the bottom of the screen OR press the

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Page Down button on the keyboard. This will bring you a new page of 16
events. Keep paging down until you locate and accept the desired event.
After completing the Minimum Heart Rate category, click on the CLOSE icon at
the bottom of the screen. You will be returned to the Edit Beats screen.
To edit the Maximum Heart Rate category, follow the above instructions to
locate the Maximum Heart Rate.

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PAGE SCAN

To see the Full Disclosure ECG on the screen display, click on the PAGE SCAN
icon on the Data Access Choices screen. Two items (Page Scan and Page
Scan Artifact) will appear for your selection.
The purpose of Page Scan Artifact is for you to further identify the artifact
data conveniently.

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The above screen shows 30 minutes of ECG data. To change the display to 20
minutes of ECG data per page, click on the 30/P icon on the bottom of the
screen until you see 20 minutes of ECG data on the screen. The icon will
change to 20/P. To change the display to show 10 minutes ECG data on the
screen, click on the 30/P icon at the bottom of the screen until you see 10
minutes of ECG data on the screen. The icon will change to 10/P.
Time is listed on the left side of the Full Disclosure ECG. Each horizontal
sweep is one minute of time in the 20-minute per page mode and the
30-minute per page mode. Each horizontal sweep is 30-seconds in the
10-minute per page mode.
For the 3 lead data, to change the channel of the ECG data on the page scan,
click on the CH 1 icon at the bottom of the screen. You can select Channel 1,
Channel 2 or Channel 3. For 12 lead data, you can switch 12 lead Channel
through the pull down menu on the bottom of the screen.
An eight-second rectangular box can be moved around the screen display with
the arrows on the keyboard OR by pointing and clicking with your mouse. If you
see an ECG of interest, you can move the rectangular box to the desired
location OR simply point your mouse to the beat you desire and click. The
eight-second rectangular box will be moved to that spot. A 3-channel
enlargement of this box can be found on the lower left of the screen. To view

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this strip in an enlarged eight-second strip, click on the ZOOM IN icon on the
bottom of the screen OR press the ENTER key on your keyboard.
To view the next page of data, click on the PGDN icon on the bottom of the
screen. To view the previous page of data, click on the PGUP icon on the
bottom of the screen.
To adjust the amplitude of ECG waves, click on the ‘+’ and ‘-’ button next to the
Page up icon.

To view a specific minute, enter the time in the time field at the bottom center of
the screen. The first field is for the hour and the second field is for the minutes.
After you have entered the time, click on the GO TO bar.
To edit in the Page Scan Mode, click on the EDIT icon at the bottom of the
screen. The eight-second rectangular box will decrease in size to an individual
beat box. This box can be moved with the arrow keys on the keyboard.
Label code: V-VE, S-SVE, T-Aberrant, P-Pause, N-Normal, F-Artifact, (for
pacemaker patient: D-Paced Beat, C-Failure to capture, E-Failure to sense)
To begin the editing process, move the box to the beat you wish to edit. You
may click on the appropriate letter from the label code in the middle bottom of
the screen OR press the appropriate letter from the label code on your
keyboard.

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After you have edited and labeled the beat, press the ESC key on your
keyboard. The eight-second rectangular box will reappear on the screen. To
edit another beat, click on the EDIT icon on the bottom of the screen.
To add a beat, click on the EDIT icon at the bottom of the screen. With the
arrow keys on your keyboard move the beat box to the beat prior to the beat
you want to add. Click on the ADD BEAT bar on the lower part of the screen.
Move the beat box until it is centered over the beat. Again, click on the ADD
BEAT bar on your screen. Press the ESC key on your keyboard.
To delete a beat, click on the EDIT icon at the bottom of the screen. Move the
beat box over the beat you choose to delete. Click on the DEL BEAT bar on the
screen. Press the ESC key on your keyboard.
The R-R Variability Graph is located above the icons on the Page Scan screen.
This graph shows you the changes in R-R during a one-minute period. In the
example above, you will note the SVE on the 30-minute page scan screen. This
SVE can also be seen on the R-R Variability Graph by the shorter line that is
colored green.
Once you have finished editing in the Page Scan mode, click on the CLOSE
icon at the bottom of the screen.

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MEGA SCAN

To access the Mega Scan graph, click on the MEGA SCAN icon on the Data
Access Choices screen.

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The purpose of the Mega Scan process is to allow you to slide a cursor through
a 24-hour trend to view areas of interest. 24-hour trends of min-average-max
heart rate are displayed in a minute-to-minute basis. VE, V-Run, SVE, SV-Run
and Pause trends are shown on an hourly basis. ST Segment trends for all
channels are shown on a minute-to-minute basis. You may toggle between QT
and QTc trends that are shown on a one-minute basis. The SDNN of Heart
Rate Variability is shown in 5-minute increments.
The Mega Scan process will also be useful in locating intermittent events of
Atrial Fibrillation and Atrial Flutter. Sudden increases in the vertical range of
the min-average-max heart rate could be indications of Atrial Fibrillation or
Flutter.
To activate the cursor, point and click your mouse anywhere within the 24-hour
graph. This vertical cursor spans from top to bottom of all 24-hour trends. To
move the cursor, you may use the arrow keys on the keyboard or point and
click with the mouse on the location you desire to see. To move to a precise
point, point and click with the mouse to the approximate location. Use the
keyboard arrows to move the cursor to the exact spot.
NOTE: To activate the QTc graph, click on the letters QT (with the white
background) at the beginning of the QT graph. The QT graph will be replaced
with the QTc graph.

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Right click your mouse and the above drop screen will appear. When you
select different channels, the ST and QT graphs will be changing accordingly.
You can move the cursor across trends for all of the simultaneously displayed
data. As you do so, a one-minute, single channel associated ECG strip will be
shown on the bottom of the screen. To activate an enlarged eight-second strip,
press the ENTER key on the keyboard or double click with your mouse.

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The enlarged eight-second ECG strip allows you to validate the ST and QT
measurements.
In the example above, ST validation is being done from Channel Ⅱ to
Channel V1. The blue marker indicates where the ST sample point should be
set. If you see that it is incorrect, you need to re-analyze the patient data and
reset the ST markers in the correct location.
In the example above, QT validation is being done on Channel Ⅰ and
Channel V2 to V6. The first green marker indicates the beginning of the Q-wave;
the blue marker indicates the ST sample point and the second green marker
should be at the end of the P-wave. If you see these markers are incorrect, you
need to reanalyze the patient data and reset the ST markers in their correct
location.
To return to the Mega Scan screen, press the ESC key on the keyboard.

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QT VALIDATION

Most Holter companies do not attempt to perform QT analysis. However,

elongated QT can have as serious, or more serious, consequences than
V-Tach, Pauses and ST episodes. This QT validation program is the first time
in Holter ECG that the Holter cardiologist or technician can validate the
accuracy of its QT and QTc analysis.
To enter the QT Validation program, point and click on the QT Validation icon.

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QT is analyzed on a beat-to-beat basis. The heart rate is factored into the QT

analysis so that QTc and QT measurements can be made from the same data.
A QTc Histogram is then developed.
Carefully examine all the details in the displayed QTc Histogram. Generally,
QTc intervals in excess of 450ms are very worrisome to the physician. All QTc
intervals in excess of 450ms are shown at the right side of the QTc Histogram.
Point and click your mouse on the right side of the histogram. A large, green
vertical cursor will appear. This cursor can also be moved with the arrow keys
on the keyboard.
To switch to other channels, mouse left click on the screen except the field of
Physician Comments. To view and validate the accuracy of these selected
QTc’s, press the ENTER key on the keyboard or left double click on the cursor.
The following screen will appear.

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On this screen up to 16 mini ECG strips appear. All of these strips correlate to
the QTc ms reading from the histogram. In the lower left-hand side of the
screen you can see how many pages of correlating strips you have.
Small vertical green lines mark the locations of the specific spots from where
the QT was analyzed. The gray colored box is the strip you are working with. To
enlarge this strip press the ENTER key on the keyboard or left double click with
the mouse or point and click on the Zoom In icon at the bottom of the screen.
An enlarged 8-second ECG strip will be displayed.

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Note that the vertical QT markers are shown on the 8-second strip and that both
the QT and QTc (second row) numbers of current channel you selected are
displayed on the lower left-hand corner of the ECG strip. The QTc number is
the same QTc number that was shown on the previously shown QTc
Histogram. The QT number is the length of the QT interval before it was
corrected for heart rate (QTc). By seeing that the markers are set correctly and
measuring an interval, you can validate the accuracy of the QTc.
To measure an interval point and click on the RULER icon at the bottom of the
page. A small ruler and red cross will appear on the screen. Place the red cross
at the beginning of one of the Q waves being measured. Drag the cross
horizontally to the end of the T wave. Release the left mouse button.

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A measurement box will appear between the two measured points. A

measurement will appear in the field above the strip (in this example, 400 msec,
1.0 mv). This number is the result of the measurement you have just made
using the Ruler. The msec measurement should be similar to the QT
measurement being shown on the bottom left of the screen. If the new display
of QT interval is similar to the original QT measurement, then you have
properly validated the accuracy of the QT analysis for the QTc selected from
the QTc Histogram.
If the QT numbers do not show a similar match, then press the ESC key on the
keyboard or point and click on the CLOSE icon at the bottom of the screen.
NOTE: If you notice that all the green cursors are set incorrectly, you must exit
the QT Validation program to the Data Access Choices screen and
Re-Analyze the patient data. Make sure that you set the ST markers correctly
per the directions in the ST QT Setup Screen.

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If you want to reject only a single QT from several QT’s that were at the same
QTc histogram location, point and click on the REJECT icon at the bottom of
the screen. This will remove the single QT that is in the gray color. You can
remove other selected QT’s by pointing and clicking on the other ECG strip
boxes and clicking on the REJECT icon.
When you have finished this process, point and click on the CLOSE icon at the
bottom of the screen. This will return you to the QTc histogram.

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To remove all QT’s from a selected histogram location, point and click on the
Reject box on the lower right side of the screen. A red line will appear on the
QTc Histogram, indicating that these QT’s and QTc’s have been eliminated
from the analysis of the QT and QTc.
Repeat the above steps as necessary. You only have to validate one or two of
these elongated QTc’s in order for the physician to know that the patient has a
very serious abnormality. After finish your validation checks, return to the QTc
Histogram screen.
To add Physician Comments on the QTc report, simply point and click in the
Physician Comments field and begin typing.
Once you have finished validating the QTc’s and entering the Physician
Comments, point and click on the Update box on the lower right hand side of
the screen. Then click on the Close box. You will be returned to the Data
Access Choices screen.

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A-FIB/FLUTTER

Generally, physicians do not wish to count any SVE beats during periods of
Atrial Fibrillation. This program allows you to easily validate and edit this data.
Point and mouse click on the A-Fib/Flu icon at the Data Access Choices
screen to begin the editing.

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This screen shows a 24-hour trend graph showing the minimum, average and
maximum heart rate for each minute. The time period analyzed as Atrial
Fibrillation is boxed in and red color-coded. The beginning and ending times of
the Atrial Fibrillation are shown in the Comments section on the lower left side
of the screen.
There is a large yellow cursor at the beginning of the boxed in A-Fib area.
The minute this cursor is on is displayed below the 24-hour trend graph (This
cursor can be moved anywhere on the 24-hour trend graph using the arrow
keys on the keyboard or by pointing and clicking with the mouse). If the
channel of the displayed minute is not of the best quality, you may point and
click on the Channel icon at the bottom of the screen or left click with your
mouse at anywhere of this screen. You can change the channel of the minute
you are viewing on the screen.
Check to see if there are any beats being called SVE’s (they would be colored
magenta on the enlarged minute in the middle of the screen). If there are, point
and click on the REMOVE SVE icon at the bottom of the screen. This will
remove all SVE’s during this one-minute period.
NOTE: If your screen cursor is placed anywhere in the A-Fib/Flutter section of
the24-hour trend graph, clicking on the REMOVE SVE icon will remove all
SVE’s during the A-Fib/Flutter period.

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As you remove SVE’s, you will see an updating screen. This lets you know all
the SVE counts for all the Atrial Fibrillation minutes have been removed from
the analysis, the template edit and all other sections of the Holter displays and
reports.
Left double clicking with you mouse on anywhere of current one minute ECG
strip or pointing and clicking on the Zoom In icon at the bottom of the screen,
you will enter the screen of enlarged 8-second ECG strip.
There are two selections (Full size and Half size) in the field of ECG Gain at
the bottom of the screen for you to adjust the amplitude of ECG waves.
You may edit the Comments section by clicking on the Add button next to the
Comments section.

Click on the Add button and the above screen appears. Enter the beginning of
the time period of the Holter recording listed as Atrial Fibrillation or Atrial Flutter.
Press the TAB key on the keyboard. Enter the end time of the period of the
Holter recording listed as Atrial Fibrillation or Atrial Flutter. Click on the down
arrow next to the Type field and select Atrial Fibrillation or Atrial Flutter. Click on
OK. Clicking on Edit button next to the Type field box to open a Windows
notebook, you can input new ECG event that will appear in the Type filed.
The time period you have added will now be noted in the Comments section and
marked on the 24-hour heart rate trend graph. To delete the items in the
Comments section, point and click on the item you want to delete and then
click on the Delete button.

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Upon completion of editing the Atrial Fibrillation, point and click on the Close
icon at the bottom left of the screen. You will be returned to the Data Access
Choices screen.

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HEART RATE VARABILITY

To work with the Heart Rate Variability (HRV) graphs, point and click on the
HRV icon at the Data Access Choices screen.

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This display shows the Poincare plots across the top of the display, the
Spectral Power Graph and the Time Domain R-R Histogram under the
Poincare plots.
The Spectral Power Graph is at the left side under the Poincare plots. Some
physicians desire to create their own frequency range. To adjust the ranges of
Very Low Frequency (VLF), Low Frequency (LF), and High Frequency (HF),
point and click anywhere in the 24 Hour Spectral Power Graph. A yellow line
will box around this third of the screen. Press on the TAB key of the keyboard
until you get to the frequency you wish to change (the range description of the
frequency you are changing will be highlighted in green above the graph). Use
the ARROW keys on the keyboard to adjust the graph tot ranges that you
believe to be correct for your testing purposes. Upon completing your
adjustments, click on the Accept bar in the middle right of the screen.
The Time Domain R-R Interval Graph is at the right side under the Poincare
plots. You may want to validate that all arrhythmia and artifact beats have been
removed from the HRV file of only normal R-R intervals. To activate the editing
of this screen, point and click your mouse anywhere in this section of the
screen. A yellow line will box around this third of the screen. You can view
the ECG data at either far end of the histogram (highlighted in green) to
determine if any of these ECG’s should be rejected from the HRV data file. To

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view the data, move the large yellow cursor to any of the minutes highlighted
in green using your ARROW keys on the keyboard or your mouse. Double
click with your mouse or press the ENTER key on the keyboard once the
cursor is set. The following screen will appear.

Only normal beats should be included in the HRV counts. Any abnormal beats
or artifact will cause the HRV data to be incorrect.
This screen shows up to 16 mini strips that have been included in this range of
the HRV interval graph. The R-R interval being counted has green markers set
above it. To reject any data, move to the ECG strip with the R-R interval you
wish to reject using the ARROW keys on the keyboard or by pointing and
clicking with the mouse. The strip will turn light gray. Point and click on the
Reject icon at the bottom of the screen. You will now see Reject at the bottom
of the strip. To reject all the intervals being counted on the screen, point and
click on the Reject Page icon at the bottom of the page. To reject all the
intervals being counted in this area of the histogram, point and click on the
Reject All icon at the bottom of the page.
To show the R-R interval in an enlarged 8-second strip, point and click on the
Zoom In icon at the bottom of the screen or press the ENTER key on the
keyboard. The interval being measured is the interval preceded by the red mark
at the top of the enlarged 8-second strip.
To return to the mini strips, point and click on the Close icon at the bottom of
the screen.

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To show the Spectral Power Graph and Time Domain R-R Interval graphs for
a selected period of time, click on the appropriate period under the Period
Select options in the middle right of the screen. The two small buttons right to
the Awake and Asleep can change the getting up time and the sleeping time.
To access the 3D Spectral Power Graph, click on the 3D Spectral bar on the
lower right of the screen.

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You can adjust the visual effect of the 3D power graph as you want through the
Draw Mode box, Animation box, Scaling box and 3D Technic box. To restore
the initial default setting, point and click on the Restore button at the bottom of
the Scaling box.
Each 5-minute data period is analyzed by the spectral frequency methodology.
A power graph is drawn for each 5-minute period, and then overlaid on each
other. The resulting 3-D power graph creates a 24-hour power graph that
provides instant visual understanding of the patient’s heart rate variability.
To view the totals for each 5-minute period, click on the Power per 5 minute on
the lower right side of the screen.

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Spectral analysis of each 5-minute period is calculated. Power is calculated for

Total Power, VLF Power, LF Power, HF Power and a formula for determining if
the period was sympathetic or parasympathetic in origin. To additional 5-minute
periods, point and click on the down arrow.
To exit this screen, click on the X at the top of the Power per 5-minute box.

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This system includes a unique feature of measuring the drug efficacy in

relation to HRV. Click on the Medication Time bar on the lower right of the
screen. The above screen appears.
Enter the time the patient took medication and then enter the medication
information from the pull down menu. Click on OK. You can also add new
medicine glossary by clicking on the EDIT button next to the down arrow. A
notebook will appear for your editing.

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An immediate analysis appears under the Medication box in the middle of the
screen. You are shown the Reference Spectral Power compared to the first
30 minutes after taking the medication, the first hour, the first two hours, the
first four hours and the first eight hours. The Reference Spectral Power is the
Total Power for the 2 hours immediately preceding the medication time.
After you have retrieved all the information from this screen, point and click on
the Close bar at the bottom left of the screen. Point and click on the Close bar
again and you will be returned to the Data Access Choices screen.
NOTE: For more detailed HRV power information, please refer to the 5-minute
power numbers described earlier. You can view and/or print these 5-minute
power numbers that were pre and post medication time.

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ST SCAN

This function is used to view and compare the ST trend of 12 or 3 Lead. The
function of ST Scan is different between 3 Lead and 12 Lead.
To work with the ST Scan, point and click on the ST Scan icon at the Data
Access Choices screen.

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12 Lead

The ST trend graph of 12 Lead is displayed at the right side of the screen with
the black background. Any point on the graph indicates 1-minute ECG wave.
The red color in trend graph indicates that the ST segment is abnormal; the
blue indicates it is normal.
The individual ECG wave of three channels at the left side of the screen is a
1-minute average ECG wave representing the beats at the position where the
white vertical cursor is located on the graph at the right side of the screen.
Right clicking anywhere of each channel, you can switch to other eleven
channels as you want. The average St Value of 1-min beats is shown at the
right corner above the individual ECG wave. The short red cursor on the
individual ECG wave marks the position of ST segment. Move the white
vertical cursor on trend graph with the arrow key on the keyboard or your
mouse, the individual wave and the average ST value will be changing
accordingly.
To see the ST dynamic changes, click on the Scan icon at the bottom of the
screen. The white vertical cursor will be automatically moving from the current
position to the right side and the individual wave at the left side of the screen
will be changing accordingly. To stop the scan, click on the Stop icon at the
bottom middle of the screen.

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You can compare the ST segment of any points in the trend graph with a
standard 1-min average wave automatically set by the program. Click on the
box next to the Compare Mode at the left bottom of the screen to enable the
function of Compare Mode. The fixed green standard ECG wave together with
white ECG wave will appear at the left side of the screen. Move the white
vertical cursor to the any position you want to compare, the white ECG wave
will change accordingly.
To see the enlarged 8-second ECG strip, first move the white vertical cursor to
the desired position and then double click with your mouse or press the ENTER
key on the keyboard or click on the Zoom In icon at the bottom of the screen.
To see the ST spectral graph, click on the circle box of 3 Lead and 3D Color
Trend at the bottom left corner of the screen. The following screen will appear.

At the right side of the screen with the black background, the ST/HR trend
graph, the trend graph of J point and ST segment of three channels and ST
spectral graph are displayed in order from top to bottom. In according with
these three channels, their individual ECG waves are at the left side of the
screen. Right clicking anywhere in the field of each channel, you can switch to
other channels from the shortcut menu. The corresponding trend graph will
also be changing accordingly.
The red color in trend graph indicates that the ST segment is abnormal; the blue
indicates it is normal. The red color in spectral graph indicates that the ST

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segment is depressed; the deep blue color indicates the ST segment is

elevated; the green is normal.
In this section, there are many functions for you to get the ST data more
accurately and more conveniently.
ST Reanalysis
With aim of getting more accurate ST data, you can reanalyze any ST segment
of different channels through resetting ST. The steps are as following.

1. Right click anywhere of the left side of the screen, a shortcut menu will
appear for you to select the desired channel you want to reanalyze.

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2. Move your mouse to the starting point of the ST segment you want to
reanalyze, press the left key of mouse and drag the white cursor to the end
point, the ST segment to be reanalyzed will be highlighted in yellow color.

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3. Point and click the channel to be reanalyzed at the left side of the screen,
this channel will be highlighted in gray color. Move the three short cursors
to reset the beginning of Q wave, J point and ST point respectively. The
yellow cursor is the current active cursor. You can switch to other two
cursors with the TAB key on the keyboard.

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4. Upon the completion ST setting, press the ENTER key to start the
reanalysis of the selected ST segment and the initial trend graph will be
updated automatically.

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ST Level

Click on the ST Level icon at the bottom left side of the screen, the above
screen will appear. At the right side of the screen shows the ST distribution of
three channels. The Y-coordinate indicates the ST evaluation or depression
value relative to the horizontal green line. The X-coordinate indicates time
(minute) occupied by the beats with the same ST value. You can get the
information of St evaluation or depression from the white words in the upper
right corner of each channel at the right side of the screen.
Point and click with your mouse in the field of different channels, the active
channel will be highlighted into gray. Moving the horizontal green line with the
up or down arrow key on the keyboard, you can see different ST distribution
with the ST values in the upper right corner changing accordingly. The red color
in the distribution graph indicates that the ST segment is abnormal; the light
blue indicates it is normal. Right clicking anywhere in the field of distribution
graph with the mouse, you can select different ST Criteria through the shortcut
menu. The distribution graph will be changing accordingly with the different
criteria.
To see the enlarged 8-second ECG strip, double click with your mouse or point
and press the ENTER key on the keyboard. The following screen will appear.

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The red ECG wave is the current channel you are checking. This function is
for you to further identify whether the result made by the program is right or
wrong. The little rectangular window at the right side of the screen shows the
entire 1-minute ECG waves with the same ST value. The number of the
1-minute ECG waves equal to the Minutes value can be seen at the screen of
ST level. Point and click the 1-minute ECG wave in the little window, the
program will take you to the corresponding enlarged 8-second ECG strip. If you
think the result of a certain 1-minute ECG wave is wrong, you can click on the
box of that 1-minute ECG wave and then click on the Update ST Edit button.
The initial data will be updated. Click on the Uncheck All button, all check
marks in the box will disappear in the little window. Click on the Close icon to
return to the screen of ST Level, click on the Close icon again to return to the
screen of ST Scan.

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3D ST Graph

3D ST Graph is used to view the changes of a certain ST segment in the mode

of 3 dimensions. This function is only available to 12 Lead.
To see the 3D ST Graph, the first step is to select a certain ST segment (see
page 95 the step 2 of ST Reanalysis) and then click on the 3D ST Graph icon at
the bottom middle of the screen. The above screen will appear.
Different color represent different ST value showed at the left side next to the
3D graph. The carmine and mazarine colors represent the ST value is
abnormal while other colors represent it is normal.
Press the left key of the mouse and move the white mouse cursor, you can
rotate the graph to view it from different angle. Click on the Reset icon at the
bottom of the screen to restore the graph to the initial position.
To print out the Graph with colors or not, select the two items in the field of
Graph Option at the bottom left corner of the screen.
To change the display order of 12 leads in the 3D graph, select the two items in
the field of Lead right to the Graph Option.
To save the current displayed graph, click on the Save icon at the bottom
middle of the screen. After saving the current graph, it can be seen in the
screen of Report. Otherwise, the item of 12Leads 3D ST will turn into gray with
no function.

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To exit this screen, click on the Close icon.

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3 Lead

At the right side of the screen, the ST/HR trend graph, the trend graph of J
point and ST segment of three channels and ST spectral graph are displayed in
order from top to bottom. ST Level is 3 leads data accordingly.
There is no 3D ST Graph for 3 leads data.
The other functions and operations are similar as 12 leads data.

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FCG
FCG is the initial capital abbreviation of Frequency Domain Electrocardiogram.
In this operation, the program provides a new function – 12-Lead power
spectrum that can get more potential information from the general ECG wave.
The corresponding analytical items of two leads (Ⅱ, Ⅴ5) include coherent
function, pulse response, transfer function, phase-shift and cross correlation.
The character of 12-Lead Frequency Domain has a series of diagnostic
description that can be used as reference in the cardiopathy diagnosis.
In addition, you can make the locating diagnosis of the myocardia ischemia
through the combination of positive guidelines in 12-Lead.
Note: FCG diagnosis is the supplement for the conventional 12-Lead ECG
diagnosis and only be as the reference.
This function includes three parts, including 12-Lead ECG power spectrum,
Limb Lead power spectrum and Precardial Lead power spectrum.
We will discuss these three parts in flowing sections.
To access the screen of 12-Lead ECG power spectrum, click on the FCG icon
at the Data Access Choices screen.

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12-Lead ECG Power Spectrum

FCG analysis is very sensitive to the coronary heart disease. Two group
histograms are displayed at the left side of the screen. The upper side is the
front plane of heart, including I, -aVR, II, aVF, III, -aVL, -I, aVR, -II, -aVF, -III and
aVL.
The lower side is the cross section of heart, including V1, V2, V3, V4, V5, V6, -V1,
-V2, -V3, -V4, -V5 and -V6. The subtractive mark indicates this lead is in the
reverse direction with the corresponding lead without the subtractive mark.
If there are three consecutive abnormal leads in the histogram, the
auto-diagnosis function will be activated and the precise position of the focus
will be pointed out.
In this screen, you can enter medical glossary into the box of Suggested
Interpretation. The first step is to open the pull-down menu under the box of
Suggested Interpretation and select the desired term, and then click on the
Insert String button. The selected term will appear in the box. To edit the
medical glossary, click on the Edit Dictionary button, a Label Database will
appear.
To keep the editing results you have done, click on the Save button. Before
saving the results, you can restore the initial status by clicking on the Restore
button.

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The Cardiac Electric Axis at the upper right corner of the screen may provide
you good reference.

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Limb Lead Power Spectrum

Click on the Limb Lead Power button at the top of the screen to access the
above screen.
The limb leads are six front leads, including II, III, aVR, aVL, aVF and I, which
are displayed in six power spectrums on the screen. The ECG analysis system
can automatically give the first five peak values of the power spectrum.
Left click on the power spectrum with your mouse, the waves will be magnified;
right click with mouse, the waves will be reduced.

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Precardial Lead Power Spectrum

Click on the Precardial Lead power spectrum at the top of the screen to access
the above screen.
The precardial leads are six horizontal leads, including II, III, aVR, aVL, aVF
and I, which are displayed in six power spectrums on the screen. The ECG
analysis system can automatically give the first five peak values of the power
spectrum.
Left click on the power spectrum with your mouse, the waves will be magnified;
right click with mouse, the waves will be reduced.

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ECG STRIP

To access the viewing, saving and printing of ECG Strips, point and click on the
ECG Strip icon from the Data Access Choices screen. From the ECG Strip
menu, you will be able to select various ECG strips for printout.
ECG Strips can be selected from other menu displays. They can also come
from ECG Strip displays in Edit, Page Scan, Mega Scan, QT Validation,
A-Fib/Flutter and HRV.
If the automatic analysis and report is selected in the Setting default menu, the
first event of each category in Abnormal ECG Events is saved for the Holter
report printout.

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PATIENT DIARY EVENTS

Adding the patient’s ECG event (symptoms and the time it’s happened) to the
list box in the field of Patient Diary Event at the left side of the screen, you can
view, label, edit and print these events from this screen. To add these
symptoms and times to the screen do the following:
1. Click on the available Event entry with no time associated to it. A gray
highlight will appear.
2. Click on the line again and a cursor will appear in the field. Using your
keyboard, enter in the symptom from the patient diary.
3. Click on the Time field next to the symptom you have just entered. The
Symptom field will turn gray.
4. Click on the Time field again and you will get a cursor in the field.
5. Enter the hour from the patient diary associated with the symptom.
Remember to use military time.
6. Enter the minute from the patient diary associated with the symptom. Press
the TAB key on the keyboard. The symptom and time are now entered into
the patient diary.
7. To save these strips for the final report, click on the Symptom to be saved.

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8. Click on the Save Symptoms bar at the bottom of the screen. You will see
the time and symptom noted in the Saved Strips column on the right side of
the screen.
9. Repeat this for all the strips you wish to save.
To view a patient event simply click on the event you wish to view and then click
on the View Symptoms bar at the bottom of the screen. An enlarged 8-second
ECG strip will appear on the screen.

To save strips from the Events you have previously edited, click on the Save
Events bar at the bottom of the screen.
To save the first strip in each Event category, click on 1 ECG Strip.
To save the first two strips in each Event category, click on 2 ECG Strip.
To save the first 3 strips in each Event category, click on 3 ECG Strip.
The strips will be added to the Saved Strips column on the right side of the
screen. These strips will be printed out with the final report.

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ENLARGED 8-SECOND STRIPS

To view, print, label and edit additional strips, go to the Select Time To View
Strips box in the upper right of the screen.
Point and click the mouse in the hour field. Using the up and down arrows, you
may scroll to the hour you desire, or simply enter the hour using your keyboard.
Press the TAB key on the keyboard and you will be moved to the minute field or
point and click the mouse in the minute field. Using the up and down arrows,
you may scroll to the minute you desire, or simply enter the minute using your
keyboard. Click on the View bar. The screen of enlarged 8-second strips will
appear.
To view and edit ECG wave in the enlarged 8-second strips refer to page 61
(View ECG Strips).
SAVED STRIPS
All the strips you have saved from all of your editing, selecting strips and
labeling strips are noted in the Saved Strips box on the right side of the screen.
Make sure to click on the Print All saved Strips option under the Print Options
box. The black dot next to this option ensures that these strips will print out
with the final HOLTER report. If this option is not selected, the saved strips will
not print out with the report.
If you choose to delete any of these strips from the final report, simply point and
click on the strip you wish to delete. The strip will be highlighted in blue. Click
on the Delete Selected Strip bar at the bottom of the screen. The strip will be
removed from the Saved Strips box and will not print out with the final HOLTER
report.
If you wish to print out all of the saved strips at this time, click on Print all Saved
Strips. A black dot will indicate this option is now active. Click on the Print bar.
All the strips in the Saved Strips box will print out. If you want an immediate
print out of a strip from the Saved Strips box, press the CTRL key on the
keyboard and mouse click on the desired strip. Click on the Print bar at the
bottom of the screen and the strip will print out.
To print a continuous group of strips from the Saved Strips box, press the
SHIFT key on the keyboard and mouse click on the first of the strips you desire.
Press the SHIFT key on the keyboard and mouse click on the last of the strips
you desire. The first and last strip you selected, along with all strips in between,
will be highlighted blue. Click on the Print bar at the bottom of the screen. The
highlighted strips will print out.

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HOURLY MODE

Some users of HOLTER ECG Systems prefer to process their HOLTER

recordings by printing out the full disclosure at one hour of ECG data per page.
The operator, in this technique, then looks at the one-hour full disclosure
print-out and makes an estimate of the number of VE, SVE, Pause, V-Tach,
etc. beats that occurred during the hour.
The purpose of the Hourly menu is to provide a display that makes it easy for
the operator to enter the hourly quantities of abnormal beats into a worksheet
type data bank.
To activate the Hourly menu, point and click on the Hourly icon.

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Fourteen columns of data are available for manually entering hourly quantities
of data after looking at the full disclosure print out.
Point and click on a location that you wish to enter data. Using your keyboard,
enter the numerical value you desire. This value can be an estimate or the
actual count of the number of such beats that occurred during that hour.
NOTE: The box that you enter the numerical value in pops up on the screen
after you have clicked the mouse. It may not appear exactly where you have
clicked on the screen. This is okay. You will see that when you click on another
location, the data you have entered will be located in the box you selected.
After entering all of the desired hourly numbers, point and click on the Save
bar at the bottom of the screen.
In some instances it may be quicker to zero out the columns and then enter the
data. To zero out a column, point and click and the column you want zeroed out.
Click on the Zero bar at the bottom of the screen. All values in the column will
have changed to zero. Enter in the numerical values you desire. When you
have finished entering in all the data, click on the Save bar at the bottom of the
screen.
To see the detailed situation of the item you selected, click on the PageScan
bar at the bottom of the screen. The screen of Page Scan will appear.
Upon finishing with this screen, click on the Close bar at the bottom of the
screen. You will be returned to the Data Access Choices screen.

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SAECG & VCG

To access the SAECG & VCG menu, point and click on the SAECG & VCG
icon, two items (SAECG and VCG) will appear for your selection. This function
is only applicable with 3 leads data. Click ‘SAECG’, the following screen will
appear.

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SAECG

SAECG is the initial capital abbreviation of signal-averaged electrocardiogram

used to catch the information of Ventricular Late Potential without hurt.
The SAECG screen display consists of two data displays. The top display is
the R-R Interval graph. Each vertical line represents the heart rate of one beat.
The longer the line the slower the heart rate. Individual R-R intervals can be
deleted by moving the cursor bar with a mouse click or with the arrow keys to
the desired location, and using F2 to reject the R-R interval.
The large data display is one minute of ECG data. Each horizontal sweep
represents 12 seconds of ECG data. Undesired ECG beats can be eliminated
by placing the mouse cursor on the desired location and clicking. Reversing
this process will cause rejected bats to be accepted. It is desirable to remove
beats with artifact from the SAECG Late Potential file. You can access minutes
1 through 6 by pointing and clicking the mouse on the Page 1, Page 2, Page 3,
Page 4, Page 5 or Page 6 tabs or you can change the minutes by pressing the
PGUP and PGDN keys on the keyboard.
Below the R-R Interval graph are function keys. These function keys are
described below:

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F1 Accept Key – Move the cursor to a blank location on the R-R Interval graph,
point and click on F1 or press the F1 key on the keyboard. The deleted interval
will be restored.
F2 Reject Key – Move the cursor to the desired vertical line on the R-R Interval
graph, point and click on F2 or press the F2 key on the keyboard. The R-R
Interval will be deleted from the SAECG file.
F4 Time – Click on the F4 or press the F4 key on the keyboard to activate the
Time Domain screen display.
F5 Freq. – Click on the F5 or press the F5 key on the keyboard to activate the
Spectral Frequency display.
F6 Min R-R – Click on the F6 or press the F6 key on the keyboard and the
screen cursor will be moved to the minimum R-R interval in both displays.
F7 Max R-R – Click on the F7 or press the F7 on the keyboard and the screen
cursor will be moved to the maximum R-R interval in both displays.
Left, Right, Up and Down Arrows – Click or press the ARROW keys on the
keyboard to move the screen cursor. The Up and Down arrows move in larger
increments than do the side to side arrows.

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F3 Auto Key – Click on the F3 or press the F3 key on the keyboard and the
above screen will appear. The percentage shown represents all R-R deviations
exceeding the percentage of the average heart rate that will automatically be
deleted. The percentage default is 10%. If desired, place the cursor on the
slide bar, click and drag to the desired percentage. Click on the Apply bar, the
program begin to analyze the Late Potential data and the results will be saved
for you to print out in the report.

Operational Usage
1. Click on F3 to set the desired percentage of rejected beats from the heart
rate average 10% is routinely used.
2. Click on Page 1. Delete all beats that have artifact in any of the 3-channel
ECG. To delete beats, point and click on artifact. The beat will be colored
gray. If you make a mistake, just click on the artifact again. The color will
change back to white and it will be added to the beat file. Repeat this
procedure for pages 2, 3, 4, 5 and 6.
3. It is recommended to have a total of 200 or more qualified beats for good
SAECG analysis. The data box at the lower right of the screen show you
the count of the Accepted Beats.
4. Click on F4 time to proceed to the Time Domain Analysis set-up.

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Time Domain
The upper side is the superimposed ECG waves without being filtered. Point
and right click this part with your mouse to select different leads. The lower side
is the synthetic superimposed and filtered ECG waves of 3-lead. The right side
lists the analytical parameters for time domain. The define and normal
range of these parameters are as following:

Normal Range (ms) Standard QRS < 100

Total QRS after filter < 114
LAS40 Under 40uV < 38
Last 40ms RMS40
25 – 250 Hz Filter > 25
40– 250 Hz Filter > 16
Noise < 1.0

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Time Domain Analysis Set-Up

Before getting these parameters, you must process the setting first.
There are four (4) vertical cursors and one (1) set of horizontal cursors on this
screen.
The active screen cursor will be highlighted in yellow. Use the Tab key on the
keyboard to change the active screen cursor. The arrow keys on the keyboard
will move the screen cursor.
Move the active cursor to the beginning of the QRS. Right click with the
mouse. Scroll down to Show Ch, and click. Move the cursor to the beginning of
the QRS. Right click with the mouse. Scroll down to Show Ch. 3 and click.
Move the cursor to the beginning of the QRS. Right click with the mouse. Scroll
down to Show All Ch. and click. Move the cursor to the beginning of the QRS.
Press the TAB key on the keyboard. The active cursor is switched and now will
be set at the end of the QRS. Right click. Scroll down to Show Ch. 1 and click.
Set the cursor to the end of the QRS. Right click. Scroll down to Show Ch. 2 and
click. Set the cursor to the end of the QRS. Right click. Scroll down to Show Ch.
3 and click. Set the cursor to the end of the QRS. Right click. Scroll down to
Show All Ch. and click. Set the cursor to the end of the QRS.

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Press the TAB key on the keyboard. The active cursor is switched. Set the
cursor at the end of the S-Wave of the Total QRS. Press the TAB key on the
keyboard.
Use the ARROW keys on the keyboard to set the cursor to the beginning of the
Q-wave of the Total QRS display.
Look at the Data Box at the lower right of the screen. Verify that the width of
the Total QRS is larger than the Standard QRS.
Click on the Close icon “X” at the top right of the screen.

Spectral Frequency Analysis

Click on F5 Freq. and the SAECG Frequency 3-D Graph will come up on your
screen.
The upper side is the superimposed ECG waves without being filtered. The
lower side is the 3D frequency-time spectrum for SAECG, which is called the
Haberl method. In principal, if the HF is higher at the right side of the spectral
frequency graph, the Late Potential is more accordingly. The detail diagnostic
method can be referred in related textbooks or papers.
View the Frequency Graph for Channel 1. You can move the active yellow
screen cursor at the end of the QRS with the ARROW keys on your keyboard.
Note that the Initial Window Width numbers will change in the data box directly

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above the 3D graph as well as the 3D graph. The information in the Data Box
at the lower right of the screen will also change.
Right mouse click. Scroll down to Show Ch. 2 and click. The SAECG
Frequency Graph will change with each channel. You will be able to view the
changes in spectral power. Right mouse click. Scroll down to the Show Ch. 3
and click.
When you are finished with this screen, click on the Close icon “X” at the top
right corner of the screen display. You will be returned to the SAEG main
screen display. Click on the Close icon “X” at the right corner of the screen
display. You will be returned to the Data Access Choices screen.

VCG

Vectorcardiogram (VCG) is an important diagnostic technique for the

cardiovascular diseases, having more superiority in the diagnosis of
Hypertrophy, Conduction Block, Plumonary-cardio disease, Myocardial
Infraction, Ischemia of Coronary Artery and Preexcitation Syndrome. The Lead
connection of VCG is Orthogonal Lead.
Point and click ‘VCG’ from the screen of Data Access Choices, the above
screen will appear.

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VCG displays the three-dimensional structure of cardiac electric activity with

three VCG graphs, including Front Plane Graph (X-Y), Horizontal Plane Graph
(X-Z), and Right Sagittal Graph (Z-Y).
The percentages in the four quadrants of each graph represent the proportion
of the QRS area in this quadrant relative to the total QRS area.
The parameters of VCG graph automatically calculated by the Electro Cardio
Composite Analytical System are as following:
　 MaxA（QRS）- the maximum amplitude of QRS loop（mv）
　 MaxA（P）- the maximum amplitude of P loop（mv）
　 MaxA（T）- the maximum amplitude of T loop（mv）
　 Angle（QRS）- the amplitude angle of QRS loop（°）
　 Angle（T）- the amplitude angle of T loop（°）
　 Angle（P）- the amplitude angle of P loop（°）
　 Rotation（QRS）- the revolving direction of QRS loop
　 CW - clockwise
　 CCW -counterclockwise
　 8-“8”loop
　 Rotation（P）- the revolving direction of P loop
　 Rotation（T）- the revolving direction of T loop
　 0.01(Amplitude) – the 0.01 second amplitude beginning from QRS loop
　 0.01(Angle)- the 0.01 second angle beginning from QRS loop
　 0.02(Amplitude)- the 0.02 second amplitude beginning from QRS loop
　 0.02(Angle)- the 0.02 second angle beginning from QRS loop
　 0.03(Amplitude)- the 0.03 second amplitude beginning from QRS loop
　 0.03(Angle)- the 0.03 second angle beginning from QRS loop
　 0.04(Amplitude)- the 0.04 second amplitude beginning from QRS loop
　 0.04(Angle)- the 0.04 second angle beginning from QRS loop

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To see the enlarged graph, double click with the mouse in the field of each
graph or click on the corresponding button at top of the screen, the above
screen will appear.
Clicking on the Play icon at the right side of the screen, you can see the shaping
process of the vector graph. With the graph proceeding, the individual ECG
wave at the right side is turning blue accordingly. You can also adjust the speed
and gain of the graph. To see the shaping process again, click on the Redraw
icon firstly, and then click on the Play icon.
In the graph, P loop is blue; QRS loop is green and T loop is yellow.
Clicking on the OK or Cancel bar, you will be returned to the Data Access
Choices screen.

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Timed Vectorcardiography (TVCG)

TVCG is the vectorcardiogram with the time being considered, which can
consecutively record the cardiac cycle in long time.
In this screen, the ECG wave of X, Y, Z Lead and the TVCG are displayed at the
left side of the screen; the VCG is displayed at the right side of the screen. The
beat with the red-yellow alternating arrow over it is the current wave of which
VCG is shown at the right side of the screen. Double click the gray arrow or
click on the Previous or Next button to change the current wave, its VCG will
be changing accordingly.
To change the speed or gain of the ECG and the TVCG, use the pull down
menu of Speed and Gain at the upper left corner of the screen.
To change the gain of the VCG, use the pull down menu of Gain at the upper
right side of the screen.
To measure the ECG or TVCG, click on the Ruler button, a ruler with red cross
will appear. Click on the Ruler button again, the ruler will disappear.
Clicking on the OK or Cancel bar, you will be returned to the Data Access
Choices screen.

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REPORT MENU
To access the Report menu, point and click on the Report icon at the Data
Access Choices screen. This function is different between 12-Lead data and
3-Lead data.

12-Lead Data

Page Print
You can print all kinds of Holter reports in this screen. The Page Print section
on the left side of the screen allows you to select which pages you want printed
in the Holter report. Move the mouse to the boxes to the left of each page print
description and click. A check mark will appear. If you click again, the check
mark will disappear. Those pages that have a check mark will be printed.
Those pages with no check mark will not be printed. The Page Print section of
ECG Strip is come from the Saved Strips box in the screen of ECG Strip. In
this example, there are eleven ECG Events to be printed.
You may preview each page of the report by clicking on the magnifying glass
icon to the right of each page print description.

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A magnifying glass is now the icon on the screen. To enlarge any part of the
report, point and click with the mouse. The area of the report page you have
clicked on will be enlarged. When you have finished previewing a page, press
the ESC key on the keyboard.

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Clicking on the Page Preview icon right to the Holter ECG Report Summary
Page will bring up the above screen, the Summary Page Edit.
To edit the numbers of each category, move the mouse cursor to the up or
down arrows next to each category and the numbers will increase or decrease
OR point and click your mouse in the field next to each description and type in
the number you desire.
Upon completion of this edit, click on the OK bar.

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Full Disclosure
Full Disclosure ECG print outs can be obtained for selected pages as follows:
1. Point and click on the desired hour in the “Print Full Disclosure” boxes. The
hour box and the Page Print section of Full Disclosure at the left side of the
screen will become lighter. Repeat this process for as many hours as
desired.
2. Select the channel to be printed from the pull-down menu in the Full
Disclosure box. Point and click on the box next to the Full Disclosure, a
check mark indicates the full disclosure will print out in.
3. Click on the Print bar. To print the report in portrait direction, the ECG
wave is the eight-second strip with full amplitude; to print the report in
landscape direction, the ECG wave is the twelve-second strip with half
amplitude. This function is only available to 12-Lead data.
To print 24 hours of full disclosure, click on the down arrow next to the Hours
per Page field. Select how many hours you want to print on one page. The
options are 1 Hour per Page, 2 Hours per Page or 4 Hours per Page. Your
selection will be highlighted in blue. Click on the Print 24 Hours of Full
Disclosure bar.
Click on the ASCⅡ button at the right side of the screen, the following screen
will appear.

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This function is for physician to review the data more simple and convenient.
Click on the Transfer To ASCⅡ button at the upper right corner of the screen,
the data will be saved into ASCⅡ.txt file in the directory: C:\HolterWin8. All
patient data will be listed in this file in time order.

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Physician Comments
The 12-Lead individual ECG waves are displayed at the lower right corner of
the screen. There are six vertical lines on the ECG wave, which represent the
start point of P wave, the end point of P wave, the start point of QRS wave, the
end point of QRS wave, the start point of T wave and the end point of T wave in
the order from left to right. The green vertical line is the current active cursor.
Use TAB key on the keyboard to switch to other cursors. To set the cursors,
point the green cursor and press the mouse left key, drag the cursor to the
correct position and release the left key. Upon completion of the setting, click
on the Print ECG Data, the ECG Data Table of this patient will be printed out.
Click on the Analysis button, the program will analyze the data based on the
new setting and show the conclusions following a serial of asterisks at the left
comments box. The conclusions may be any items from the following:
"Sinus rhythm, normal ECG",
"Atypical ECG",
"Sinus rhythm, borderline ECG",
"Sinus rhythm, abnormal ECG",
"No further interpretation",

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"No condition Associated",

"Ectopic rhythm",
"Arm leads reversed",
"Dextrocardia",
"Atypical Wolff-Parkinson-White Pattern",
"Type A Wolff-Parkinson-White Pattern",
"Type B Wolff-Parkinson-White Pattern",
"Possible right atrial enlargement",
"Right atrial enlargement",
"Possible left atrial enlargement",
"Left atrial enlargement",
"Moderate left axis deviation",
"Abnormal left axis deviation"
"Moderate right axis deviation",
"Abnormal right axis deviation",
"Indeterminate axis",
"Low QRS voltage in limb leads",
"Low QRS voltage in chest leads",
"Low QRS voltage",
"S1-S2-S3 pattern, consistent with pulmonary disease, RVH, or normal
variant",
"Consistent with pulmonary disease",
"Incomplete right bundle branch block",
"Right bundle branch block",
"Right bundle branch block, plus possible RVH",
"Incomplete left bundle branch block",
"Left anterior fascicular block",
"Left posterior fascicular block",
"Left bundle branch block",
"Nonspecific intraventricular conduction delay",

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"Nonspecific intraventricular conduction block",

"Possible right ventricular hypertrophy",
"Right ventricular hypertrophy",
"Right ventricular hypertrophy with repolarization abnormality",
"Minimal voltage criteria for LVH, may be normal variant",
"Voltage criteria for LVH",
"Possible left ventricular hypertrophy",
"Left ventricular hypertrophy with repolarization abnormality",
"Cannot rule out anterior myocardial infarction",
"Possible anterior myocardial infarction",
"Anterior myocardial infarction",
"POSSIBLY acute",
"PROBABLY recent",
"PROBABLY old",
"Age undetermined",
"Cannot rule out septal myocardial infarction",
"Possible septal myocardial infarction",
"Septal myocardial infarction",
"Cannot rule out anteroseptal myocardial infarction",
"Possible anteroseptal myocardial infarction",
"Anteroseptal myocardial infarction",
"Cannot rule out lateral myocardial infarction",
"Possible anterior lateral infarction",
"Lateral myocardial infarction",
"Cannot rule out anterolateral myocardial infarction",
"Possible anterolateral myocardial infarction",
"Anterolateral myocardial infarction",
"Cannot rule out inferior myocardial infarction",
"Possible inferior myocardial infarction",
"Inferior myocardial infarction",

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"with posterior extension",

"Nonspecific ST elevation",
"ST elevation, consistent with epicardial injury, pericarditis, or early
repolarization",
"ST elevation, probably early repolarization",
"Early repolarization",
"Possible acute pericarditis",
"Acute pericarditis",
"Possible septal subepicardial injury",
"Septal subepicardial injury",
"Possible anterior subepicardial injury",
"Anterior subepicardial injury",
"Possible anteroseptal subepicardial injury",
"Anteroseptal subepicardial injury",
"Possible lateral subepicardial injury",
"Lateral subepicardial injury",
"Possible anterolateral subepicardial injury",
"Anterolateral subepicardial injury",
"Possible inferior subepicardial injury",
"Inferior subepicardial injury",
"Junctional ST depression, probably normal",
"Abnormal junctional ST depression",
"ST depression, possible digitalis effect",
"Minimal ST depression",
"Moderate ST depression",
"Marked ST depression, possible subendocardial injury",
"Marked ST depression, consistent with subendocardial injury",
"probably digitalis effect",
"or digitalis effect",
"T wave abnormality, possible anterior ischemia",

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"T wave abnormality, consistent with anterior ischemia",

"T wave abnormality, possible lateral ischemia",
"T wave abnormality, consistent with lateral ischemia",
"T wave abnormality, possible anterolateral ischemia",
"T wave abnormality, consistent with anterolateral ischemia",
"with ST abnormality",
"or digitalis effect",
"T wave abnormality, possible inferior ischemia",
"ST & T wave abnormality, possible inferior ischemia",
"or digitalis effect",
"T wave abnormality, consistent with inferior ischemia",
"Abnormal QRS-T angle",
"Nonspecific T wave abnormality",
"probably digitalis effect",
"Tall T waves, possible hyperkalemia",
"Short QT interval",
"Long QT interval".
The comments ahead the asterisks are automatically given by the program,
which come from the editing results in previous analysis. To edit the Physician
Comments, point and click in the comment field. A cursor will appear on the
screen. You may begin adding or deleting comments at this time. Upon
completion of your editing, click on the SAVE bar to the right. Click on the
AUTO bar before saving, the comments will be returned to the initial status.

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You may have some standard comments or descriptive phrases you regularly
use on reports. You may keep them in the LABEL DATABASE. To access this
database, click on the EDIT bar on the bottom left of the screen. The above
screen will come up.
To add phrases or words to the Label Database, point and click in the Label
field at the top of the screen. A cursor will appear in the field. Type in the word
or phrase you desire and then click on the ADD TO LIST bar at the right of the
screen. The phrase or word will be added to the list.
To remove a word or phrase from the list, simply point and click on the word or
phrase you wish to remove. A blue highlight bar will appear over the word.
Point and click on the CANCEL bar to the right of the screen. The word will be
deleted from the list.

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To use the words or phrases in the Label Database, point and click on the down
arrow in the empty field next to the Physician Comments box. A drop screen will
appear that will include all the words and phrases in the Label Database. Click
on the word or phrase you desire. Click on the INSERT bar. The word or
phrase will be added to the Physicians Comments. Click on the Save bar to
keep the editing results.

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The field under the Physician Comments field is also an identification tag field.
You may enter a descriptive word that would identify this type of Holter
recording, in the above example we have put in the description of ATRIAL
FIBRILLATION. After entering the word in this field, click on the Insert bar, and
Atrial Fibrillation will be added in the Physician Comments field.
This Holter report has now been included in a subdirectory of all ATRIAL
FIBRILLATION reports. At a later date, the physician my wish to access all of
his ATRIAL FIBRILLATION Holter reports. This report would now be included in
the ATRIAL FIBRILLATION reports.
Clicking on the “Auto” bar allows you to restore the original narrative in the
Physician Comments section.

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To edit the patient’s information, click on the Modify Patient’s Info bar on the
lower right of the screen. The above screen will appear.
You may add or change any of the data in these fields with the exception of
the patients start time, recording date and the use of the flash card.
NOTE: If you have entered a wrong start time, you must reload the SANDISK
compact flash card and process the data again.
When you have completed the edit, click on the Close icon.

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3 Leads Data

Most operations in this screen are same as those of 12-Lead except the
following parts:
Full Disclosure
There are three channels for your selection in the Full Disclosure box. Point
and click on the desired hour in the “Print Full Disclosure” boxes. The gray
Full Disclosure box will become lighter. Point and click on CH1, CH2 or CH3 in
the Full Disclosure box. A black dot indicates which channel the full disclosure
will print out in.

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ABP Report
To print out a combo report of Holter ECG and Ambulatory Blood Pressure,
point and click on the Get Data bar next to the ABP Report option. The above
screen will appear.
Select the patient’s ABP report that coincides with the Holter ECG. Remember,
the start times of the Holter ECG and ABP recording must be within 5 hours of
each other. Click on the OK bar. The ABP Report page will now have a check
mark in its box indicating the ABP Report page will print with the rest of the
report.
Note: This function is only available when you have installed the ABP Analysis
System first.
ECG Strip
The ECG Strip box is at the left side of the screen, which doesn’t exist in the
12-Lead data report. There are four options in this box, including 3CH, 12CH,
VCG and Add-ons (additional) CH. When you save the ECG events in the
Saved Strips box in the screen of ECG Strip. The number of ECG events will be
shown in the rectangular box of the ECG Strip in the field of Page Print. The
ECG Strip and four options in ECG Strip box will also become light, indicating
these reports can be printed now.

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The standard lead format for “ECG Strip” is 3-lead. In order to obtain a 12-lead
ECG print out or a VCG print out, you should have used the Orthogonal 7-lead
hookup. If you want to print out all of the ECG strips in a 12-lead strip format,
point and click in the box next to 12 CH. The program will change X, Y, Z data
of 3 leads to standard 12 leads data (I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,
V6) according to Vijen method and print it out. A check mark will appear
indicating ECG strips will print out in the 12-lead format. If you want to print out
all of the ECG strips in the VCG format, point and click in the box next to VCG.
A check mark will appear indicating strips will print out in the VCG format. If you
want to print out the ECG strips in a 18-lead strip format, point and click in the
box next to Add-ons CH. To deselect an ECG strip format, point and click on
the box next to the format you do not want to have printed out. The check mark
will disappear and strips will not be printed out in that format.
NOTE: If you have check marks next to 3 CH., 12 CH., VCG and Add-ons CH.,
ECG strips will print out in each of these formats!
SAECG
The SAECG report will be printed out only when you have analyzed the Late
Potential data in the screen of SAECG.
Physician Comments
There is no Analysis function in 3-Lead data compared with 12-Lead data in the
report.

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HOLTER REANALYSIS

On occasion you may want to Re-Analyze the Holter recording. This could
happen because you want to select different sample points for the ST-QT
analysis, or place the primary focus of arrhythmia analysis on different
channels, etc.
To start the Re-Analysis process, got your Data Access Choices screen. Point
and click on the ReAnaly icon. A pop-up window will appear on the screen and
ask you to confirm reanalysis of the patient. Point and click the mouse on “Yes”.
You may follow all the previous instructions for analyzing the patient’s data.

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PRIOR HOLTER

The purpose of the “Prior” menu is to be able to store Holter recordings and to
have instant access of saved Holter recordings. If you selected Yes for the Auto
Save in the “Settings” menu, then all of the recordings will automatically be
saved in the “Prior” menu. If you selected No for the Auto Save in the
“Settings” menu, then only the last Holter recording processed will be saved.
To access the “Prior” menu, point and click on Prior at the main ECGLAB
HOLTER screen.

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The Patient Database shows you the name of the patient saved, the sex of the
patient, the test date and start time, if the recording was a pacemaker study, if it
is a Summary Report only, the patient’s identification number (if you entered
one when entering the patient information at the beginning of the scan), and the
directory that the Holter study is saved in.
To access a patient’s entire Holter study, point and click on the patient’s name.
A blue highlight bar will appear over the patient’s name and information. Click
on the Access bar at the bottom of the screen or press the ENTER key on the
keyboard. You will be taken to the Data Access Choices screen of that patient’s
Holter study. From this screen you may edit and/or retrieve any of the data
from this Holter study.
Another way to access a patient’s Holter study is to use the Search option.
Type the patient’s name and click on the Search Now bar at the center bottom
of the screen. All studies that have been saved with this patient’s name will
appear on the screen. To access the patient’s Holter study, click on the
patient’s name and click on the Access bar at the bottom of the screen. If there
are multiple studies with the same name, verify the date of the study and click
on the study that corresponds with the patient’s name and the date desired
and then click on the Access bar at the bottom of the screen.

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If you have assigned the patient’s identification numbers when you initially
entered the patient data, you may access the Holter study by entering the
identification number in the ID field and then click on the Search Now bar at
the center bottom of the screen. The studies that have been saved with this
patient’s identification number will appear on the screen. To access the
patient’s Holter study, click on the patient’s name and click on the Access bar
at the bottom of the screen. If there are multiple studies with the same
identification number, verify the date of the study and click on the study that
corresponds with the patient’s identification number and the date desired and
then click on the Access bar at the bottom of the screen.
Another way to access a patient’s Holter study is to use the Comments option.
If you used the identification tag feature when you edited the report (see page
162), you may enter the identification tag in the Comments field under Search.
Point and click your mouse in the Comments field and enter the identification
tag. Click on the Search Now bar at the center bottom of the page. All Holter
studies that have this identification tag in the Physician Comments section of
their Holter report will be shown on the screen. To select the patient’s study you
desire, point and click on the patient’s name and then click on the Access bar
at the bottom of the screen.
This feature is also useful if the doctor desires to see all of the patient’s studies
done that have a certain ailment, such as V-Tach, A-Fib, etc. By following the
above instructions you will be able to call up all of a particular type of study with
just a few clicks of the mouse.
To print a list of all the patients in the Patient Database, point and click on the
Print List bar at the bottom of the screen. Click on OK for your printer and the
list will print out.

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To delete a patient’s study from the Patient Database, point and click on the
study you wish to delete. A blue highlight bar will appear over the study. Point
and click on the Delete bar at the bottom of the screen. A prompt will appear on
the screen asking you if you wish to delete the patient’s data. Click on Yes if
you want to delete the patient’s study, click on No if you decide you do not want
to delete the patient’s study or click on Cancel to cancel the action.

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To automatically print a report of a patient’s Holter study from the Patient

Database, point and click on the patient’s report you wish to print. A blue
highlight bar will appear over the study you have selected. Click on the Print
Report bar at the bottom of the screen. A Batch Print menu will appear.
Point and click on the boxes next to the pages of the report you wish to print. A
check mark indicates a page will print. To deselect a page, point and click again
on the box next to the page you wish to deselect. The check mark will
disappear. After you have selected all the pages you wish to print, click on the
Print bar. The printer prompt will appear on the screen. Click on OK. The report
will then print out.

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To export a patient’s file to other directory or CDR, go to the Patient Database

of the Prior menu. Point and click on the study you wish to transfer. A blue
highlight bar will cover the patient study you have selected. Click on the Export
Patient bar at the bottom of the screen, an Open Menu will appear for you to
select the destination directory. Click on the Open bar, the above screen will
appear, showing the messages about copying. Click on the Copy bar and the
patient data will be copied to the new directory. The default name of patient data
is Save×××. The ‘×××’ is the serial number of patient data, which is starting
from 000 increasing progressively.
Prior to exporting data to a CDR, verify the patient Holter studies you wish to
transfer are in the Patient Database. Note the patient’s names and directory the
study is saved under.
To see the full directory name the patient’s study is saved under, click on the
right arrow on the bottom of the screen until the entire directory name is shown.
Make a list of the patient’s names, study dates and full directory names you
wish to copy to the CDR.
Prior to exporting patient data to a CDR, you must have a CDR-W installed in
the computer along with its driver (The driver is supplied by the manufacturer of

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the CDR-W. Do not use any driver other than the manufacturer’s driver
supplied with your CDR-W).
The CDR disk that you want to export the patient studies to must be formatted.
To format a CDR disk using the Adaptec Easy CD Creator 4 Deluxe Program,
do the following:
1. Insert a blank CDR in the CDR-W drive. The Adaptec program will come
on the screen.
2. Click on the DATA bar of the main menu that appears on the screen.
3. Click on Direct CD.
4. Type in the name of the disk and then click on FINISH.
5. A message will appear on the screen to let you know the CD is ready for
copying. Click on OK.
NOTE: If you are not using the Adaptec software, please follow your software
manufacturers directions on how to format a CDR.
After you have copied the files to the hardware or CDR you may want to keep
only the Holter reports stored in the Patient Database. To keep a Holter report
only, click on the patient study you wish to keep only a Holter report on. A blue
highlight bar will cover this patient’s name. Click on the Summary bar at the
bottom right of the screen, a prompt message will come up.

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Click on Yes if you wish to delete the patient’s 100% edited Holter ECG file and
retain the Holter ECG report only. The patient’s information line in the Patient
Database will now say YES under Summary, reflecting that only the Summary
report is stored in the Patient Database.
Click on No if you wish to retain the patient’s entire Holter study.
Click on Cancel if you wish to cancel this action.

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To import a patient’s Holter study from other directory that contains the
patient’s Holter study.
Click on the “Prior” menu from the ECGLAB HOLTER main screen. Click on
the Import Patient bar at the bottom right of the screen. The above menu will
appear.
Point and click on the down arrow next to the Look In field to find the patient
data as above screen showing. Click on the OPEN bar.

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The above screen appears, showing you the list of all the files that you have
stored on the directory. Click on the patient’s name for the study you wish to
retrieve. A blue highlight bar will appear. Click on the IMPORT bar. The patient’s
study will be copied to the hard drive of the computer and will be listed in the
PRIOR menu.
If you wish to import all of the patient’s studies from the directory, click on the
first patient study. A blue highlight bar will appear. Press the SHIFT and
CONTROL key (at the same time) followed by a click on the last patient. All of
the patient’s names will be colored with a blue highlight as in the above
example. Click on the IMPORT bar. All patient’s files will be copied to the hard
drive of the computer and will be listed under the PRIOR file.

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PACEMAKER ANALYSIS

To process a new Pacemaker recording or to practice with the Pacemaker

Demo file, point and click on the NEW icon on the ECGLAB HOLTER 12.0 Plus
Main Screen.
NOTE: If you have used the ENROLL feature, insert the compact flash card
into the ImageMate reader and then click on the NEW icon.

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The above patient menu screen will appear. There are four fields that must be
filled in with data in order to proceed. They are Start Time, Record Date,
Recorder, Pacemaker and Patient Name.
Enter the data in each data field. To move to the next field, press the TAB key
on your keyboard or point and click in the field with your mouse.
The Recorder field allows you to select a Flash Card (Digital) Holter recorder or
a DEMO practice field. This setting will default to its last setting when you
power up the computer.
The CLOSE icon will return you to the ECGLAB HOLTER 12.PLUS main
screen.
After entering all of the data, click on the START icon.
NOTE: If you have used the ENROLL feature, the patient information will load
in automatically. After the data comes up on the screen, click the START icon.
You will be prompted to insert the compact flash card into the reader. Insert the
compact flash card and after you hear the beep click on OK. If you have used
the ENROLL feature, click on OK. Do not remove your compact flash card.

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PACEMAKER SETUP

The top of the screen show a 60-second strip of all three channels. The green
box is the cursor that indicates the enlarged 8-second strip shown below. To
choose another 8-second strip from the minute, simple point and click on the
area you desire and the cursor will move to that area and a new enlarged
8-second strip will be shown on the screen.
The enlarged 8-second strip is the Pacemaker Setup Graph. Click on the first
vertical line (marked S1) and drag it to a pacemaker spike. Click on the second
vertical line (marked B) and drag it to the end of the beat following the
pacemaker spike. Click on the third vertical line (marked S2) and drag it to the
spike immediately following the beat marked by the second line (B).
Locate the Pacemaker Type at the bottom left of the screen. Click on the arrow
and scroll down until you find the type of pacemaker the patient has.
Locate the Firing Type at the bottom left of the screen. Click on the arrow and
scroll down and choose between Dual Firing and Single Firing.
Locate the Beat to Beat (Upper Limit) field on the lower part of the screen. Click
in the field and enter the upper limit for the patient’s pacemaker. Locate the
Beat to Beat (Lower Limit) field on the lower part of the screen. Click in the
field and enter the lower limit for the patient’s pacemaker.

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Click on the Channel you desire for Full Disclosure.

To select different channels for Arrhythmia Analysis, click on the box next to
Primary for the Primary analysis channel until the channel you desire is
displayed. To select a different channel for secondary arrhythmia analysis,
click on the box next to second until the channel you desire is displayed.
Clicking on the Full Size box under ECG Gain will double the amplitude of the
signal on the enlarged eight-second strip.
If you desire another minute of ECG to select the eight-second strip from, click
on the PgUp or PgDn icon at the bottom of the screen. If the electrodes are
placed in opposite direction, you reverse its ECG wave by clicking on the
Reverse icon at the bottom of the screen.
After you have the pacemaker setup to your liking, point and click on the
ACCEPT icon at the bottom of the screen. The program will do the pacemaker
analysis and take you to the Data Access Choices screen.

The operations of pacemaker patient data in this screen are similar with those
of those of patient data without pacemaker.

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