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20. Appendix I –– Decision categories
20.1. Rhythm analysis decision categories and rules
The program simulates physician thinking, uses decision tree type process to determine the rhythm diagnosis. The process
takes into consideration the R-R distance regularity,the QRS complexes shape similarity, heart rate, the P-wave shape
recordable on the averaged complex, and the P-Q distance in case of measurable P.
SINUS RHYTHM
The P-wave formally regular, the P-Q distance is 120-200ms, the R-R distances' fluctuation does not exceed +/-12.5 %,
the QRS complexes are identical, the heart rate is in the 60-90/min range.
LOWER ATRIUM RHYTHM
Category regarding P-wave abnormality. In this case atrium activation comes from below, which results negative P in
leads III and aVF.
ACCELERATED A-V LEAD THROUGH
The atrium-ventricle lead through time is less than 120ms.
EXPANDED A-V LEAD THROUGH
The atrium-ventricle lead through time is longer than 200ms.
SINUS RHYTHM WITH EXTRASYSTOLE OR ARTEFACT
The R-R distances are regular, the QRS complexes however show deviation to each other, which could be the result of
noise.
SINUS BRADYCARDIA
The sinus rhythm conditions are met, but the heart rate is less than 60/min.
SUPRAVENTRICULAR TACHYCARDIA (OR FLUTTER)
The sinus rhythm conditions are met, but the heart rate is over 120/min.
SINUS TACHYCARDIA
The sinus rhythm conditions are met, but the heart rate is between 90-120/min.
LOW ATRIAL POTENTIAL (UNCERTAIN P-WAVE MEASUREMENT)
P-wave measurement is uncertain due to low atrial potentials.
SINUS ARRHYTHMIA (SUPRAVENTRICULAR EXTRASYSTOLE?)
Irregular sinus rhythm (variable R-R distances, but identical shape QRS complexes) or supraventricular origin
extrasystoles.
P-WAVE NOT FOUND (AV-JUNCTIONAL RHYTHM)
No recordable P-wave, this raises the possibility of rhythm originating from the so-called junction of AV clot with
narrow QRS's.
VARIABLE R-R DISTANCE (SUPRAVENTRICULAR EXTRASYSTOLE OR ATRIAL FIBRILLATION)
R-R distances change, QRS complexes are identical. P-wave measurement is questionable.
FLUTTER
R-R distance changes exceed 25%, QRS complexes are identical, heart rate is over 115/min.
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HS112 C-1 User Manual
R-6730-EN02-E
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