Related Manuals for Spacelabs Healthcare Pathfinder SL
Summary of Contents for Spacelabs Healthcare Pathfinder SL
- Page 1 Pathfinder SL v1.9 98000 Ambulatory ECG Analysis System 070-2567-03 Rev. A | www.spacelabshealthcare.com O P E R A T I O N S M A N U A L...
- Page 2 Consult Documents YOU MUST READ THE ACCOMPANYING DOCUMENTS (NOTE: Further instances of this symbol within this manual may be represented in black and white) WARNING Actions or circumstances that may result in personal injury or death. (NOTE: Further instances of this symbol within this manual may be represented in black and white)
- Page 3 U.S. and foreign patents and/or pending patents. Specifications and price change privileges are reserved. Spacelabs Healthcare considers itself responsible for the effects on safety, reliability and perfor- mance of the equipment only if: • Assembly operations, re-adjustments, modifications or repairs are carried out by per- sons authorized by Spacelabs Healthcare, and •...
- Page 4 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 5: Table Of Contents
FCC Compliance and Advisory Notice Cleaning and Maintenance Pathfinder SL Compatibility 1.4.1 System Requirements Manuals Disclaimer Installation Information Working with Pathfinder SL 1.8.1 Sitting Properly 1.8.2 Arranging the Equipment UDI Identifier Pathfinder SL - System The Time Bar Pathfinder SL Screens... - Page 6 Create New Event Types / Event Labels Printing ECG Periodic Strips Mouse/Keyboard/Hot Keys Mouse and Keyboard 6.1.1 Dragging ECG Events Keyboard Beat classification keyboard shortcuts Morphology 12-Lead Holter View all 12 Leads Scan on 12 Leads Pathfinder SL v1.9 Operations Manual...
- Page 7 8.2.1 Calipers/Measurements Detailed 12-Lead Review 8.3.1 Display Menu 8.3.2 Display Markers 8.3.3 Making Measurements with Markers 8.3.4 Marker Flags 8.3.5 Moving marker flags with the mouse 8.3.6 Making measurements with Calipers 8.3.7 Markers, Caliper and keyboard shortcuts Event Editing Event Review Screens Filtered Event List Event Summary Table Multi-Event Screen...
- Page 8 15-8 15.12.1 To use the Frequency 3D screen: 15-9 15.13 HRV Terms and calculations 15-9 15.14 Heart Rate Calculation 15-9 Sleep Apnea 16.1 Indications and Intended Use 16-1 16.2 Warning 16-1 16.3 Precautions 16-2 Pathfinder SL v1.9 Operations Manual viii...
- Page 9 16.4 Review the ECG Quality and QRS Detection. 16-2 16.5 Artifact Significant Misdetection in Sleep-Time Periods 16-2 16.6 Set the Sleep Periods 16-2 16.7 Analysis Results 16-3 16.7.1 Sleep Period Apnea Classification : 16-3 QT Analysis 17.1 What is QT Analysis? 17-1 17.2 Before you Begin...
- Page 10 19.4 ST Graphs 19-4 19.5 ST Event Table 19-4 19.6 Not ST Button 19-5 19.7 12-Lead ST 19-5 19.8 ST Reports 19-5 Signs and Symbols Pathfinder SL v1.9 Operations Manual...
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Page 11: Introduction
ECG and the analysis results, and construct a report for physician use. The Spacelabs Pathfinder SL Holter Analyzer is intended for use on adult patients only as a screening device to determine the need for clinical diagnosis and evaluation by polysomnography based on the patient’s score. -
Page 12: General
• Increase the separation between the equipment and the receiver • Connect to an outlet on a circuit different from that to which the receiver is connected • Consult the dealer or an experienced radio/television technician for help. Pathfinder SL v1.9 Operations Manual... -
Page 13: Cleaning And Maintenance
The supporting PC should be regularly serviced, maintained and backed up to support recovery or restores. Pathfinder SL Compatibility Compatible with: • Sentinel Cardiology Information Management System V9.x, V10.0.x, V10.5.0 •... -
Page 14: Manuals
They should not be tugged or twisted or used to lift the equipment. Working with Pathfinder SL Pathfinder SL should only be operated by an appropriately skilled or trained person. The operator should be trained in electrocardiography. A qualified medical practitioner should make the diagnosis. -
Page 15: Sitting Properly
Use the mouse mat to prevent mouse slipping and where available a mouse mat with a forearm support / rest. UDI Identifier The Pathfinder SL v1.9 UDI (Unique Device Identification) identifier can be found by clicking on ‘Help’ from within the Pathfinder SL software followed by ‘About Pathfinder SL’. 070-2567-03 Rev. A... - Page 16 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 17: Pathfinder Sl - System
2. Pathfinder SL - System Full Disclosure is the first screen displayed, the icons and menu options remain the same throughout analysis. The top of the screen can be split into several sections: Title Bar: The bar across the very top of the screen shows the patient’s name and ID. -
Page 18: The Time Bar
Pathfinder SL Screens There are many different screens provided by Pathfinder SL, each with their own purposes. Switching between screens is simple as the time being displayed is consistent on all screens that support any idea of a “current time”... -
Page 19: 7-Day Holter Analysis
Displays 12-Lead ECG with a rhythm strip 7-Day Holter Analysis A useful feature in Pathfinder SL is the ability to download and display up to 7-day’s Lifecard CF Holter ECG continuously, over 1 analysis. One seven day report is compiled showing all data for the recording on the summary page. -
Page 20: Tool Bar
This icon will turn on / off beat annotation - including the beat trigger arrow. 2.4.1 ECG Scan Toolbar Icon Function Play ECG Stop ECG Speed of Flowing ECG Channel displayed 2.4.2 Setups Cog-Wheel Icon Function Provides access to settings for that feature. Pathfinder SL v1.9 Operations Manual... -
Page 21: System Set Up
3. System Set Up The Pathfinder SL displays, analysis settings and guided scan settings can be set up for each customer and their default preferences stored. Display From the top menu bar click on Settings and then ECG Display Settings. -
Page 22: Secondary Display
The 2nd display Full Disclosure screen does not share all the same editing functions as the main Full Disclosure screen. Its primary purpose is to show the wider context of events in Full Disclosure and to enable report edit / comment & preview while scanning. Pathfinder SL v1.9 Operations Manual... -
Page 23: Context Menus
The view tabs are on the bottom left of the screen: Full Disclosure: Use this to zoom in on an event or see it in wider context. Particularly useful while reviewing Morphologies, Graphs and HRV screens. Filtered Event List: View a full or filtered list of the events found. The operator can decide how many of each type of event is displayed. -
Page 24: Saving Settings
Pathfinder SL when first installed. Global Setups These are setups that are visible to and can be used by all Pathfinder SL systems on the network. Setups from one Pathfinder SL analyzer can be saved as Global setups to make them available to other Pathfinder SL analyzers in a Sentinel network. - Page 25 Pathfinder SL analyzer, by selecting it and clicking on “Make Default”. This feature should be used where there is a need for a particular Pathfinder SL analyser to use a default setup that is independent of the standardized “New Analysis Setup.
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Page 26: Analysis Options Activated: Dongle Reader
Analysis Options Activated: Dongle Reader This enables the operator to view which options have been activated on their Pathfinder SL system. To launch this utility: All Programs - Spacelabs Healthcare - Pathfinder SL Dongle Reader. This can also be accessed via the Windows Start button. -
Page 27: Arrhythmia Analysis
ECG data with a lot of noise can result in Pathfinder SL incorrectly classifying beats. The noise may be due to poor hook-up or low quality electrodes. To help avoid this, noisy regions of ECG are automatically inhibited and no analysis is attempted. - Page 28 >= 40 bpm < 80 % of Prevailing NN Interval SV Escape >= 120 % of prevailing NN Interval SVE Run >= 3 beats >=3 beats at >= 130 bpm until rate <= 110 bpm. On Pathfinder SL v1.9 Operations Manual...
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Page 29: Saving Analysis Settings
The order in which they are displayed is reflected in the reports. Event Severity Pathfinder SL helps the operator by presenting the most severe instances of events in the Event Summary and Filtered Event List Screens. There are three properties that relate to”Event Severity”: •... - Page 30 On the event strip labels, the accompanying 1 minute heart rate is calculated over the surrounding 1 minute heart rate. Maximum and Minimum heart rates can be reported with a separate HR section page in the report and/or by printing 8 second ECG strips. Pathfinder SL v1.9 Operations Manual...
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Page 31: Analysis Menu
A dialogue will prompt the operator to select ‘Save’ to store any analysis completed so far. Pathfinder SL will close taking the operator back to Sentinel. To resume analysis from the Holter Test Screen click on a test, then select “Resume Analysis, and if there are multiple analyses for that test, select the analysis that you would like to resume from the “created”... -
Page 32: Thresholds
The operator can also use these thresholds to exclude unwanted beats. Use the option to ‘Lock Sliders’ to have the same changes apply to all channel simultaneously. Pathfinder SL v1.9 Operations Manual... -
Page 33: Insert A Trigger / Beat
Insert a Trigger / Beat Where Pathfinder SL has detected a QRS it will place a yellow trigger arrow underneath. In instances where the analyzer has missed a trigger and created an event (dropped beat or pause) the operator can insert a new beat of any classification. - Page 34 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 35: Pathfinder Sl Workflow
5. Pathfinder SL Workflow Download a recording into the Sentinel CIMS per the Sentinel user manual, navigate to the Holter test screen and select the downloaded test to start the Pathfinder SL analyzer. Note: Previously started Pathfinder SL analyses can also be re-opened from this screen. - Page 36 Use the Full Disclosure screen to verify that the analyzer is triggering and classifying the beats correctly. Trigger / Triggering: Pathfinder SL displays a yellow arrow underneath a beat to indicate that the algorithm has seen it. This is called the Trigger arrow. The user should verify the analyzer Trigger arrow is correct prior to verifying the Events.
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Page 37: Scan The Recording
Having verified that the analyzer has triggered and classified beats correctly, use this screen to preview all events found in the recording. The time bar across the top of the screen shows the total recording duration, depending on the recorder this can be up to 7-days. The panel down the left shows the events types. -
Page 38: Arrythmiagraph Markers
From the ECG Scan Toolbar, click on the Start / Pause icon [a forward arrow]. Depending on the scan mode selected the ECG will run on the display until the analyzer finds either: • A new Form • An Event Or the scan is manually stopped by the Operator. Pathfinder SL v1.9 Operations Manual... -
Page 39: New Form
For operators who are not confident with the event label provided by Pathfinder SL but who wish to print the event in the report there is the option ‘Review’. The event will be shown against the original category but in the column ‘Review’... -
Page 40: Reclassifying Individual Beats
For the new Event the operator can set how the event is printed. The options are: Summary: An 8 second strip covering the event will be printed. Default for fixed duration events (e.g. Couplet, Triplet, SVE etc) Start: A strip at start of the event will be printed Pathfinder SL v1.9 Operations Manual... -
Page 41: Printing Ecg
ECG. Accept the Operator Selected Event tag for the event or enter one of your own by selecting Print Strip (default). Pathfinder SL will auto-scale to the best print scale, although the operator can change the scale as required. For full scale ECG strips you can also select to include all channels or what is displayed on screen. - Page 42 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 43: Mouse/Keyboard/Hot Keys
6. Mouse/Keyboard/Hot Keys Aside from using the fixed mouse commands from the Context menus, you can select or move the ECG using both the mouse and the keyboard. Mouse and Keyboard Select ECG: This may be useful when selecting a long event to print or a period of artifact to Inhibit. Hold down the shift key and then either click with the mouse to the end point or arrow down using the keyboard to select an area of ECG. -
Page 44: Dragging Ecg Events
“Ctrl ←”: Move ECG cursor left a large amount. “Alt ←”: Move ECG cursor left a small amount. Move ECG cursor right. → “Ctrl ←”: Move ECG cursor right a large amount. “Alt ←”: Move ECG cursor right a small amount. Pathfinder SL v1.9 Operations Manual... -
Page 45: Beat Classification Keyboard Shortcuts
Command Functions Move ECG cursor to the start of the row. Home “Ctrl Home”: Move ECG cursor to the start of the recording. Move ECG cursor to the end of the row. “Ctrl End”: Move ECG cursor to the end of the recording. (This is the + key on the numeric keypad.) Zooms in on the ECG. - Page 46 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 47: Morphology
7. Morphology To open the Morphology screen, click on the Morphology icon on the top menu bar. Note: Selecting the Morphology screen during ECG load will pause the analysis. The screen is split into several sections. The top half of the screen shows the different morphology (or form) types by tab. The default tabs are: Ventricular, Normal, SV, Unclassified, Removed, Artifact and Paced. - Page 48 Toggle baseline filter: This will re-set all the beats in form to sit on the same baseline making for easier comparison of shapes. Overlay: Select a Form and then Overlay from the left control panel. This will overlay every beat in form. Use this to quickly identify forms with beats incorrectly included. Pathfinder SL v1.9 Operations Manual...
- Page 49 Generic Forms: The last form on each Tab is the generic form. The Generic form contains classified beats, but there are either not enough of them to create a unique Form, or they occur too far apart to be included in a Form. The operator can select single or multiple beats by holding the Ctrl key or right clicking on a beat and selecting “Select Similar beats”.
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Page 51: Lead Holter
8. 12-Lead Holter With a recording taken from the Lifecard 12, Pathfinder SL can display and scan on up to all 12 Leads. Using the 12-Lead ECG viewer users may make measurements and run interpretation on 10 second strips of the recording. -
Page 52: Calipers/Measurements
Using the grey icons under the time bar the operator can control which information is shown and also the screen format. 8.3.1 Display Menu The display menu allows the operator to control the layout and content of the 12-Lead display. It has the following options: Pathfinder SL v1.9 Operations Manual... -
Page 53: Display Markers
Layout: Select ‘layout’ to change the number and format of channels displayed (3x4 / 4x3 / 6x2 / 6x1 (2 pages) and 12x1). Display/Hide Pacing Spikes Display/Hide the Rhythm Strip Display/Hide Information Tabs: This will turn on/off the text box at the top of the ECG Screen: Finding and Interpretations as well as the Information tabs;... -
Page 54: Making Measurements With Calipers
Move currently selected marker right by one pixel. Move all markers or both ends of currently selected caliper left by one Alt+Shift+Left Arrow: pixel. Move all markers or both ends of currently selected caliper right by one Alt+Shift+Right Arrow: pixel. Pathfinder SL v1.9 Operations Manual... - Page 55 Keyboard shortcuts When ECG is selected there will be a thick outline around the currently selected trace’s box. You may select an ECG trace by clicking it. Repeat the last marker/caliper (if available) for the currently selected ECG Insert: trace. Delete the currently selected marker/caliper (if any).
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- Page 57 9. Event Editing After completing the ECG scan and verifying the morphologies are correct, the operator should move to Event Editing. There are a number of ECG review screens available from the tabs along the bottom. RR Histogram: This provides a chart of all the RR intervals in the recording. The interval length is shown along the X axis in ms, with the frequency of the interval up the Y Axis.
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Page 58: Event Review Screens
Show 8s strip plus 1 min HR: Adds a 1 minute averaged Heart Rate Graph under the 8 Sec- ond Strip. Event Review Screens There are 3 Event Review screens available to the Pathfinder SL user from the left tabs: • Filtered Event List • Event Summary Table •... -
Page 59: Event Summary Table
To set the criteria for all events to Hourly / or Display for Whole Recording, select the buttons on the bottom and then OK to return to the Filtered Event List. The list will now only display the specified events. Click on the top of the list to see the 1st Event displayed in the top half of the screen. -
Page 60: Edit Patient Details / Diary Events
All beats within AF are highlighted in yellow with an N as their beat classification. AF beats are excluded from all SVE Event and SVE Beat Counts. AF Forms are included in the Normal Morphology Forms. Pathfinder SL v1.9 Operations Manual... -
Page 61: Manual Creation Of Af Events
The Pathfinder SL report includes an optional AF Rate Control section. It allows the operator to determine the patient’s heart rate behavior in AF and compare this with the behavior when not in AF 9.6.1 Manual Creation of AF Events To manually create a episode of AF, highlight the ECG with the left mouse and from the menu select Create Arrhythmia Event, and then AF. - Page 62 This page is intentionally blank Pathfinder SL v1.9 Operations Manual...
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Page 63: Report Creation And Data Export
10. Report Creation and Data Export Users can choose if Pathfinder SL uses the “Enhanced Front Page” - a new format for the report’s front or it allows operators to choose the Standard Front Page, as their default. Click on the Report Summary icon to edit, add comments and preview the report summary. If users have a 2nd display with their system, this screen can be displayed throughout the analysis for typed comments and review. -
Page 64: Report Comments
10.2.1 Preview The Pathfinder SL report can be previewed by selecting “Report” and then “Preview Report” from the Main menu. Within the Preview screen the operator can see the selected report in colour. Across the top are the report display and navigation options including 2 pages on screen, Zoom In, Zoom Out, Page Up, and Page Down. -
Page 65: Autostore
10.2.3 AutoStore Pathfinder SL can be configured to automatically store a report on exit of the application. To configure this option, select Report from the main menu and click on the “Autosave Report on Exit” option. When enabled this menu option will have be checked. -
Page 66: Create A Default Report Format
10.3 Exporting Data It is possible to export analysis data from Pathfinder SL by selecting the ‘Analysis Export’ menu option. Data can be exported in the following formats: As a text file of beat trigger times, classifications and patient ID. -
Page 67: Pacing
The intended use of the Pathfinder SL Pacing detection is to allow the use of Holter ECG to aid a clinician to identify the predominant pacing behavior(s) for a given subject, and also to help locate unusual behavior which they can then interpret, annotate and report. -
Page 68: Pacing Graphs
Create Pacing Event. This will add an event for this interval to the pacing Event Table. You can add a comment for the event, eg Undersense, and this will appear on the strip in the report and on the screen. Pathfinder SL v1.9 Operations Manual 11-2... -
Page 69: Rr Intervals
11.3.1 RR Intervals This table shows the number of intervals by type in ms. Peak of R to Peak of R R-Pace Peak of R to Pace spike Pace to R Pace spike to Peak of R Pace to Pace Pace spike to Pace spike The number of intervals for the entire recording that qualify the above criteria are shown across the top of the table. -
Page 70: Combined
The Paced beat graph is included in the main graphs page. A pacing report page can also be selected in the Report setting dialogue that will add a page of pacing graphs, scatter plots, pacing summary table and pacing events table. Pathfinder SL v1.9 Operations Manual 11-4... -
Page 71: Graphs
12. Graphs Click on the Graphs icon on the top menu bar. The 3 trend graphs that are displayed are: Heart Rate Trend Ventricular Beats Trend Paced Beats Trend Move the yellow marker to different times in the recording. The same marker point will be shown in all 3 graphs. - Page 72 This page is intentionally blank Pathfinder SL v1.9 Operations Manual 12-2...
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Page 73: Trend Table
13. Trend Table The Trend Table displays the total events in the recording per hour. Click on the Trend Table icon on the top menu bar to open the screen. The operator can edit events from the Trend Table in 4 ways: Edit an Event type for an hour: right click on the individual cell and then select Edit Events from the menu. - Page 74 If you decide that the edits are incorrect, you can right click and select “Undo All Manual Edits”, this will remove your edits, and replace them with the values that the analyzer has calculated. Pathfinder SL v1.9 Operations Manual 13-2...
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Page 75: Hrv Analysis
14. HRV Analysis This chapter explains the method for Heart Rate Variability analysis. The columns in the tabulated data are described, including how they are calculated and their definitions. The HRV Analysis option enables you to have a detailed look at the Heart Rate Variability and operates in parallel with Arrhythmia analysis. -
Page 76: Definitions
To access the HRV Settings, click on the ‘cog-wheel’ icon in the top left of the HRV display. From this window, the operator can define the largest percentage increase or decrease between consecutive Normal-Normal intervals, which will be accepted in the HRV calculations. Intervals outside these criteria are ignored. Pathfinder SL v1.9 Operations Manual 14-2... -
Page 77: Hrv Graphs
14.4 HRV Graphs Click on the tab in the bottom left of the screen to view the HRV Graphs. The HR and NN graphs are displayed on the top of the screen. The bottom of the screen show the NN Interval distribution histogram and 2 scatter plots: NN to NN Intervals (all included intervals) and RR to RR intervals (all intervals in the recording). - Page 78 This page is intentionally blank Pathfinder SL v1.9 Operations Manual 14-4...
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Page 79: Advanced Hrv
The Advanced HRV option allows you to perform comprehensive heart rate variability analysis, including Enhanced HRV (EHRV) analysis for a selected epoch(s) or the entire Holter recording in 48 hour sections. HRV analysis is performed on analyzed ECG active in the Pathfinder SL Holter system. 15.2 What is HRV Analysis? HRV is the variation of R-R intervals exhibited in a sample of ECG. -
Page 80: Accessing Hrv
15.3 Accessing HRV You can only use the HRV functionality on ECG in Pathfinder SL. Click on the Advanced HRV icon to open the program. 15.4 Time Domain Analysis: With the Summary Statistics screen displayed, click Filter. Enter the maximum heart rate to be included in the analysis, such as the maximum heart rate from the preceding Holter analysis (range is 60 - 400 bpm). -
Page 81: Viewing On-Screen Epoch Reports
Enter desired frequency parameter settings, as needed. The default is 5-minute epochs every 10 minutes. Click OK. With the Pane view enabled, click the RR Intervals screen. Click the Power Spectrum icon. In the Period text box, select a period of time from 2 minutes to 24 hours. This period indicates the time period in which beats are brought into the analysis. -
Page 82: Hrv Screens
These statistics are averaged data taken from selected intervals throughout the ECG. Note: In the line item named Successive N-Ns differing by > n msec, n is the value assigned in the Parameters screen. Pathfinder SL v1.9 Operations Manual 15-4... -
Page 83: Multi-Epoch Analysis Of Hrv Screen
15.9 Multi-Epoch Analysis of HRV Screen The Multi-Epoch Analysis of HRV screen shows R-to-R interval variability over the entire period of analysis. This screen also displays pertinent statistics along with parameters that were used in analysis. The screen displays two charts: Mean Epoch RR Interval/Standard Deviation This chart illustrates the Mean Heart Rate (HR) per epoch (which displays in red) and Standard Deviation (SD) of R-to-R intervals per epoch (which displays in blue). - Page 84 In the pane view on the left, click Scatter Plot (All). To remove specific beat types shown in the chart, click the corresponding buttons that represent the beat types at the top of the screen. Pathfinder SL v1.9 Operations Manual 15-6...
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Page 85: Nn Interval Histogram Screen
To scroll up / down or left / right on the scale, click the Arrow buttons. To magnify areas of interest, click the Zoom In / Out buttons. (Continue clicking the Zoom buttons to zoom further in / out. To reset the chart to its original state, click the Reset button. 15.10 NN Interval Histogram Screen The NN Interval Histogram screen shows the number of R-R intervals that occurred at each... -
Page 86: Rr Intervals Screen
• The Z-axis plots a time line of Spectral analysis repetition from a selected start time to the end of a selected Total Analysis length. The system defaults to a 3-D line graph with a maximum PSD of 25. Pathfinder SL v1.9 Operations Manual 15-8... -
Page 87: To Use The Frequency 3D Screen
15.14 Heart Rate Calculation Pathfinder SL calculates heart rate as follows. For each beat The heart rate is calculated using a sliding average of the intervals of the previous 3 beats. For each period The heart rate for the period is calculated by summing the intervals for all valid beats within the period and then dividing by the number of valid beats in the period to get the average HR. - Page 88 For each period there must be at least a minimum amount of valid interval time, otherwise the rate is set to 0 for that period. See the table below for details. Analysis Period Minimum Interval Time (seconds) 10 seconds 1 Minute 30 s 1 Hour 30 s Pathfinder SL v1.9 Operations Manual 15-10...
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Page 89: Sleep Apnea
Lifecard CF, Lifecard 12 or evo recorders, which the analyzer can use to create a derived respiratory rate. Apnea is an option for the Pathfinder SL software. It assists a physician to screen for these types of Sleep Disordered Breathing. -
Page 90: Precautions
The operator can define the sleep periods to be used in Apnea analysis. Sleep periods can be defined by : Entering times in the Edit Sleep periods dialog (accessed by clicking on the “Edit Sleep Periods” button in the Apnea analysis control panel. Pathfinder SL v1.9 Operations Manual 16-2... -
Page 91: Analysis Results
Selecting a region of the Apnea graphs and selecting “Create Sleep Period” from the context menu. Note: Sleep periods MUST be at least 4 hours in duration. The Sleep Apnea algorithm is then run on the ECG. 16.7 Analysis Results The results of the analysis are shown in the graphs on the Sleep Apnea display. - Page 92 These “AHI” values are the definitions usually used for sleep disturbance in polysomnographic tests. Please note that Pathfinder SL gives estimates of these values, which may differ from the “true” AHI that would be obtained from a polysomnogram under identical conditions.
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Page 93: Qt Analysis
17. QT Analysis 17.1 What is QT Analysis? QT analysis is the measurement of the QT interval of normal heartbeats (or analysis of the repolarization period of the heart cycle). QT analysis may be defined and measured in any of three different base intervals: •... -
Page 94: Before You Begin
QT-interval measurement in Pathfinder SL is automatic with operator adjustments to both the Q and T position values. It is the responsibility of the operator to ensure the accuracy of any QT- interval data that is included in their final report and to use the facilities provided to check the correctness of the QT-interval measurements and to exclude from the report any areas of ECG where they believe the measurement to be incorrect. - Page 95 The Standard Deviation QT measurement for the selected channel, QTc SD corrected using the selected correction formula. Min 1-minute HR (bpm) The shortest QQ intervals expressed as an equivalent BPM Max 1-minute HR (bpm) The longest QQ intervals expressed as an equivalent BPM Percent analysed The % of the recording analysed To view the corresponding ECG to the QT go to the Full Disclosure screen.
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Page 97: Advanced Qt Analysis
18.1 QT Option Overview Advanced QT analysis is performed only on analyzed ECG active in the Pathfinder SL Holter system. Click on the Adv QT icon. If the recording is more than 24 hours, the analyzer will ask you which 24 hour period to analyze. -
Page 98: Retrospective Qt Analysis
You may change the display scale using the arrow buttons at the top right hand corner of the ECG screen. g. Beat information is displayed by clicking on the double arrow. Click Apply to apply these settings to the system. Pathfinder SL v1.9 Operations Manual 18-2... -
Page 99: Prospective Qt Analysis
Click Start to start the retrospective analysis. The analysis progress is indicated by the progress bar on screen. When analysis is complete, the results are displayed starting with the QT Histogram screen, or Summary report Screen. This depends upon the setup of the QT Report in Advanced Options. 18.3 Prospective QT Analysis With the QT screen displayed, click the Prospective Analysis button. - Page 100 Show or hide the navigation pane • Access the Options menu • Display patient information Note that Tamp = T wave amplitude, and DI is defined as DI = RR-QT. DI stands for Diasystolic Interval. Pathfinder SL v1.9 Operations Manual 18-4...
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Page 101: Qt Histogram
18.4 QT Histogram Click on QT Histogram, to display a graph that shows the number of valid and invalid beats in form. These beats correspond to the color-coded index to the side of the graph. (Blue = Valid, Red = Invalid) Click in the graph (at the bottom) to see the corresponding ECG at the top of the screen. -
Page 102: Trends
To move through the ECG, click the left/right arrows located at the upper-right corner of the ECG. To scroll or zoom the Trends, click the Arrow and/or Zoom icons on the toolbar at the top of the screen. Pathfinder SL v1.9 Operations Manual 18-6... -
Page 103: Scatter Plot
18.7 Scatter Plot Click Scatter Plot on the left pane to view the Scatter Plot. To see different views of this plot, click the Arrow and/or Zoom icons on the toolbar at the top of the screen. No editing can be performed in this view. 18.8 QT Strips Click on the QT Strips title to view the strips. -
Page 104: Summary Report
Click on Summary Report to see the recording statistics. The criteria used for analysis are included in this report 18.10 Hourly Reports Click on QT and QTc Hourly Report to see the mean, maximum and minimum values for QT, QTc and Heart rate Pathfinder SL v1.9 Operations Manual 18-8... -
Page 105: Analysis Options
18.11 Analysis Options If performing a prospective analysis, with Pauses enabled, the Pause Criteria settings (below) will determine when analysis will pause so that you may see why measurements cannot be made on a particular beat. If Prospective Analysis is not enabled in your system, the section entitled Prospective Analysis will be ‘greyed out’. -
Page 106: Qt Rejection Criteria
T wave. The Max HR should be set at 150 or less for adults but may be increased for neonates, for example. 18.14 User Profiles Once you have determined and set your different advanced options, you may save them in a user profile. Pathfinder SL v1.9 Operations Manual 18-10... -
Page 107: Review Options
18.15 Review Options If the Bazett correction value is set to zero, the previous valid RR interval will be used to calculate QTc. This is the default setting and applicable for recordings with stable or resting heart rates. Any changes to this value should be noted when reporting QTc. Report Averaging Length: A running average filter applied to the sequences of valid values before determining the maximum, minimum and standard deviation values reported in the report summary and tables. -
Page 108: Report Options
A dialog will open advising that the configured files (xml and xls) have been exported, and their location. In Pathfinder SL, create a report as normal. The QT Summary and Hourly tables are now included, provided the Advanced QT section is selected in the report format. -
Page 109: St Analysis
19. ST Analysis This chapter explains the method for interactive ST analysis, including options available in the displays and how to adjust the analysis parameters / event detection criteria. To access the ST screens, click on the ST screen selector icon 19.1 The ST Screen The ST screen is split into 2 parts. -
Page 110: St Action Replay Display
Rest of ECG: This will apply the change from this point forward. Use these options to review the ECG and ensure the markers are correct throughout. Based on these and the ST Analysis settings Pathfinder SL will create ST Events for review. Pathfinder SL v1.9 Operations Manual 19-2... -
Page 111: St Analysis Settings
19.3 ST Analysis Settings To set ST settings, click on the Cog-Wheel icon in the ST analysis control panel. 19.3.1 Measurement Point Offsets From here type in the measurement points for the ST Analyzer, all measurement points are shown as offsets from the QRS trigger point. Ref: Set the isoelectric level (shown as minus ms from QRS Trigger.) J: Sets the J point on the ECG (The start of the ST segment) Slope Reference Point: A point post J point where you determine whether the ST slope is... -
Page 112: Pre/Post Event Times
The third tab on the bottom of the screen is the ST Event Table. Based on the ST Analysis Settings Pathfinder SL will create an event in the list for operator review. For each event the corresponding ECG is displayed in the top of the screen. - Page 113 19.8 ST Reports The ST section within the Pathfinder SL report contains a summary of the ST segment shifts including the total number of ST episodes, the max ST Deviation, the time of the max deviation and the Ischemic Burden of the episode. The ST section also states the total Ischemic Burden and the mean daily Ischemic Burden.
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- Page 115 Healthcare products. No one product contains every symbol. General Safety Consult Documents Consult instructions for use available on accompanying CD THIS SYMBOL MEANS YOU MUST or via the Spacelabs Healthcare READ THE ACCOMPANYING website DOCUMENTS Caution - hazardous voltages. To WARNING reduce risk of electric shock, do not remove the cover or back.
- Page 116 General Use ON — Power Connection to OFF — Power Disconnection Mains from Mains OFF Position for Push Button ON/OFF Power Switch START (NIBP) Key STANDBY Key Power ON/OFF Key START/STOP STOP or CANCEL Key Pathfinder SL v1.9 Operations Manual 20-2...
- Page 117 Frequently Used Functions Video Output Infra Red Communications Port PRINT REPORT Key Universal Serial Bus (USB) Network Connection Power Indicator LED Audio Output, Speaker HELP (Explain Prior Screen) Key Data Input/Output Keypad Arterial Pulse PCMCIA Card Keyboard Connection Mouse Connection Serial Port 070-2567-03 Rev.
- Page 118 Not made with natural rubber latex Certification and Compliance Canadian Standards Association ETL Laboratory Approved Approved CE marked in accordance with the Radio transmission device. High Medical Device Directive, 93/42/EEC levels of ionizing radiation Pathfinder SL v1.9 Operations Manual 20-4...
- Page 119 Manufacturer Information and Traceability Manufacturer Date of Manufacture Serial Number The letters ‘SN’ stand for ‘Serial Catalog Number Number’ Each device has its own unique serial number Notations and Abbreviations Abbreviations used as symbols are shown below. C.O. ECG Channel Cardiac Output ECG Channels –...
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- Page 122 35301 SE Center St, Snoqualmie, WA 98065. USA | T +1 425 396 3300 | +1 800 522 7025 Unit B, Foxholes Centre, John Tate Road, Hertford, SG13 7DT. UK | T +44 (0)1992 507700 | F +44 (0)1992 501213 www.spacelabshealthcare.com ©2018 Spacelabs Healthcare Specifications subject to change without notice. 070-2567-03 Rev. A...
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