Schiller
WelchAllyn Schiller MT100 and 200 Holter Analysis System Section 1 User Guide
User Guide
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Cardio Menu MT-100/MT-200 User Guide Taking a Holter Recording
MT-100/MT-200 Holter Data Management and Analysis System
Section 1 - Taking a 24 Hour Holter Recording
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Commencing a 24 hour Holter Recording Note: We strongly recommend that the ECG signal is checked before commencing every Holter recording. However, the MT-100 Holter recorder can be started without first checking the ECG signal if required - see Annex A. To check the signal from the patient and commence a Holter recording proceed as follows:
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INSERT FRESH BATTERIES IN THE MT-100. Gently apply downward pressure on the battery cover top and open cover - insert 2 AA 1.5V batteries - ensure correct orientation of the batteries. Close battery cover and 'click' to secure.
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Prepare patient (Electrode placement shown). Form a stress loop in every lead for electrode security and patient comfort. Give enough slack between stress loop and electrode to allow patient to move without affecting electrode positioning. Secure leads and electrodes with tape or plaster. Instruct patient to place hands above head, ensure that the electrodes remain positioned and that no undue stress is placed on the leads and electrode positions.
MT-100/MT-200 User Guide Taking a Holter Recording
Commencing a 24 hour Holter Recording Electrode Placement
Holter ECGs use a bipolar lead system (one positive and one negative lead) for each channel. Channel 1 approximates to modified lead V 5 : Channel 2 approximates to modified lead V2 . Channel 1
Place the WHITE negative electrode under the clavicle on the right sternal margin. Place the RED positive electrode in the fifth left intercostal space on the anterior axillary line (position approximately equates to V5).
Channel 2
Place the BROWN negative electrode under the clavicle to the left sternal margin. Place the BLACK positive electrode in the fourth left intercostal space near the sternum (position approximately equates to V2 ).
Ground
The GREEN ground electrode should be centered over a rib on the right side of the body. Exact placement is not critical and does not affect the recording
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The above electrode placement is suggested. Other electrode configurations are possible.
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Ensure that the QRS complex is bigger than the T wave.
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To avoid artifacts in women patients the red and black electrodes can be placed lower if necessary
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Commencing a 24 hour Holter Recording ° ° °
Remove the Protective cover on the Opto (PC) connector on the MT-100 Holter unit Remove the protective cover on the opto connector on the back of the PC Connect the MT-100 Holter recorder to the opto connector on the back of the PC with the opto cable assembly The special opto cable must be handled with care. To ensure reliable service from the opto cable observe the following points:
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Take care not to crush the cable with a heavy object.
Take care not to run over the cable with, for example a chair.
Do not tread on the cable.
When not in use, coil the cable in a loop - DO NOT BEND.
Open the MT-200 program on the desktop (double click with the mouse) or the Start menu>Schiller>MT-200. The welcome page is displayed :
MT-100/MT-200 User Guide Taking a Holter Recording
Commencing a 24 hour Holter Recording
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With the mouse click on the `New Recording` icon on the extreme left of the function icon bar
The patient data screen is displayed:
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Commencing a 24 hour Holter Recording °
Enter patient data.
Select the next data entry field with the mouse OR
Select the next data entry field with the TAB key on your computer
If the patient is known to have a pacemaker fitted check the pacemaker box. If this box is not ticked pacemaker spikes will not be detected or displayed.*
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When the details of the patient have been entered press the ENTER key on your computer or click with the mouse on OK. The following is displayed:
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Switch the MT-100 on by pressing the event button.
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Click OK (in the above screen). The patients ECG is displayed.
MT-100/MT-200 User Guide Taking a Holter Recording
Commencing a 24 hour Holter Recording Note: The data displayed or entered on the other pages of patient data - selected by clicking on the tabs at the top of this screen (Recording data, Assignment and Diagnosis) - are available only after the recording has been made. *
For pacemaker signals to be detected by the MT-200, the pacemaker detection function must be switched on at the MT-100 before starting data acquisition - this is done by checking the pacemaker box in the patient data screen. Pacemaker signals are detected in the long-term ECG recording by the MT-100 when the slopes and amplitudes of the signal exceeds preset limits and when pacemaker detection is enabled. The MT200 program cannot determine pacemaker spikes itself and it is not possible to detect pacemaker signals by later analyzing the recording in the program if the pacemaker detection function was not enabled during the original recording. This is because the MT-200 uses a sampling rate of 500Hz (i.e. a digitalization interval of 2ms) and the short duration of the pacemaker signals (less than 1ms), makes complete digital processing of the detected pacemaker signals impossible. Therefore, analogue processing of the ECG signals is applied by the MT-100 for pacemaker detection. Pacemaker detection is confined to the first channel of the MT-100 and is therefore optimal when the amplitude of the pacemaker signal for the first ECG channel is greater than that for the second channel. In some instances this is not the case, and it is recommended that the real-time ECG traces are viewed on the screen before starting the long-term recording. Pacemaker detection is automatically enabled on the real time display. The pacemaker signals however, are not always detected. If this is the case and the amplitude of the pulse is greater in the second channel, simply exchange the electrodes of channels 1 and 2. Before starting the long-term ECG recording the pacemaker detection on the MT-200 must be enabled. Pacemaker signals are marked in the MT-200 program by vertical lines in the ECG after evaluation of the recording. Note that these lines are correctly positioned in relation to time but are not proportional in either amplitude (voltage), or duration of the pacemaker pulse, nor do they indicate the polarity. The pacemaker representation is always positive, but the actual pacemaker spike may be positive or negative.
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Commencing a 24 hour Holter Recording
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Check the signal - reapply electrodes if necessary.
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Click START RECORDING to commence the recording. Recording has now commenced and the MT-100 will continue to record the patients ECG for 24 hours or until terminated. Recording is indicated on the MT-100 by the LED indicator flashing every 2.5 seconds (see MT-100 User Leaflet).
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Remove the connector from the Holter Recorder MT-100 and replace the protective cover over the connector.
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Remove the connector from the PC and replace the protective cover on the connector.
MT-100/MT-200 User Guide Taking a Holter Recording
Commencing a 24 hour Holter Recording °
Instruct the patient on use. The following should be mentioned: °
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Logging the time of activities and symptoms in the patient diary. Instruct the patient to press the EVENT button at any time during the recording to register and event. Event acknowledgment is given by the LED flickering continuously for approximately 7.5 seconds.
PC Connector
LED Indicator
EventButton
The MT-100 is not waterproof the patient should be advised not to take a bath or shower.
MT-100 Indications During Use The following table gives the MT-100 LED indications during use.
MT-100 Functions
LED Indication
Unit active
LED lit - momentarily flashes off every 2.5 seconds
Unit Recording
LED off - momentarily flashes on every 2.5 seconds
Event Recorded (during recording)
Blinks continuously for 7.5 seconds after an event is recorded (event button pressed during recording).
Monitor mode - ECG displayed on PC
Flashes off and on (ON 1s, OFF 1/4s)
Downloading recording to PC
Flashes on and off (ON 1/4s, OFF 1s)
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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At the End of a 24 Hour Holter Recording To download an ECG recording from the MT-100 Holter recorder to the MT-200 program proceed as follows:
1.
Remove the electrodes from the patient.
2.
If the MT-100 Holter unit is still recording (LED blinking every 2.5 seconds), stop the recording as follows: press the event key and hold pressed until the LED comes on - then release the event key. The LED is switched off.
3.
Remove the protective cover from the opto connector (see MT-100 operating leaflet) and remove the protective cover on the opto connector on the back of the PC.
4.
With the opto cable link connect the Holter to the opto connector on the back of the PC.
5.
Switch the MT-100 Holter recorder on by pressing the Event button. The LED is lit - and blinks every 2.5 seconds).
6.
Select the data transfer icon with the mouse.
The following is displayed showing that the recording is being transferred
Data transfer is automatic and takes approximately 90 seconds for a complete 24 hour recording. On completion a message is displayed to indicate that data transfer has been successful. The Event screen is displayed:
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MT-100/MT-200 User Guide Taking a Holter Recording
At the End of a 24 Hour Holter Recording 7.
Analyze the recording - Select the analyze recording icon with the mouse Or select `Analyze ECG` in the analyze menu.
Analysis of a complete 24 hour recording may take a few minutes. A counter giving the number of analyzed beats is displayed at the top of the analyzes screen with a progress indication. The ST data is analyzed after the Event analysis.
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Problems If one of the following message appears either before starting a recording or when attempting to transfer a recording from the MT-100 to the PC, the most probable cause is: °
the opto cable assembly is not inserted correctly in either the MT-100 or the computer
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the MT-100 is not switched on.
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the AT card has not been installed correctly
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the address set in the program and the AT card are incompatible.
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Ensure that the MT-100 is switched on (LED indicator on the MT-100 lit)
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Check that the opto cable is securely connected to both the PC and the MT-100
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Ensure that fresh batteries are correctly positioned in the MT-100 (when commencing a recording.)
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Try again - if the problem persists contact your nearest Welch Allyn agent.
If using the program for the first time:
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Check that the address set on the AT board and in the program are the same - see Section 5
If the following message appears it indicates that the hardlock key is not present or incorrectly inserted, or if there is no general license.
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MT-100/MT-200 User Guide Viewing a Recording/ Using the Program
MT-100/MT-200 Holter Data Management and Analysis System
Section 2 - Viewing a Recording
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Introduction The MT-200 program gives different views. Each view gives various data and analysis information of the recording. Each view is selected by clicking on a view icon situated at the top of the screen. With the view icons are additional function icons which provide easy and quick access to common functions; all of these icons are displayed in all views at all times. In the ECG (Rhythm) and zoom views, additional function icons - to change size of the trace and/or the time segment of the recording - are given to the left of screen. Function icons View icons
Tool icons
All icons are selected in the same way by positioning the cursor on the icon and clicking with the (left) mouse button. When an icon is dimmed it means that this function is not available for the currently displayed screen. For example, when in ST view the zoom function is not available and the zoom icon is dim i.e. this function is not possible. The patient name is always displayed at the top of the page when an ECG recording is displayed. Page 2. 2
MT-100/MT-200 User Guide Viewing a Recording/ Using the Program
Introduction The function and view icons, are only active (can be selected) when a patient recording is displayed. When an icon function cannot be selected, the icon is dimmed.
View Icons Event View
This gives an overview of all events for the entire 24 hour period. Use this view to quickly identify and select a specific time segment for display.
Analysis Summary View This provides a tabular overview of all important measurements taken over the entire recording Event Samples View
This allows three event samples from every category of event, to be selected and displayed. This view can also be used to select the user selected event samples for printing.
Rhythm View
This zooms in on a specific time segment of ECG for closer analysis (scrolling).
Event Chart
This provides a graphical overview of all events for the entire 24 hour recording.
ST Trend View
This option provides a graphical overview of the ST trend with tabular measurements for ST episodes.
Template View
This optional feature provides a graphical overview of the different types of averaged QRS waveforms with classification, detected over the entire recording.
Pacemaker View
This option provides a graphical overview of QRS templates measured in relation to the pacemaker pulse, over the entire recording.
Heart Rate Variability This optional feature provides a graphical and toolbar overview of the heart rate variability over the entire recording. Note: All options can be enabled with a code (for the hard-lock key) supplied from Welch Allyn. The lower section of the Event view and the Rhythm view additionally displays either a specific zoom segment of the ECG, or the heart rate trend over the complete recording. Zoom View
This gives a zoom view of a selected segment of the ECG. In this view it is also possible to edit (reclassify) specific QRS complexes. See `Reclassifying / Editing a QRS Complex` later in this section.
HR Trend
This displays the heart rate trend over the entire recording.
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Introduction Function Icons The recording function icons are as follows:
Save Recording Save current recording E-Mail Send currently displayed recording by E-mail Print Preview Display print page layout (pages that will be printed when the printer is selected Scroll Back Icon Scroll backward (in time) of the zoom ECG currently displayed. Scroll Forward Icon Scroll forwards (in time) of the zoom ECG currently displayed Scroll Event (back) Icon Go to previous event Scroll Event (Forward) Icon Go to next event
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MT-100/MT-200 User Guide Viewing a Recording/ Using the Program
Introduction Tool Icons The ECG toolbar is displayed in Rhythm and Zoom views on the left hand side. Use the ECG tool bar to:
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increase/decrease the size (amplitude) of the ECG increase / decrease the speed of the ECG move up / down a page (ECG view) move up / down an ECG line (ECG view) immediately print a selected half hour segment of the recording (ECG view) select a zoom section of the recording for printing (zoom view)
The page up/down and line up/down are not applicable and are not displayed in the zoom view
Center
Page Down
In the ECG View - center the selected (highlighted) ECG section in the middle of the screen
Move to next page
In the Zoom View - position the selected QRS complex (cursor above and below QRS complex) slightly to the left of center in the zoom screen
Shift the display up one line
Print In the ECG View - immediately prints 1/2 hour of the selected (highlighted) ECG. A rhythm section of the recording is printed giving 1/4 hour before, and 1/4 after the selected section. In the Zoom View - this sets the selected pointer (Event view) to print the zoom section selection when requested. `User Selected` box checked prior to printing. Page Up Move to the previous page. Each page displays between approximately 1 and 24 minutes of recording dependent on the speed selected
Line Up
Line Down Shift the display down one line Decrease Speed Decrease scale of ECG (ECG closer) Increase Speed Increase scale of ECG (ECG spacing wider) Increase Amplitude ECG bigger Decrease Amplitude ECG smaller Select Channel Select channel 1, channel 2 or both channels (for display) Auto Scroll Down Automatically scroll down through the recording
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Accessing and Opening Files Use the open file icon to °
Open a file
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Review stored files
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Show all Exported /not exported or validated / not validated recordings
Opening a file Click on the file icon
in the main function icon bar to display all recordings
Click on the arrow by the side of the icon to display the last 4 saved recordings
The files (and folders) in the folder stated at the top of the display are listed: The last folder to have been selected is displayed at the top of the screen, and the files contained in that folder are displayed. Move the mouse to select the required record that you require.
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The `V` and the `E` columns indicate if the recording has been validated or exported
MT-100/MT-200 User Guide Viewing a Recording/ Using the Program
Accessing and Opening Files Note: Only MT-200 files can be opened by the MT-200 program.
2.
Highlight the file that you wish to open and then `double click` with the mouse
If a file you require is not displayed:
check the `files of type box`. In this box you can specify specific file types for display. If in doubt we recommend that the default is left at `all files`.
check the `Change Dir` box to select another folder the file you require may be in another folder
Welch Allyn Schiller Art. No. 2. 510 107 ©2000
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Event and Zoom View Click on the Event View icon
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