ECG LEAD CONFIGURATION
The above is the Lead Placement menu that displays various suggested electrode location for the 7 electrodes.

The 300-3 Mini-Holter is 25% the size of the standard digital Holter recorder from DMS. The 7-lead, 3 channel recorder reads-in at 1024 samples per second and writes-to memory at 512 samples. This read-in sample will make a pacemaker spike significantly improved for difficult pacemaker patients. The recorder's very high sample rate also allows for diagnostic quality SAECG Late Potentials and Vectorcardiography to be performed from any part of the 24-hour Holter ECG.

Anytime during the electrode placement process or the 24-hour recording the ECG can be viewed using either a DMS isolation cable into the PC or laptop or using a Blue Tooth interface into the PC or laptop.

PATIENT ENROLL PROGRAM
This enhanced enroll program allows you to enter the patient's demographics prior to the patient being hooked up. When using the DMS 300-3 mini Holter recorder, simply plug the recorder into the download cable, enter the patient's information and all of the data will be written to the recorder's internal memory card. The data is stored directly to the 256MB memory that is in the DMS 300-3 mini Holter recorder. When the patient returns and the 24-hour data is downloaded, all the patient's demographics download as well. This positively prevents any patient file mix-up.

The digital Holter recorders use 40, 48, or 64, 128 and 256 MB compact (mini) flash cards. Prior to the patient recording, the patient information is entered into the flash card. When the patient returns after the Holter recording is completed, the memory flash card is removed from the recorder, and inserted into the Holter playback system. The patient data is then automatically entered by the computer. The patient information data is displayed, so that the operator can validate the specific patient information. This capability provides security to the physician and patient, so that there will be no mix-up of memory flash cards and patient names.

ST AND QT SET-UP
The top of the screen shows 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, simply 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. If dual spikes, place on atrial. If ventricular spike only, place on ventricular. Click on the second vertical line (marked B) and drag it to the end of the QRS 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).

The Pacemaker setup screen allows you to enter the pacemaker type, firing type and upper and lower pacemaker limits.

PACEMAKER ANALYSIS
The top of the screen shows 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, simply 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. If dual spikes, place on atrial. If ventricular spike only, place on ventricular. Click on the second vertical line (marked B) and drag it to the end of the QRS 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).

The Pacemaker setup screen allows you to enter the pacemaker type, firing type and upper and lower pacemaker limits.

DATA ACCESS MENU
After the analysis is completed, the Data Access Choices menu is displayed. This menu allows immediate access to Edit, Page Scan, Mega Scan, QT Validation, A-Fib/Flutter, HRV, ST Scanning, ECG Strips, Hourly Totals, SAECG/VCG, Report and Re-Analysis access.

This menu allows the Holter operator access to many functions that do not exist on most Holter ECG systems.

TEMPLATE EDITING
The Template edit feature is the fastest and most efficient method in the Holter industry for insuring accurate counts of VE, SVE, and Aberrant arrhythmia beats. All abnormal beats can be instantly reviewed and edited for Pauses, fast HR 2:1 blocks, longest R-R intervals, ST Episodes, V-Runs, V-Pairs, V-Bigeminy, V-Trigeminy, VE's, SV-Runs, SV-Bigeminy, SV-Trigeminy, R on T, Min HR, and Max HR.

This menu assures the Holter operator that the printed Holter ECG report will be accurate. This results from high quality screen displays that permit a review and, if needed, a quick change in any data that will end up in the final Holter ECG report.

With the new Histogram Edit feature you are now able to create a new category for arrhythmias, such as Ventricular Escape or Bundle Branch Block.

ABNORMAL ECG EVENTS
All categories of Abnormal ECG events can be instantly displayed. For example, if there were 48 VE-Pair events, you can easily display 3-pages of these events. Within 10-seconds you can verify that all 48 VE-Pairs are accurate. If one or more of the displayed events is not a VE-Pair, then it can be immediately re-classified.

Immediately enlarged into a large 8-second ECG for detailed viewing. Any ECG beat can be immediately edited and/or re-classified.

ECG STRIP MENU
Each time the patient presses the event button on the Holter recorder, a special signal is placed on the memory card in the digital Holter recorder. This ECG event is automatically displayed on this ECG Strip menu, and time is accurate within 1-second. The patient activity and symptom can be entered for each automatic ECG event, so that the patient activity and symptom is printed on the ECG strip.

This menu also allows the Holter operator to select 1, 2, or 3 events from each Abnormal ECG category. Within 1-second, all of the Abnormal and Event Button ECG's are listed on the right side of this menu. Any listed ECG can be reviewed and, if desired, deleted. Any ECG from any portion of the Holter recording can be added to this menu.

This menu also allows a 12-Lead ECG strip to be printed from any ECG listed on this menu.

8-SECOND ECG DISPLAY
This menu has many unique features that are very much appreciated by experienced Holter operators. The high resolution graphics gives a clear viewing of P-waves and Q-waves. The 1-minute ECG is shown at the top of the display. All arrhythmia beats are color coded in the 1-minute display. The PgUp and PgDn functions, with either the mouse or keyboard, slides the data instantly backward and forward in time. In less than 10-seconds the operator can see all the ECG data that is 5-minutes before and after the target ECG data.

If needed, any ECG beat can be immediately edited. Simply move the mouse to an ECG beat and perform a right mouse click. Then a single command with either the mouse or keyboard will immediately re-classify the individual beat. A unique Ruler function allows the precise measurement of intervals and amplitudes. The measurement is printed on the ECG strip.

There is no longer any need for calipers. Simply click on the Ruler icon and perform any measurement using the ruler tool!

PAGE SCAN
Full Disclosure can also be viewed on the computer's screen display. The user can select a display of 10-minutes, 20-minutes, or 30-minutes. A rectangular box surrounds an 8-second ECG from any portion of the Page Scan display. The enlarged 8-second, 3-channel ECG is shown at the lower left corner. All beats are color-coded for VE, SVE, Pause, and Normal. The lower right section of the display shows the R-R interval graph for each beat of the minute in which the rectangular box is located. Each R-R interval is also color-coded.

The mouse can also move the rectangular box to any location in the Page Scan. Also, arrow keys can be pointed at any single color-coded beat, and immediately edited.

At any time the user can instantly display the large 8-second ECG display for data shown in the rectangular box.

MEGA SCAN
This menu correlates multi-analysis for any 1-minute of ECG data. The menu shows a 24-hour analysis on a minute-by-minute basis for the following types of ECG analysis:

ST SCAN AND VALIDATION OF ST SEGMENT ANALYSIS
A vertical marker is located on the exact location of each beat from which the ST depression or ST elevation is measured. This provides instant visual verification that the ST is being measured from the correct location in the ST Segment. If the location is incorrect, the entire 24-hour Holter ECG can be re-analyzed with the ST sample point in the proper location. This re-analysis takes approximately 1-minute.

The analysis for ST is performed in both Delta and Absolute ST formats. The user can choose which ST format is reported in the various Holter ECG report pages.

ST analysis is performed independently on all channels of ECG data on a beat-to-beat basis. All ventricular, artifact, and wandering baseline beats are eliminated from ST analysis.

SAECG LATE POTENTIALS
This is unique in Holter ECG. The first 10 minutes of the 300-7 recording has a frequency respons of 0.05 to 500.0 Hz. The sample rate for the SAECG file is 1024 samples per second for each ECG channel. These are the minimum requriements for the American and European Heart Associations for diagnostic SAECG Late Potentials.

The filtered QRS is determined by a computer algorithm. If you desire, you can edit the beginning and ending QRS markers. The section at the end of the QRS that is designated for SAECG Late Potential analysis is color-coded. This gives the user a visual verification that the analysis is being conducted in the appropriate area.

The computer algorithm reports analysis of Standard QRS width, Filter QRS width (Fqrs), LAS<40uV and Last 40ms. A positive SAECG test is generally considered to be a fQRS in excess of 113ms.

ATRIAL FIBRILLATION/FLUTTER ANALYSIS
Atrial Fibrillation has become an ever increasing concern for the cardiology clinician. Holter ECG is an excellent test for detecting transient a-fib.

The purpose of a Holter A-Fib technology is to detect the minutes of A-Fib rhythm and what the heart rates are associated with A-Fib activity. The red area in the above graph shows about 6 hours of A-Fib rhythm. You can move the cursor to any minute of the 24-hour trend grap and visually verify the sinus or A-Fib rhythm for the minute of ECG data. An icon allows for all SVE beats to be deleted for all A-Fib minutes.

QT VALIDATION
QT analysis is avoided in most Holter systems. However, elongation of the QT interval can be the precursor to a mortality event. The detection of abnormal QTc and QT intervals are important analysis functions for a Holter ECG recording. This Holter system has the most advanced QT validation program available.

QT is analyzed on a beat-to-beat basis. The heart rate is factored into the QT analysis so that QTc and QT measurements are made for the same data. A QTc histogram is then developed. Those QTc measurements at the far right side of the histogram that exceed a QTc of 450 ms are generally recognized as the worrisome QT intervals.

The mouse arrow is placed on a selected QTc interval, and its actual ECG is displayed on the screen display. The Ruler function is then activated to verify that the correct QT and QTc measurements were made. If appropriate, the QTc histogram data can be rejected. When the data is verified as being an abnormal QTc and QT event, the data is saved and included in the QT report. Each and every QTc and QT abnormality is easily and quickly validated.

QT MARKERS ON ECG DISPLAY
After the mouse is clicked on a location on the QTc histogram, the data is first displayed in the 16 per page ECG format. Vertical markers are shown at both the beginning of the Q-wave and the end of the T-wave. The purpose is to give the user a visual validation that the QT analysis was performed for the correct QT interval. For more detailed viewing, the large 8-second ECG is instantly displayed. Vertical QT markers are also shown on this display for further QT validation.

HEART RATE VARIABILITY
This displays shows the Poincare and Lorenz plots across the top of the display. The left side is a spectral power graph. The user can adjust the VLF, LF, and HF ranges to whatever they believe is correct for their testing purposes. The right side of the graph is a Time Domain R-R interval graph. You can view the ECG data at either far end of the histogram to determine if any of these ECGs should be rejected from the HRV data file

PRIOR PROGRAM
This menu stores both the Holter Report for each patient, and the 100% ECG file for each Holter recording. Batch Printing of multiple Holter ECG reports is also accomplished with this menu. The Holter recording file is automatically stored into this program. If desired, the Holter ECG file can be deleted.

This menu also includes a Diagnosis search capability. For example, the physician or technician may label each completed Holter recording with various labels: such as; V-Tach, HRV, QT, ST, etc. At a later date the physician may want to do some research work on the QT patients. You would simply go to this Prior menu and type in QT and click on the search icon. All of the QT patient files, containing 100% of their Holter ECG recordings, would be retrieved.