Multi-functional device for cardiologic telemedicine and diagnostic holter.

A major requirement for cardiologist is to prevent severe injuries by monitoring the patients not only during the hospitalization but also when the patient is at home, followed by the family doctor. Nowadays, different systems are available to record ECG and to send it to the hospital via phone or internet connection, where a specialist can read the data and decide the best strategy to improve the therapy. These devices can present different levels of complexity, depending on their clinical aim: from the standard ECG recorder able to acquire 12 signals to the simplified system to acquire up to 3 channels at a low resolution but for a longer time to evaluate arrhythmias. Both these approaches present some problems connected or to the difficulty for the patient to manage the acquisition and then the transmission to the hospital or to the high specialization and the low versatility of the devices. The purpose of our work was to realize and validate a versatile, powerful and easy to use instrument (TH16) to perform both standard ECG and 24 hours holter recordings. TH16 was designed for family doctors, making them able to perform standard ECG, holter recordings during pathologic events and then to transmit the data to the specialist via TCP/IP protocol. By simply programming the device, TH16 can acquire and store up to 20 standard ECG recordings or 3 ECG channels for 24 hours. Firmware on TH16 allows post acquisition or background analysis to help the doctor in the diagnosis. After acquisition, data are sent to the hospital using the integrated modem and the specialist can perform the analysis. The software on the server allows the specialist to make the diagnosis and to send it, through a friendly web interface, to the doctor who can modify the therapy of the patient. TH16 testing involved 3 cardiologists and 20 family doctors. 174 ECG and 230 holter recordings were performed in the ambulatory or at the patient home and transmitted to the hospital. 86% of the recordings where correctly acquired and a complete diagnosis was possible. In the other cases, artefacts due to unstable or wrong positioning of the electrodes make impossible to analyse the signals. All the diagnosis were performed in 24 hours and the feedback to the family doctor was immediate. TH16 demonstrated to be a powerful and easy to use device, well tolerated by patients. The intermediary role of the family doctor between patient and specialist represent the best solution in order to optimize the procedures.