review, page 2: Cardiac Device
By: Stewart Cameron MD
Ever wanted to get a quick rhythm strip on a patient
when there's no ECG machine around? Want to do it with
your PDA? Welcome to the world of handheld cardiac monitoring.
It's astonishing enough that this little device
actually works. I've eaten desserts bigger than this. ActiveECG
for Palm OS Handhelds was approved for marketing by the US FDA
in May 2001 and the Therapeutic Products Directorate of Canada
in August. Active Corporation of Castine Maine is marketing the
devices for $499 US from the ActiveECG website.
The actual device is slightly thicker than your
standard PDA, but is undeniably pocket sized. It connects to Palm
handhelds with a cable that fastens to the sync connector. It
has a belt clip to fasten it to the patient's clothing. The three
lead wires unwind from a track in the ActiveECG and snap on to
standard monitoring electrodes. They are placed on the left leg
and each arm to give lead II.
The Palm software is simple and easy to use. It opens a patient
file with a name you enter from the keyboard, but there's a more
convenient route too. There are some customizable buttons for quick
one tap creation of a record...e.g. "New Patient". You
can enter the details later, a nice touch. This interface has been
designed to work with finger taps on nice big tabs and hot areas:
no need for a stylus! This is useful when one is already fiddling
with leads and cables. A connection status icon alerts you to any
Your PDA display can give a remarkably decent reading of the rhythm
in real time. The display can be customized to three different voltage
amplitudes and scan rates to aid interpretation. No calibration
is required and the signal is remarkably stabilized. A beep for
each QRS complex can be emitted if desired.
It gets even more fun: the software can record several strips for
later review. These recorded traces are transferred to your PC when
you sync for later viewing or printing. You can even document your
interpretation of the strip, and print them off for the patient
The software includes three programs: the Palm OS application (only
88k), a "conduit" utility that works during syncs to transfer
the strips to your PC, and the Windows viewer for examining the
strips on your PC.
PC requirements are rudimentary: the system is claimed to work
with any 486 processor or better and Windows 95 or later. The device
supports the Palm OS products only, although a special cable is
necessary for Visors and it must be obtained from another company.
Pocket PC's need not apply.
After you have shown off to your colleagues and impressed a few
patients, the gee whiz factor wears off. You start to wonder...
can it really make diagnoses for you? I've used it on the ward,
in our clinic and on housecalls, and it delivers.
It has confirmed a case of atrial fibrillation
And revealed a bigeminal rhythm.
It was not fooled by a pacemaker and even indicates when one is
This device would be quite useful for home visits,
or the nursing home patient with palpitations when a full 12 lead
is not readily available. It could be employed to monitor a patient
while in transport or awaiting EMS. The documentation claims it
can even function through defibrillation, although none of my colleagues
were willing to let me test this feature on them. In a few cases,
a reassuring strip might obviate the need for a full 12 lead in
a low risk patient. The instant feedback would be a welcome feature
for those patients. It also does not require disrobing, since there
are no chest leads.
This device is easy to use, portable and relatively cheap. It held
up well during the few weeks I carted it around. It remains to be
seen how well it endures over a longer term.
While the device is fun and useful, it is uncertain at this time
if it can cost justify itself in a Family Physician's office.
Obviously, it will also not be much help for the more pressing
situations where you are concerned about ischemia or infarction
and need a full ECG. If this device succeeds, a full 12 lead model
would be a welcome addition to the product line.
Stewart Cameron MD
Family Medicine Halifax, Nova Scotia
ActiveECG review page: 1
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