CardioDay V2.5 Operator Manual - UM - 2092513-004 - E

GE Healthcare
CardioDay® V2.5
Holter ECG Analysis Software
Operator Manual
2092513-004 Revision E
CardioDay® V2.5 Holter ECG Analysis Software

English
© 2019 General Electric Company
All Rights Reserved
Publication Information
The information in this manual applies only to CardioDay® V2.5 Holter ECG Analysis Software. It does not ap-
ply to earlier versions. Due to continuing product innovation, specifications in this manual are subject to
change without notice.
This manual is developed and owned by GETEMED Medizin- und Informationstechnik AG (GETEMED),
Oderstr. 77, 14513 Teltow, Germany, and it is branded by GE Healthcare.
MARS, SEER, and MUSE are trademarks owned by GE Medical Systems Information Technologies, Inc., a Gen-
eral Electric Company going to market as GE Healthcare. All other marks are the properties of their respective
owners.
CardioDay and CardioMem are trademarks owned by GETEMED.
Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United
States and/or other countries.
This product complies with the regulatory requirements concerning medical devices from the following bodies:
Revision History
The document part number and revision appear at the bottom of each page. The revision identifies the docu-
ment’s update level. The revision history of this document is summarized in the following table.
Revision Publication Date Description
A 2016-08-19 Internal costing release.
B 2016-08-31 Internal maintenance release.

C 2017-01-21 Initial customer release.
D 2017-07-18 Added support for importing MARS recordings and sorting classes. Edited pro-
cess of adding a patient diary event.
E 2019-07-15 New feature: “Site and location filter”

Integrated PDF printer
MUSE Diagnosis setting
New print variables
New setting for ECG background grid on the computer screen
New setting for order of strips in final report
New setting for ECG background grid of strips in final report
To access these and other manuals online, go to http://www.gehealthcare.com/documents and click Enter
Customer Documentation Portal. To request paper manuals at no charge, contact your sales representative.
Allow 7 days for delivery.
2 CardioDay® V2.5 2092513-004 Revision E

2019-07-15
Contents
1 Introduction.......................................................................................................... 11
Intended User ............................................................................................................................ 13
Intended Use .............................................................................................................................. 13
Contraindications ..................................................................................................................... 14
Prescription Device Statement ........................................................................................... 14
Regulatory and Safety Information.................................................................................. 14
Safety Conventions ..................................................................................................... 14
Safety Hazards .............................................................................................................. 15
Supply and Accessory Information ...................................................................... 17
Manufacturer Responsibility ................................................................................... 17
Product and Package Information ....................................................................... 18
Service Information ................................................................................................................. 20
Service Requirements ................................................................................................ 20
Additional Assistance ................................................................................................. 20
Manual Information ................................................................................................................ 20
Manual Purpose ............................................................................................................ 20
Document Conventions ............................................................................................. 21
Related Documents ..................................................................................................... 22
2 The optimal path for Holter / Ambulatory ECG evaluation ........................ 23
Part I
Downloading and evaluating Holter ECG recordings
3 Downloading ECG data ...................................................................................... 27

Recorder memory card types ............................................................................................. 27
Program start, User login...................................................................................................... 28
Start window options ............................................................................................................. 29
Selecting the recording slot for the patient’s ECG recording ............................... 30
Download recording ................................................................................................... 30
Sorting the list of patient names ........................................................................... 31
Entering patient data ............................................................................................................. 32
Signal evaluation and setting of Analysis parameters before
downloading the ECG data .................................................................................................. 34
Signal evaluation during pre-analysis ................................................................ 35
Overview and Retry after pre-analysis ............................................................... 38
Pacemaker parameters and pulse widths ........................................................ 38
Setting customized Analysis parameters before downloading .............. 39
2092513-004 Revision E CardioDay® V2.5 3

4 Screen structure and symbols .......................................................................... 41
Screen layout ............................................................................................................................. 42
Tool buttons ................................................................................................................................ 43
5 Opening recordings and reports on the Recordings tab ............................. 45
Using the "Search for" parameters to filter the patient and
recordings list............................................................................................................................. 46
The Info and Status columns .............................................................................................. 46
Opening long recordings ...................................................................................................... 47
Reports for separate recording blocks or the total recording ................. 47
Tabs available when opening the total report ................................................ 48
6 Evaluation and correction on the Regions tab .............................................. 51
7 Evaluation and correction on the Classes tab ............................................... 55
Assigned keys on the Classes tab ......................................................................... 56
The sections of the Classes tab ......................................................................................... 57
Status display below the QRS class windows ................................................. 57
Display in an individual class window ................................................................ 58
QRS zoom display......................................................................................................... 59
ECG context display .................................................................................................... 60
Regions in the ECG context display...................................................................... 61
Measuring ECG sections............................................................................................ 61
Channel selection, Inverted waveform display, Colors ............................... 63
Evaluation of the QRS class characteristics ................................................................. 64
Additional class characteristic “1” ........................................................................ 65
Additional class characteristic “M” ....................................................................... 65
Correction of the QRS class characteristics ................................................................. 66
Correction of characteristic assigned to a whole class –
the asterisk [*] ................................................................................................................ 66
Quick-Scan for quick evaluation and correction, splitting a QRS Class........... 67
8 Evaluation and correction on the Events tab ................................................ 69
Assigned keys on Events tab ............................................................................................... 69
Analysis parameters and event classification ............................................................ 69
Evaluation and correction of the event classification – overview .................... 72
Screen layout and operation of the Events tab .......................................................... 74
Listing of events in the separate event classes .............................................. 76
QRS complex and switching tabs ......................................................................... 77
Reclassification of events using the + and – keys ......................................... 77
Designating an event to be an artifact .............................................................. 78
RR interval or heart rate in the ECG context display .................................... 78
Deleting and renaming event classes ................................................................ 78
Adding a Patient diary event ............................................................................................... 79
Heart Rate Turbulence [HRT] .............................................................................................. 80

Quantifying of HRT by Turbulence Onset and Slope .................................... 80
Background information / Relevance ................................................................. 81
Setting the minimum and maximum RR intervals .................................................... 82
Editing events on the Classes tab ..................................................................................... 83
9 The HR Min/Max tab............................................................................................ 85
Display of “manual” events, i.e., events triggered at the recorder ..................... 85
Evaluation and correction of the extreme heart rate values ............................... 86
Adding an undetected QRS complex manually .............................................. 87
Accepting or changing extreme values automatically calculated ........ 87
Zooming in and out ................................................................................................................. 88
10 The Statistics tab ................................................................................................. 91
Mean heart rate and mean RR interval .......................................................................... 91
Diff. RR absolute ........................................................................................................................ 93
Statistical calculation ................................................................................................. 93
Diff. RR > 50 ms distribution ................................................................................................ 94
Statistical calculation ................................................................................................. 94
ST diagrams, evaluation and correction of the extreme values of the
ST deviation................................................................................................................................. 96
PR trend ........................................................................................................................................ 97
QT analysis .................................................................................................................................. 98
QT trend ............................................................................................................................ 99
QT-RR distribution ......................................................................................................101
QT histogram ................................................................................................................102
AFib – Detection of atrial fibrillation...............................................................................102
Statistical calculation ...............................................................................................102
Background information / Relevance ...............................................................102
Explanation of the displays and color assignments ...................................103
Context menu options..............................................................................................104
11 The Report tab ................................................................................................... 105
The software-generated Summary of the report ....................................................106
The Diagnosis part of the report .....................................................................................107
Printing a logo ..........................................................................................................................108
12 The Full disclosure tab ..................................................................................... 109
13 The PM (Pacemaker) events tab ..................................................................... 113
Detectable pacemaker event classes ...........................................................................114
Basis for the analysis and evaluation of pacemaker events ..................114
Analysis algorithms of the stimulation impulse differentiation .........................114
Effective stimulation in the ventricle (V-QRS) .................................................114

Effective stimulation in the atrium (without oesophagus lead) .............115
AV-sequential stimulation (A-Pace, V-Pace) without
differentiation of the width of the stimulation impulse.............................115
Exit block ........................................................................................................................115
Oversensing ..................................................................................................................115
Undersensing ...............................................................................................................115
Fusion beats .................................................................................................................115
Independent transmission in DDD pacemakers (A-QRS)..........................115
Synchronous behavior of DDD pacemakers ..................................................115
14 The Heart rate variability tab ......................................................................... 117
Heart rate variability > Lorenz plot and Interval distribution .............................117
Statistical calculation of the Lorenz plot .........................................................118
Relevance of the RR Lorenz plot ..........................................................................118
Statistical calculation of the interval distribution ........................................118
Relevance of the interval distribution ...............................................................119
Deceleration and Acceleration capacity .........................................................121
Heart rate variability > RR histograms .........................................................................121
Heart rate variability > RR-FFT .........................................................................................123
Background information / Relevance ...............................................................124
Heart rate variability > 24h RR-FFT ................................................................................126
15 The 12-channel ECG tab ................................................................................... 129
Screen structure and operation ......................................................................................130
Measuring, editing, and exporting ECG sections .....................................................130
Creating 12-channel markers ..............................................................................131
General setup and print setup of 12-channel markers ............................131
Automatic creation of markers ............................................................................131
Automatic Measurement ........................................................................................132
Editing the automatically generated values ..................................................133
Convert marker / Show recorder events .........................................................134
Export of ECG sections, the Marker list .............................................................135
16 The Respiration tab........................................................................................... 137
The Analysis sub-tab ............................................................................................................138
Specification of the analysis period ...................................................................139
Start of analysis ..........................................................................................................139
Evaluation and correction of the results of the respiratory
analysis ...........................................................................................................................140
The Report sub-tab................................................................................................................141
17 The AFib tab – Frequency analysis for detection of atrial fibrillation .... 143
18 The TWA tab – T Wave Alternans ................................................................... 147
Screen layout and operation ............................................................................................147
Select analysis channels .....................................................................................................149

Start analysis ............................................................................................................................149
Evaluation and correction of the TWA analysis ........................................................149
Valid and invalid TWA values ............................................................................................150
19 The Episodes tab – evaluation of episodes imported from an
event recorder ................................................................................................... 151
20 The Print tab ....................................................................................................... 153
Selecting a printer ..................................................................................................................154
Configuring a PDF file destination ..................................................................................154
Default and customized print selection templates .................................................154
Printed check box...................................................................................................................155
25 mm/s ECG strip settings ...............................................................................................156
General > Report and Overview.......................................................................................156
Print > Full disclosure ............................................................................................................159
Print > Saved events .............................................................................................................161
Saved events > Overview 8 or 32 events/page ............................................162
Saved events > 25 mm/s ....................................................................................................162
Saved events > 1 min + 25 mm/s........................................................................164
Saved events > 10 min + 25 mm/s .....................................................................165
Saved events > Patient diary ................................................................................166
Print > Statistics ......................................................................................................................167
Statistics > General > QRS classes ......................................................................167
Statistics > General > Event table .......................................................................168
Statistics > General > Event histogram ............................................................168
Statistics > General > ST trend .............................................................................170
Statistics > General > HR diagram + Min/Max minute ..............................171
Statistics > General > PVC + SVE histograms .................................................172
Statistics > General > Heart Rate Turbulence ...............................................173
Statistics > General > AC/DC Capacity .............................................................174
Statistics > Heart rate variability (Standard) > YT/PNN50 ........................175
Statistics > Advanced heart rate variability (RR-FFT) >
RR intervals ...................................................................................................................176
RR Lorenz plot ..............................................................................................................177
Min. sympathy. innervation index .......................................................................179
24 h RR-FFT ...................................................................................................................180
RR interval spectra.....................................................................................................180
Statistics > PR/QT trend > PR trend ....................................................................182
Statistics > PR/QT trend > QT-/QTc trend ........................................................183
Statistics > PR/QT trend > QT histogram..........................................................184
Print > Respiration > Overview and Marked episodes ...........................................185

Print > 12-channel ECG........................................................................................................187
Print > AFib > Statistic ...........................................................................................................188
Print > AFib > Frequency analysis ...................................................................................189
Print > Pacemaker..................................................................................................................190
Pacemaker > Event histogram .............................................................................190
Pacemaker > Function analysis ...........................................................................191
Relevance ......................................................................................................................192
Print > TWA > Trend ...............................................................................................................194
Print > TWA > ECG ..................................................................................................................195
Print > Event Recorder > Selected Marker...................................................................196
Part II
The CardioDay menus
21 The Recording menu ......................................................................................... 199

Recording > Start....................................................................................................................199
Recording > Open... ...............................................................................................................199
Recording > Reanalyze... .....................................................................................................199
Recording > Patient data... .................................................................................................200
Recording > Properties… .....................................................................................................200
Recording > Close recording .............................................................................................201
Recording > Import… .............................................................................................................201
Importing MARS Recordings ..................................................................................201
Recording > Monitoring acquisition ...............................................................................202
Recording > Delete ................................................................................................................203
Recording > Exit ......................................................................................................................204
22 The Recorder menu ........................................................................................... 205
Recorder > Hookup................................................................................................................205
Adding a recorder to the recorder list...............................................................206
Establishing a connection to a device already in the recorder list ......209
Receiving or sending patient data .....................................................................209
Site and Location ........................................................................................................210
Processing MUSE orders .........................................................................................210
Recorder settings for a recording, the Options field ..................................211
Viewing ECG waveforms and checking the signal quality.......................211
Print diary.......................................................................................................................212
Recorder > Transfer patient data....................................................................................213
Recorder > Download recording or Download long recording .........................214
Recorder > Download event recording ........................................................................214

23 The Export menu ............................................................................................... 217
Export > Print to file … ...........................................................................................................217
Export > HRV data export ...................................................................................................218
24 The Archive menu.............................................................................................. 219
Selecting for archiving .........................................................................................................219
Selecting for Restoring .........................................................................................................220
Deleting recording(s) from the archive .........................................................................220
25 The Extras menu ................................................................................................ 221
Extras > Reanalyze events... ..............................................................................................221
Extras > Print screen .............................................................................................................221
Extras > Create 12-channel markers… .........................................................................222
26 The Setup menu ................................................................................................. 225
Setup > Screen, Scale, and Colors ..................................................................................225
Setup > File path… ..................................................................................................................228
Setup > RR-FFT options........................................................................................................229
Setup > Other options ..........................................................................................................229
Setup > Other options > Archive ..........................................................................230
Setup > Other Options > Miscellaneous ...........................................................231
Setup > Other options > TWA ................................................................................232
Setup > Other options > MUSE connection.....................................................234
Setup > Other options > Monitoring connection ..........................................235
Setup > Report .........................................................................................................................236
Customizing and saving report templates .....................................................236
Setup > Report > Advanced... ................................................................................239
Setup > 12-channel markers…..........................................................................................242
Setup > Printer… ......................................................................................................................243
Setup > Rebuild list of recordings ...................................................................................243
Setup > Site and location administration… .................................................................243
Add site ...........................................................................................................................244
Add a location ..............................................................................................................245
Editing a Site or Location ........................................................................................245
Disabling a site or deleting a location ...............................................................245
Importing Sites and Locations from MUSE .....................................................246
Setup > User administration…...........................................................................................246
Overview ........................................................................................................................246
User administration for a new installation .....................................................247
Adding a new user account...................................................................................248
Adding a new group account (for domain computers only) ...................250
Guest user rights on failed or canceled authentication ...........................251
Changing the default administrator password after installation .........251

Selectable user rights ...............................................................................................251
Site and Location management for users and groups .............................253
Setup > Change user ............................................................................................................254
27 The Help menu ................................................................................................... 255
Help > Contents.......................................................................................................................255
Help > Quick start guide ......................................................................................................255
Help > About .............................................................................................................................255
Help > Version ..........................................................................................................................255
Help > Options .........................................................................................................................256
Part III Appendices
A Variables for customizing the report templates ......................................... 259

Patient data ..............................................................................................................................260
General data .............................................................................................................................260
Analysis parameters .............................................................................................................261
Pacemaker-related analysis parameters ....................................................................261
Event data and measured values ...................................................................................262
Heart rate variability parameters ...................................................................................266
Heart Rate Turbulence and Deceleration capacity ................................................267
Combined variables ..............................................................................................................268
Pacemaker data .....................................................................................................................269
Information on the recording ...........................................................................................269
Information on recordings from an event recorder ...............................................270
B Definitions........................................................................................................... 271
C System limitations ............................................................................................ 273

1 Introduction
1
This document describes the CardioDay V2.5 Holter ECG Analysis
Software and is intended for a trained physician or healthcare pro-
fessional knowledgeable in Holter interpretation.
CardioDay is a software package that allows you, after having per-
formed a long-term continuous electrocardiographic (ECG) record-
ing on a digital flash memory Holter recorder, to download and an-
alyze the data from the recorder, review it, and produce printed re-
ports.
NOTE:
CardioDay does not perform any diagnosis of data by itself
but only displays ECG morphologies and associated, calcu-
lated graphs such as heart rate trends, Heart rate variability,
and other statistical values in graphical form. The physician
will be able to review, edit, and print the data collected.
The ECG data are downloaded onto the software by either down-
loading them directly from a Holter recorder or by opening an exist-
ing data file. Once you have selected the data source and entered the
patient information, CardioDay performs a pre-analysis on a short
section of the ECG data file. The results of this pre-analysis are then
presented. You may now view and, if necessary, edit the analysis
parameters displayed in the Signal evaluation and analysis parame-
ters window. After the analysis parameters have been reviewed
and edited, CardioDay analyzes the complete ECG recording and
presents the results. If you generally use the same parameters over
and over again, you may store these values as default analysis pa-
rameters.
After performing the ECG analysis, CardioDay displays the Regions
window for identifying artifacts. Then, in the Classes window,
CardioDay has classified the QRS complexes into classes of similar
morphology using specially designed algorithms. If, for example,

Introduction
due to artifacts, it is necessary to reclassify a single beat or a partic-

ular class, then this can be done with just two clicks of the mouse.
Once any corrections have been done, CardioDay automatically
performs a new Event analysis based upon these changes and up-
dates the list of cardiologically significant events.
The events detected by the software are weighted according to their
significance and displayed in hierarchical order in the Events window.
The most significant events from each event class are automatically
marked for printing. As in the case of the QRS morphology classes,
you must also view and validate the event classification and, if nec-
essary, perform corrective action by editing the classes. To aid you in
performing this task, a zoomed version of the selected QRS complex
as well as the ECG context are simultaneously displayed on the
computer screen. Furthermore, the Events tab allows you to evaluate
and edit the detected minimum and maximum values of the RR in-
terval and to quantify any Heart Rate Turbulences [HRT].
Other tab windows offer you powerful and easy to use tools for car-
rying out further assessments of your patients’ ECG:
 The HR Min/Max tab allows you to check the minimum and
maximum values of heart rate over the duration of the re-
cording.
 The Statistics tab allows you to quickly view and assess
graphical analysis results.
 The Report tab allows you to review a software-generated,
tabular summary and to enter your diagnosis.
 The Full disclosure tab allows you to review a full disclosure
of the raw ECG data at any time and thus enables you to vali-
date the analysis results.
 The Heart rate variability tab allows you to use algorithms,
including Fourier transformation of the complete ECG record-
ing, that comply to internationally accepted standards to pro-
vide various types of information on the Heart rate variability
of the patient’s heart rate in graphical form.
 The 12-channel ECG allows you to assess 12-channel ECGs.
 The Episodes tab allows you to assess imported event episodes.
 The PM Events tab allows you to analyze the pacemaker’s
mode of operation separately.
 The Respiration tab allows you to evaluate the results of an
analysis CardioDay has performed on signals of impedance
variations recorded by the respective version of CardioMem.
During the sleep phase these signals correspond to the respi-
ration activity.

Introduction
 The AFib tab allows you to evaluate the ECG data for possible
signs of atrial fibrillation.
 The TWA tab allows you to analyze and evaluate the complete
ECG recording for T Wave Alternans. This provides a variety of
information on beat-to-beat alternans in the morphology of
ST segment and T wave.
 The Print tab allows you to make your Preselection of the
graphical displays and reports in the Print Preview before
printing or before storing files.
Intended User
The CardioDay software is intended to be used by a trained physician
or healthcare professional knowledgeable in Holter interpretation.
Intended Use
The CardioDay V2.5 Holter Analysis Software is designed for the ac-
quisition, analysis, edit, review, report, and storage of ambulatory
and multi-parameter ECG data.
Results of the automated analysis are intended to assist the physi-
cian in the interpretation of the recorded data. This information is
not intended to serve as a substitute for the physician overread of
the recorded ECG data.
The CardioDay V2.5 system is intended to be used by trained opera-
tors under the direct supervision of a licensed healthcare practi-
tioner in a hospital or clinic environment.
Patient population includes both adult and pediatric human pa-
tients.
CardioDay V2.5 provides the user arrhythmia study and Holter anal-
ysis capabilities.
Data acquired may be used for the following indications:
 Evaluation of symptoms that may be caused by cardiac ar-
rhythmia and/or conduction disturbances,
 Evaluation of symptoms that may be due to myocardial ische-
mia,
 Detection of ECG events that alter prognosis in certain forms
of heart disease,
 Detection and analysis of pacemaker function and failure,
 Determination of cardiac response to lifestyle,
 Evaluation of therapeutic interventions,
 Investigations in epidemiology and clinical trials.

Introduction
Contraindications
There are no known contraindications to using the device.
Prescription Device Statement

CAUTION
United States federal law restricts this device to sale by, or on
the order of, a physician.
Regulatory and Safety Information

This section provides information about the safe use and regulatory
compliance of this system. Familiarize yourself with this informa-
tion, and read and understand all instructions before attempting to
use this system. The system software is considered medical soft-
ware. As such, it was designed and manufactured to the appropri-
ate medical regulations and controls.
NOTE:
Disregarding the safety information provided in this manual is
considered abnormal use of this system and could result in in-
jury, data loss, or a voided warranty.
Safety Conventions
A Hazard is a source of potential injury to a person or damage to
property or the system.
This manual uses the terms WARNING, CAUTION, and NOTICE to
point out hazards and to designate a degree or level of seriousness.
Familiarize yourself with the following definitions and their signifi-
cance.
Definition of Safety Conventions

Convention Definition
WARNING Indicates a potential hazard or unsafe practice, which, if
not avoided, could result in death or serious injury.
CAUTION Indicates a potential hazard or unsafe practice, which, if
not avoided, could result in moderate or minor injury.
NOTICE Indicates a potential hazard or unsafe practice, which, if
not avoided, could result in the loss or destruction of prop-
erty or data.

Introduction
Safety Hazards
The following messages apply to the system as a whole. Specific
messages may also appear elsewhere in the manual.
Warnings
WARNING:
GENERAL RISK TO PATIENT HEALTH AND LIFE - The life or health
of a patient may be put at risk if the medical personnel do not
have all the information contained in the operator manual.
Carefully read the operator manual. It contains important in-
formation for a correct ECG analysis.
WARNING:
MIXING UP RECORDINGS - The life or health of a patient may
be put at risk if a different patient's examination is assigned to
this patient, thus resulting in an incorrect diagnosis.
Take special care to always select the correct examination
and correct patient in the software. To ensure that a recording
is not assigned to the wrong patient, always enter the pa-
tient's ID into the recording medium or write the patient's ID
on the medium before starting the recording.
WARNING:
USING THE RESULTS OF THE AUTOMATIC ANALYSIS FOR DIAG-
NOSIS - Using the results of the automatic analysis for diagno-
sis without first validating them may put the patient's life or
health at risk.
The ECG morphology classification and events resulting from
the automatic analysis of the ECG data by CardioDay must
not be used for diagnostic purposes before they have been
validated by a trained physician or healthcare professional
experienced in Holter ECG analysis.
In addition, it is extremely important that you view and vali-
date the raw ECG data (Full disclosure tab) and that you do
not rely solely on the analysis results generated by the soft-
ware itself. For example, strong interference fields, movement
artifacts, or loose electrodes may influence the signal mor-
phology and produce classes or events that are not consistent
with the patient’s actual heart condition.
Cautions
CAUTION:
AMBULATORY DATA - Ambulatory ECG data from Holter re-
corders are not intended to be used as a substitute for a
standard diagnostic quality resting 12-channel ECG.
Do not use the 12-channel data of CardioDay as diagnostic
quality resting 12-channel ECG.

Introduction
CAUTION:
RISK OF SIGNAL INTERFERENCES BY ELECTROSTATIC DIS-
CHARGE – Possible electrostatic discharge of electrical de-
vices can interfere with the signals of the ECG waveforms.
Do not touch the patient and the computer or its accessories
simultaneously. Accessories include keyboard, mouse, printer,
or any other device connected to the computer.
Notices
NOTICE:
POSSIBLE LOSS OF BLUETOOTH CONNECTION - If you use any
unauthorized Bluetooth wireless equipment, optimum wireless
performance cannot be assured.
Be aware that a Bluetooth connection can be disconnected or
interrupted, if the Bluetooth wireless technology has not been
tested and verified using this equipment.
NOTICE:
MALFUNCTIONING OF THE BLUETOOTH CONNECTION – To en-
sure that the correct Bluetooth module is used, it can became
necessary to disable an internal Bluetooth module on the
computer.
If your computer’s internal Bluetooth module cannot connect
to the recorder, disable the module and use the Bluetooth USB
adapter.
NOTICE:
POSSIBLE LOSS OF BLUETOOTH CONNECTION – Bluetooth
connections can be disturbed by WLAN connections.
Understand that the wireless transfer process cannot be
guaranteed under all circumstances when using Bluetooth
wireless technology.
NOTICE:
INTERFERENCE WITH OTHER WIRELESS EQUIPMENT - Other
devices could interfere with the equipment, even if they com-
ply with CISPR emission requirements.
Understand that range loss can occur if Bluetooth wireless
technology and other RF devices (e. g., WLAN) devices are
used near each other.

Introduction
NOTICE:
UNRELIABLE PERFORMANCE – All electronic equipment can be
infected by malicious software.
GE Healthcare products are scanned for viruses before they
are delivered. To ensure they remain virus-free, we recom-
mend implementing the following precautions:
Install a good quality virus scanning program and regularly
update it.
Initiate procedures to prevent infected software reaching your
computer, e.g., check the source of any software you use, use
only original software packages and, if possible, use your PC
solely for use with CardioDay.
Do not install CardioDay onto a computer that is used for
downloading information from the Internet.
NOTICE:
DATA LOSS – Data are not completely safe when they are
stored for a prolonged period.
We recommend regularly storing patient and recording data
using appropriate storage procedures.
Supply and Accessory Information

For ordering information and a list of supplies and accessories that
have been approved for use with this device, see the supplies and
accessories manual that is supplied with your recorder.
Manufacturer Responsibility
The manufacturer is responsible for the effects of safety, reliability,
and performance only if the following conditions are met:
 Assembly operations, extensions, readjustments, modifications, or
repairs are carried out by persons authorized by GE Healthcare.
 The electrical installation of the relevant room complies with
the requirements of the appropriate local, state, and other
government regulations.
 The equipment is used in accordance with the instructions for use.

Introduction
Product and Package Information

This section describes the location of the labels used on the pack-
aging of your device. It also describes the symbols used on the la-
bels.
Symbols
The following symbols may appear on the packaging. Familiarity with
these symbols assists in the safe use and disposal of the equipment.
For equipment symbols not shown, refer to the original equipment
manufacturers (OEM) manuals.
Symbols are used to convey warnings, cautions, prohibitions, man-
datory actions, or information. Any hazard symbol on your device or
packaging with markings in color indicates there is certain danger
and is a warning. Any hazard symbol on your device or packaging
that is in black and white indicates a potential hazard and is a caution.
Symbol Description
Catalog or Orderable Part Number
Indicates the manufacturer's catalog or part number.
Serial Number
Indicates the manufacturer's serial number.
Manufacturer Name and Address
Indicates the name and address for the manufacturer of
this device.
Rx Only Rx Only
US Federal law restricts this device to sale by or on the or-
der of a physician.
Follow Instructions for Use
Read and understand the operator's manual before using
the device or product.
As a mandatory action sign, this symbol is identified by a
blue background and white symbol.
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The CE Mark and Notified Body Registration Number signi-
fies the device has met all essential requirements of Euro-
pean Medical Device Directive 93/42/EEC.
PCT (GOST-R) Mark
Indicates the device or product conforms to applicable
Russian Gosstandard technical and safety standards.
CAUTION
CONSULT ACCOMPANYING DOCUMENTS – There may
be specific warnings or precautions associated with
the device that are not otherwise found on the label.
Consult the accompanying documentation for more infor-
mation about safely using this device.
Fragile
Indicates the contents are fragile. Handle with care.

Introduction
Symbol Description
Keep away from sunlight
Indicates that you must keep the device away from direct
sunlight.
Keep Dry
Indicates that you need to keep the container away from
rain and other sources of moisture.
Temperature limits
Indicates the upper and lower temperature limitations for
the transportation and handling of this package.
Pressure limits
Indicates the upper and lower air pressure limitations for
the transportation and handling of this package. The limits
are indicated next to upper and lower horizontal line.
Humidity limits
Indicates upper and lower humidity limits. They are indi-
cated next to the upper and lower horizontal lines.
This way up
Indicates the correct upright position of the package.
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Indicates you may recycle this material or device. Recycle
or dispose of in accordance with local, state, or country laws.
Labels on the product package

This section identifies the labels on the product package. See the
“Symbols” section on page 18 for detailed descriptions.
The product label identifies the following information for shipping:
 Product description
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 Manufacturer and distributor information
Packaging label
The packaging label contains handling, cautionary information, and

disposal symbols.

Introduction
Service Information
This section provides information pertaining to the maintenance
and servicing of the system. Familiarize yourself with this informa-
tion before requesting service from GE Healthcare or its authorized
representatives.
Service Requirements
It is the user’s responsibility to report the need for service to
GE Healthcare or to one of their authorized agents.
Additional Assistance
GE Healthcare maintains a trained staff of application and technical
experts to answer questions and respond to issues and problems
that may arise during the installation, maintenance, and use of this
system.
Contact your local GE Healthcare representative to request addi-
tional assistance.
Manual Information
NOTE:
This manual explains all CardioDay features. Note that some
features may not be included in the standard package and
must be purchased separately. Furthermore, some options, as
well as recorder types, might not be available in your region.
To get more information about available options, please con-
tact your local GE representative.
This section provides information for the correct use of this manual.
Keep this manual with the equipment at all times and periodically
review it. Request training assistance from GE Healthcare, if needed.
Manual Purpose
This manual provides information necessary for the configuration
and safe operation of this equipment in accordance with its func-
tion and intended use. It is not intended as a replacement for, but a
supplement to, thorough product training. Keep it with the equip-
ment at all times. Additional manuals can be found on the manual
DVD of CardioDay or can be downloaded online. To access other
manuals online, go to www.gehealthcare.com/documents and click
Cardiology.

Introduction
Document Conventions
This document uses the following conventions.
Typographical Conventions
The following table identifies the typographical conventions used in
this document, other GE Healthcare Diagnostic Cardiology product
documents, and third-party product documents distributed by GE
Healthcare Diagnostic Cardiology.
Convention Description
Bold Text Indicates keys on the keyboard, text to enter, or hardware
items such as buttons or switches on the equipment
Italicized Bold Indicates software terms that identify menu items, buttons,
Text or options in various windows.
KEY1+KEY2 Indicates a keyboard operation. A plus (+) sign between the
names of two keys indicates that while holding the first key,
you should press and release the second key. For example,
“Press Ctrl+Esc“ means to press and hold the Ctrl key and
then press and release the Esc key.
Enter Indicates that you must press the Enter or Return key on the
keyboard. Do not type Enter.
<space> Indicates that you must press the spacebar. When instruc-
tions are given for typing a precise text string with one or
more spaces, the point where you must press the spacebar
is indicated as: space. This ensures that the correct number
of spaces is inserted in the correct positions within the literal
text string. The purpose of the < > brackets is to distinguish
the command from the literal text within the string.
> The greater than symbol, or right angle bracket, is a concise
method to indicate a sequence of menu selections.
For example, the statement “From the main menu, select
System > Setup > Options to open the Option Activation
window” replaces the following:
1. From the main menu, select System to open the
System menu.
2. From the System menu, select Setup to open the
Setup menu.
3. From the Setup menu, select Options to open the
Option Activation window.
Illustrations
All illustrations in the document are provided as examples only. De-
pending on system configuration, screens that appear in the docu-
ment may differ from the screens as they appear on your system.
Notes
Notes provide tips or additional information that, while useful, are
not essential to the correct operation of the tools. They are called
out from the body text through a flag word and indentation:

Introduction
Related Documents
The following documents are referenced in this manual and provide
additional information that may be helpful in the configuration,
maintenance, and use of this product.
 CardioDay V2.5 Pre-Installation Manual
 CardioDay V2.5 Customer Installation Manual
 CardioDay V2.5 Installation and Field Service Manual
 CardioDay V2.5 Quick Start Guide
 CardioDay V2.5 Privacy and Security Manual

2 The optimal path for Holter / Ambulatory ECG
2
evaluation
CardioDay is state of the art software for Holter ECG evaluation.

This manual, split into parts I, II and III, provides you with guidelines
to obtain results very quickly, even though CardioDay offers a great
diversity of special functions.
 Part I provides all the information necessary for evaluating
Holter ECG recordings including:
o Downloading recordings, including how to set the
Analysis parameters for the pre-analysis of a short
segment of the recording.
These parameters can be adapted for the final analysis.
o Using the Recordings tab to open stored recordings and
reports.
Filters are available to search for specific recordings or
patients.
o Evaluating the noise regions detected during analysis
using the Regions tab.
You can also manually mark other regions of a record-
ing that you do not want to have analyzed.
o Evaluating the ECG QRS/Beat classifications and QRS
complex groups via the Classes and Events tabs.
o Using the Report tab to write your diagnosis, which is
available for printing and archiving together with a soft-
ware-generated summary of the relevant cardiologic
data.

The optimal path for Holter / Ambulatory ECG evaluation
The remaining tabs are used for special research and analysis
features. These features may be purchased as extensions to
CardioDay.
 Part II explains all of the main CardioDay application menus:

o The Recording menu, where you can open or import the
recording files, analyze them, or edit the associated pa-
tient data.
o The Recorder menu, where you can download Event
and Holter recordings, transfer patient demographic
data to connected Holter recorders and provides an ECG
waveform Hookup preview function.
Additionally, for the downloading of long Holter record-
ings (duration of more than 48 hours), a separate sub-
menu is available.
The Hookup function of this menu allows for the use of
an online/connected Holter recorder to check the ECG
signal quality and electrode placement prior to starting
a recording.
o The Export menu, where you can generate a PDF file or
export the data to another computer.
o The Archive menu, where you can archive recordings
and evaluation results to and restore them from local or
network locations.
o The Extras menu, where you can perform additional
tasks, e.g., reanalyze an open recording and edit the
analysis parameters for this.
o The Setup menu, where you can customize the software
according to your own requirements.
 Part III contains the manual appendices and includes the fol-
lowing sections:
o List of the variables for customizing the Report tem-
plates,
o List of definitions,
o Table of system limitations.

Part I
Downloading and evaluating

Holter ECG recordings
3 Downloading ECG data
3
NOTE:
Before an analysis can begin, the data stored in the recorder
must be downloaded onto the computer.
NOTE:
To enter event recordings that have been recorded using the
CardioMem CM 3000 L3, refer to “Recording > Import…” on
page 201.
A recording is downloaded from a recorder or from a memory card.
Before the recording is analyzed, you can accept or change the
analysis parameters. You can repeat the analysis at any time with
changed parameters.
NOTE:
To download recordings, you need the Download recording
right assigned to your user credentials.
To overwrite an existing recording with a newly downloaded
one, you additionally need the Delete recording right as-
signed to your user credentials.
For details on user rights refer to “Setup > User administra-
tion…” on page 246.
Recorder memory card types

 CardioMem CM 3000 and the SEER 12 series recorders use re-
movable memory cards. For downloading recordings and pa-
tient data, a Compact Flash Card Reader is required.
 CardioMem CM 4000, SEER 1000, SEER Light, and SEER Light
Extend series recorders have non-removable memory cards.
For downloading recordings and patient data, the recorder is
connected to the PC via the integrated USB interface.

Downloading ECG data
Program start, User login

Use either of the following methods to start CardioDay:
 From the Windows Start Menu, select Programs > GEHC >
CardioDay
 On the computer desktop, double-click the CardioDay icon.
For authentication and to assign user rights, CardioDay prompts the

user for a User name and a Password upon starting the program.
User login
To log on as a local CardioDay user, enter the User name and Pass-
word of your local CardioDay account.
You can also log on to CardioDay via Single Sign-on (SSO) by using
the user name and password of your Windows account. This re-
quires that a matching CardioDay group account be configured in
the CardioDay user management (for details, refer to “Setup > User
administration…” on page 246).
If the “Auto logon” feature is activated for a CardioDay account that
is associated with your Windows account, CardioDay will not ask
you for user name and password. You can refer to the CardioDay
status bar at the bottom of the main window to check the account
that was automatically used to identify you on CardioDay.
NOTE:
At the time of installation, the CardioDay administrator default
password is 14012013. After the installation is complete,
change the password as described in the “Setup > User ad-
ministration…” section on page 246.
For recorders of the SEER 1000 series, always use the same
administrator password to connect to the recorder from all

software programs (iOS App, PC App, CardioDay, and Cardio-

Read). This password is stored on the recorder along with the
patient data to protect it against unauthorized use.
Start window options

The following window appears once the program has been started:
Start window
The Start window can be opened via the Start Icon at the top of the
main application window. The individual Start menu functions are
also available via the icons and Recording and Recorder menus at
the top of the main application window.
 The Hookup feature can be used, depending on the recorder

type, via Bluetooth connection or via USB connection to view
and check the signal quality of the electrodes attached.
A Bluetooth connection can be established with CardioMem
CM 4000, SEER 1000, and CM 3000-12 BT recorders.
A USB cable connection can be established with CardioMem
CM 3000-12 and SEER 12 recorders.
 The Transfer patient data feature allows you to enter and

store patient data onto the recorder or memory card prior to
the start of the recording.
 The Download recording feature and—for recordings of more
than 48 hours—the Download long recording feature are
used to download ECG data from a Holter recorder and store
them on a Holter recording storage slot presented in the
Download data window. For details, refer to the “Download
recording” section on page 30.

If there is at least one free recording slot for an additional re-

cording, a line marked Free will be displayed at the top of the
list.
If no Free recording slot is available, the system will select the
oldest slot file to be overwritten. Before accepting that selec-
tion, check the file’s Status to confirm it is eligible for deletion.
If the file is not eligible, select one that is by clicking on it. Re-
gardless of which slot file is selected, you receive a warning
that you are about to overwrite data and must confirm the se-
lection before proceeding.
When downloading long recordings, you must take into ac-
count the information contained in the section about “Open-
ing long recordings” on page 47.
 The Open existing recording feature allows you to open a re-

cording already stored on your PC or in the network.
Selecting the recording slot for the patient’s ECG recording

NOTE:
To overwrite recordings, you need the user or user group right
Delete recordings assigned to your user credentials.
For details on user rights, refer to “Setup > User administra-
Download recording
To download data from the Holter recorder, select Download re-
cording (or Download long recording for recordings of more than
48 hours) in the Start window.
A window containing the list of recording slots will be displayed. This
will include an entry for each Holter recording stored by the Cardio-
Day system. Each list item will describe the patient demographics,
the recording details and status as well as the active user that may
have a recording open.
NOTE:
If the user chooses to overwrite an existing recording slot, the
user will be presented a warning to either accept or cancel
the overwrite/delete operation.

Recording slots for storing ECG recordings
By default, 100 recording slots are available for downloading and

storing ECG recordings, although the number of available recording
slots can be as high as 4095. For information on how to change the
number of recording slots refer to the CardioDay V2.5 Installation
and Field Service Manual.
If a free recording slot is available, it will be marked “Free” at the top
of the list. Otherwise, you need to select an older recording from the
list that can be overwritten.
Recordings are automatically sorted according to date when the
window is opened, with oldest recordings listed at the top.
Sorting the list of patient names

If you click the column heading, the list of patient names will be or-
ganized according to this criterion. For example, if you click the Last
name field, the patients are listed alphabetically according to name.
If you click it again, the order of the list is reversed, i.e., the alpha-
betical list runs from Z to A. This function is valid for all column
headings except First name and User.

Entering patient data

NOTE:
To enter patient data, you need the user or user group right
Edit patient data assigned to your user credentials.
NOTE:
Review your local government, regulatory and institution se-
curity and privacy rules for handling of Patient Health Infor-
mation (PHI). Laws and restrictions (HIPAA) may state that you
must have written permission to access or enter PHI into an
Electronic Database or a Clinical system.
After you have selected a free recording slot for recorder download,
the template for entering patient data opens. This template can be
accessed at any time through the menu Recording > Patient data.
If you transfer data prior to performing a recording, the entire or
parts of the template transferred may contain data.
Patient data window
The fields are mainly self-explanatory, except for the following

fields:

Field Description
Date of recording
Click the symbol that is displayed at the top right of the

window to select the monthly calendar. The displayed
date format changes depending on the Language and
Regional settings of your Windows installation.
Length of pre- Designates the period of time at the beginning of the
analysis ECG recording used by CardioDay to check the quality of
the signal and to select optimum analysis parameters
(channel, amplification, and so on).
The minimum value is 12 minutes.
Full resolution Determines whether the data is downloaded from the re-
corder in its native resolution.
The option should only be unchecked if there is limited
archive space available. If unchecked the downloaded
data is downsampled to 128 Hz / 8 Bit.
Start analysis Determines whether the Signal evaluation and analysis
automatically parameters window is not displayed and the analysis of
the recording is performed using the default analysis pa-
rameters.
Print Determines whether the analysis results are printed im-
automatically mediately after the automatic analysis process is com-
pleted. The hardcopies generated correspond to the de-
fault print selection previously defined.
Start time Determines whether a preceding recording segment will
be excluded from the analysis.
You can change the original Start time if you know that
the signal is distorted in the first part of a recording. If
you do not change the Start time, you can also delete
these regions later on the Regions tab.
3 channels with Determines whether a third, computed channel will be
5 electrodes displayed if only 2 channels have been recorded. The cal-
culation of the third channel is performed in analogy to
that of the third limb lead in Einthoven’s Triangle.

Field Description
Pacemaker Determines the type of pacemaker used. If you have pur-
chased the Pacemaker analysis option, the pacemaker
events will be displayed on the PM tab. If you do not
know the pacemaker type, select the Detect automati-
cally option.
NOTE:
The Type of pacemaker option cannot be stored on
the SEER Light and SEER Light Extent recorder. This
field will default to No PM on download of the re-
cording. If information about a pacemaker is availa-
ble, set the correct pacemaker type, otherwise leave
the value No PM. If the recording contains pace-
maker data, you can reanalyze the recording any-
time with proper pacemaker settings.
Site number / Set the Site and Location for the recording. The Site and
Location number Location assigned to the current user will be available in
the drop-down menu. The default Site and Location of
the current user is selected automatically.
If no default Site and Location is assigned to a user, Un-
known is selected by default. You can select any other
available Site and Location. The selection of Unknown
assigns the recording to no Site and Location and makes
it visible to all users. For details, refer to “Setup > Site and
location administration…” on page 243 and to “Site and
Location management for users and groups” on page
253.
Patient data window field descriptions
If CardioDay is connected to the CardioMem CM 4000 recorder,

which supports the Voice recording feature, the Play voice record-
ing field is activated.
Signal evaluation and setting of Analysis parameters

before downloading the ECG data
NOTE:
If the Start analysis automatically button is checked in the
Patient data window, the window for Signal evaluation and
setting of analysis parameters does not open and the re-
cording is downloaded directly. You can proceed as explained
in “Opening recordings and reports on the Recordings tab” on
page 45.
When you confirm the patient, recorder and download options en-
tered by pressing OK in the Download data window, the ECG data

as given by Length of pre-analysis is read. The program automati-

cally selects—depending on screen size and grid setting—a section
of a few second’s length. This section is displayed in the context
window and, using these data, the internal start parameters of the
program are initialized.
If no ECG signals have been recorded within the Length of pre-
analysis, the pre-analysis should be repeated with a longer Length
of pre-analysis, e.g., 60 minutes.
In the lower part of the window you can examine the ECG section of
interest. The individual setting options are described below.
Signal evaluation and analysis parameters
Signal evaluation during pre-analysis

After the pre-analysis, a window opens in which you can evaluate
the pre-analysis results, in particular the suggested evaluation
channel and the sensitivity of each of the two channels.
Duration of recording
If the recorder has been removed before the end of the set record-
ing duration without having been switched off, you can use this en-
try to set the indicated Duration of recording to the actual record-
ing duration and exclude artifacts from the download. You can also
use the Regions tab after the pre-analysis in order to remove any
noise regions or flat lines. This is explained in “Evaluation and cor-
rection on the Regions tab” on page 51.
QRS classification
After evaluating the signal, the program suggests a channel that
will be used as the primary analysis channel in the 2-channel QRS
classification.
Sensitivity
Change the sensitivity only if necessary. In most cases the default
setting of Medium gives best analysis results. However, take the fol-
lowing into consideration when evaluating sensitivity:
 If the signals have amplitude of less than 0.7 mV, you can set
the sensitivity to High.

 If the signals have amplitude of more than 2 mV, you can set
the sensitivity to Low.
 If a recording has a high T wave amplitude, it might happen
that CardioDay will trigger those T waves as QRS complexes.
In order to avoid this, you can set the sensitivity to Low.
 If a channel is turned off, it will not be analyzed.
 If you set a channel to off / fft, this channel will only be in-
cluded in the algorithm classification of the beats if a QRS
complex was detected on the analysis channel at the same
time.
Noise detection
If you select the Noise detection option, noisy regions of a recording
that have been detected in both channels are marked automati-
cally for your evaluation and, if necessary, correction on the Re-
gions tab.
If you select the Noise detection option, noisy regions of a record-
ing that have been detected in one channel only are marked auto-
matically for your evaluation and, if necessary, correction on the
Events tab in the Noise event line.
If a region is automatically classified as noise but you disagree and
want to have this region included in the analysis, you need to man-
ually remove this region.
For additional information, refer to “Evaluation and correction on
the Regions tab“ on page 51.
NOTE:
When changing the noise suppression setting, the original
data will not be modified. Use this function to remove noise
regions from recordings with very high noise.
QRS differentiation
The Normal parameter is suitable for most recordings. The follow-
ing parameters can be selected:
 Sensitive
 Normal (default)
 Insensitive
Your selection affects the QRS classification that CardioDay carries
out followed by the event analysis. If you select Sensitive, more QRS
classes will be formed than with the Normal parameter in the auto-
matic analysis for your subsequent evaluation and correction. If you
select Insensitive, fewer QRS classes will be formed.

Default parameters set

Additional Analysis parameters can also be modified and set for
this analysis or Saved as part of the Default analysis parameters
used in future recorder downloads.
Example for pediatric cardiologic analysis parameters
You can select a Default of the parameters displayed in the windows

for individual patient groups. These parameters are explained in the
“Analysis parameters and event classification” section on page 69.
You can customize the default set of parameters and store them
using Save as default under the name you selected in the Default
parameter set field. After activating this field using the right mouse
button, you can also enter a new name.
You can also select an additional set of analysis parameters that
are available for specific patient groups or analysis methods.
The default selections are:
 Standard
 Pacemaker
 Child up to 12
 Child up to 1
 Arrhythmia
 User1
 User2
Suppress SVEs during AFib episodes

If you select this option, supraventricular extrasystoles are not clas-
sified by CardioDay as events if, at the same time, atrial fibrillation is
present. For additional information, refer to “AFib – Detection of
atrial fibrillation” on page 102.
Minimum beat count for SVE tachycardia

With this setting you determine the minimum number of beats with
which an event is classified as SVE tachycardia. If you set the value

2, an event of two SVEs with a heart rate higher than the set Tachy-
cardia threshold SV is counted as a SVE tachycardia.
If you want to include the SVE Couplets and SVE Triplets in the final
report, the Minimum beat count for SVE tachycardia must be set
to 2.
Report templates
In CardioDay V2.5, you can store customized Report templates.
During pre-analysis, you can select the Report template that will be
used during subsequent analysis. If no customized templates have
been generated, the default template will be used.
For additional information, refer to “The software-generated Sum-
mary of the report” on page 106.
Overview and Retry after pre-analysis

If you click the Overview button, the segment of the ECG wave-
forms defined by Length of pre-analysis setting is displayed in the
workspace.
While in the ECG waveform Overview workspace, clicking the Re-
turn button will return you to the Signal evaluation and analysis
parameters settings window.
If you press the Retry button after having changed parameters, the
pre-analysis is performed again with the updated parameters.
Pacemaker parameters and pulse widths

Enter the pacemaker parameters and select the pacemaker type. If
the type is not known, select Detect automatically. (It is possible to
enter the other parameters after having viewed the ECG.)
Pacemaker parameters and pulse widths
Enter the parameters for automatic pacemaker analysis:

 Type
 Base rate
 Max. rate

 Hysteresis (absolute minimum rate)

 Maximum AV time (atrioventricular delay, atrioventricular
time interval)
If a pacemaker with different pulse widths in the atrium and in the
ventricle has been used, you can additionally enter the limits of the
detected pacemaker pulse widths. (The pulse width differentiation
allows better analysis results, especially for noisy recordings.)
If you click the Histogram button, the pulse widths detected in the
ECG are displayed.
If you click the Evaluate histogram button, the limits of the de-
tected pacemaker pulse widths from the histogram are used for the
complete recording. You can save the pacemaker settings—to-
gether with the other analysis parameters—as the default by click-
ing the Save as default button.
Setting customized Analysis parameters before

downloading
If you confirm the signal evaluation suggested by CardioDay and
the current Analysis parameters by clicking OK, the entire ECG re-
cording will be downloaded.
This process, which is visualized with a progress bar, takes approxi-
mately 1 to 3 minutes, depending on recording duration, recorder
type, and computer performance.
If, when starting work with CardioDay, you at first want to use the
available Defaults for specific patient groups, you can select them
here and gain initial experience with the analysis parameters. For
additional information on the individual Analysis parameters refer
to “Analysis parameters and event classification” on page 69.
NOTE:
For a new signal evaluation, you do not need to download the
ECG data again. Using the Recording > Reanalyze menu op-
tion you can reanalyze the original data. All results already
stored for the recording are discarded.

4 Screen structure and symbols
4
This chapter presents the screen structure that CardioDay displays
after a recording has been opened for evaluation.
If you select Start > Open existing recording, the Recordings tab
opens where you select and open a patient’s recording. (On the Re-
cordings tab, you can also open additional recordings after having
finished an evaluation.)
If you open a recording, the Regions tab opens, followed by the
Classes tab, which is used as an example in this chapter. The
screen structure changes from tab to tab.
NOTE:
If some labels are not completely displayed, the Large Fonts
setting is selected under Display in the Windows Control
Panel. Select the Small Fonts setting.

Screen structure and symbols
Screen layout
Following is an overview of the screen layout. The layout is similar
on the different tabs. This section does not provide details.
1
2
3
8
Structure of the CardioDay screen
The CardioDay screen is divided into the following items:

1. The title bar contains the name of the program, the name and
date of birth of the patient currently being edited, and the
date of the recording.
2. The menu bar presents the individual functions of the program
in functional groups. We recommend that you get to know
CardioDay using the menu bar. Later you will be able to ac-
cess the most important functions faster by clicking tool icons.
3. The toolbar presents tool icons for the most frequently used
functions, which in this way can be accessed directly with one
mouse click.
4. The upper and lower workspace areas change depending on
the tab and the status of the evaluation. In the upper work-
space area, among other things, QRS classes (as in the exam-
ple above) or event histograms are displayed. In the lower
workspace area, the ECG context is displayed on most tabs.
5. The status bar displays various program and file status infor-
mation. For additional information, refer to “Status display be-
low the QRS class windows” on page 57.

6. The lower workspace area provides information that is more

detailed. For example, on the Classes tab in the QRS zoom
display, you can view a single QRS complex or all the com-
plexes of the selected class superimposed upon each other.
The ECG in the vicinity of the selected QRS complex is dis-
played on the right-hand side.
7. The tab bar allows for simple and fast switching between the
tabs by clicking with the mouse. The individual working steps
of the Holter ECG evaluation are distributed over special tabs.
It is recommended to work through the tabs in the order dis-
played.
Pressing the F2 function key will switch to the respective next
tab.
8. The info bar displays the time of the active QRS complex as
well as the User and Group names.
Tool buttons
Tool buttons allow quick access to frequently used options also
found as a menu or as an option of the Start window. For further in-
formation, please refer to the respective sections.
“Start window options”, page 29
“Downloading ECG data“, page 27
“Recording > Import…“, page 201
“Recording > Open...“, page 199
“Entering patient data“, page 32
“Recorder > Hookup“, page 205
“Extras > Reanalyze events...“, page 221

“Extras > Print screen”, page 221
This button refers to different export locations like MUSE, GDT

interface, or WorklistCommander. For additional information,
refer to the CardioDay V2.5 Installation and Field Service Man-
ual.

5 Opening recordings and reports on the
5
Recordings tab
The Recordings tab can be opened in one of two ways:

 From the Start window, select Open existing recording, or
 From the Recording menu, select Open.
The Recordings tab

Opening recordings and reports on the Recordings tab
After completing an evaluation, you can select additional record-

ings on the Recordings tab.
If you open a selected recording, the Regions tab opens, followed
by the Classes tab. The screen structure changes from tab to tab.
Using the "Search for" parameters to filter the patient and

recordings list
You can use the filter criteria Last name, Patient ID, Referring phy-
sician and Location to search for recordings.
If you enter a letter or number in the empty field Search for, the first
entry beginning with that letter or number will be found.
If you select Show matching only, only the recordings matching the
filter are displayed.
On this tab, the reports of the stored recordings are displayed with-
out these recordings having been opened.
The Info and Status columns

Most of the columns on the Recordings tab are self-explanatory,
but the following columns require additional explanation.
Under Info you find additional information about the recording, e.g.,
whether it contains 12-channel (12) or pacemaker (PM) information.
The following table identifies and describes possible values in the
Info field.
Value in Info column Meaning
PM Pacemaker
12 12-Channel
L3 Event recorder
CM100 Event recorder
CM3 CM 3000
CM4 CM 4000
M Long recording (multi day)
S1000 SEER 1000
SLight SEER Light, SEER Light Extend
MARS MARS recording
Monitor Monitoring acquisition

Under Status you find the following recording status indicators:

Status Description
Diagnosed The diagnosis written on the Report tab has been re-
viewed, which is confirmed by checking the Diag-
nosed checkbox.
Printed The recording has been printed to a configured print
location.
Archived The recording has been stored on an Archive location.
(See “Setup > Other options > Archive” on page 230.)
PDF The recording has been stored to a PDF file location.
(See “Configuring a PDF file destination” on page 154.)
MUSE The recording report has been stored to a MUSE sys-
tem. (See “Setup > Other options > MUSE connection”
on page 234.)
Opening long recordings

A recording that is longer than 48 hours and downloaded as a long
recording is automatically split into 24-hour or 48-hour blocks.
Reports for separate recording blocks or the total

recording
If you select a long recording in the patient list, the separate record-
ings are displayed above the report on the right side of the window.
For every selected recording block, the report is displayed.
From the list of recording blocks displayed in the upper right side of
the window, you can select/open individual recording blocks. For
each individual recording block opened, the standard working step
tabs will be available for Holter ECG evaluation.
At the end of the list, you can select Total to view a report for the
total recording. This report serves as an overview and does not con-
tain all details of the usual reports. If you open the Total recording
with a double click, only certain tabs with a reduced number of sub-
tabs are offered for evaluation.

The Recordings tab, recording blocks of a long recording
Tabs available when opening the total report

When opening the total report of a 7-day recording, the following
tabs are available.
The Statistics tab displays the heart rate trend chart over the com-
plete 7 days in the upper part of the screen. Yellow lines show the
separation between the single days.
The lower part of the screen shows the atrial fibrillation index. If a
period of AFib has been detected during the recording period, it will
be indicated by a yellow highlighted area. With a double-click in this
AFib area, CardioDay will open the corresponding 24-hour block so
that you can perform the Holter analysis on that selected day.

Statistics tab for a long recording
The Report tab displays the summary of all events detected over
the complete recording duration. Furthermore, the strips that were
saved for the reports in the Events tab of each recording block can
be selected for the printout.
Report tab for a long recording
The Heart rate variability tab displays the heart rate trend chart
over the complete 7 days in the upper part of the screen. Yellow
lines show the separation between the single days.
The lower part displays the Heart rate variability over the 7-day pe-
riod. The RR interval spectra provide an overview of the results of

the spectro-temporal RR interval analysis in subsequent 5-minute

time segments. For additional information, refer to “Statistics > Ad-
vanced heart rate variability (RR-FFT) > RR interval spectra” on page
180.
Heart rate variability tab for a long recording

6 Evaluation and correction on the Regions tab
6
On the Regions tab you evaluate the noise regions detected by
CardioDay. You can mark with the mouse other regions of the
recording that you do not want to have analyzed.
You can mark regions either in the heart rate trend curve in the up-
per left area of the screen or in the ECG context display in the lower
area of the screen. In the ECG display, you also can directly deter-
mine regions of atrial fibrillation.
The Regions tab

Evaluation and correction on the Regions tab
NOTE:
Noise regions are not included in the analysis. You have to re-
move regions marked as noise from the Regions tab if they
should be analyzed.
Noise regions marked on the Regions tab are shown on the
Full disclosure tab by a red line.
If, during downloading, you have selected the option Noise detec-
tion in the window Signal evaluation and analysis parameters,
noisy ECG regions are automatically marked and shown on the Re-
gions tab.
 In the heart rate trend graph, you can create only noise re-
gions.
 In the ECG context graph, you can create both noise and atrial
fibrillation regions.
ECG context display with context menu
The following actions are available when marking regions:

 To activate the zoom function, drag the mouse pointer diago-
nally over the heart rate histogram.
 To mark a new noise region, drag the mouse pointer parallel
to the time axis over the histogram. When you start dragging
the mouse, a small circle will appear around your mouse
pointer. As long as the mouse pointer is inside the circle, you
mark a region; when the mouse pointer leaves the circle, the
zoom function is activated. In the ECG context display, the
marked region is shown by a red line.
 To mark a region for storage as either a noise region or an

atrial fibrillation region, drag the mouse pointer over the ECG
context display, open the context menu, and select Save as
noise region or Save as AFib region.

Evaluation and correction on the Regions tab
 To open the context menu, right-click on the region marker in

the ECG context display. From the context menu, you can do
the following:
o Remove the selection of the marked region.
o Select the zoom factor of the Amplitudes.
o Perform the Channel selection.
o Select the Colors of the waveform display.
o Select Print region to open a print preview of the
marked region.
 To remove a region marking, you can also highlight the entry
in the list on the upper right area of the screen and press the
Delete button.

7 Evaluation and correction on the Classes tab
7
The Classes tab displays the results of the QRS classification carried
out by CardioDay after having downloaded and analyzed the data.
The workspace is divided into several sections.
1 2 3 4
Workspace of the classes tab
1. QRS Zoom Display

2. QRS Class
3. Status Bar
4. ECG Context Display

Evaluation and correction on the Classes tab
The results displayed on the Classes tab are based on time and fre-
quency calculations. Following evaluation and any necessary cor-
rections by a healthcare professional trained in Holter interpreta-
tion, the QRS classes are also the basis for the subsequent classifi-
cation and evaluation of rhythm events.
If you are already familiar with the evaluation and editing of the
QRS classification, you can accelerate your evaluation work as ex-
plained in “Quick-Scan for quick evaluation and correction, splitting
a QRS Class“ on page 67.
Assigned keys on the Classes tab

The following keyboard shortcuts can be used on the Classes tab:
Keyboard shortcut Function
N declares the active single QRS complex as a normal
beat
V declares the active single QRS complex as a ven-
tricular beat
X declares the active single QRS complex as an aber-
rant beat
P declares the active single QRS complex as a pace-
maker beat
A declares the active single QRS complex as an arti-
fact
Enter marks next QRS class window
Ctrl+Enter marks QRS class window to next screen
Ctrl+S saves ECG strip to the report
Backspace marks preceding QRS class window
Ctrl+Backspace marks QRS class window to preceding screen
Arrow right/down switches to next QRS complex
Arrow left/up switches to preceding QRS complex
Del declares marked QRS class as Normal / Artifact /
Aberrant / Paced / Ventricular (switching function)
Ctrl+G opens the Enter time window for selecting the spe-
cific time point that will be displayed in the ECG
context window.
NOTE:
The combined classes for manually edited single beats with
characteristic NM, VM, XM, PM, or AM cannot be edited. For
details refer to “Additional class characteristic “M”” on page
65.

The sections of the Classes tab

Status display below the QRS class windows
Classes are listed in order of the number of beats within a class,
starting with the highest. You can change the sorting criteria and
list the classes in order of class type. You can move between clas-
ses using the scroll bar or Enter key.
The status bar is located below the QRS class section and above the
QRS zoom and ECG context display:
1 2 3 4 5 6 7 8
QRS class section with status display
1. QRS Complex – Displays the sequential number of the QRS

complex within the QRS Class displayed.
2. The sorting button allows you to change the sorting criteria
for the classes. You can choose between the number of beats
within a class or the class type.
3. Overview – Check the Overview box to limit a QRS class char-
acteristic to a maximum of four classes. The four classes rep-
resent the four possible polarity combinations of the two ECG
channels, i.e., positive-positive, positive-negative, negative-
positive, and negative-negative.
NOTE:
For most of the cases, we recommend only QRS com-
plexes with the characteristics N and A be combined. If,
for example, V and X are combined, this can make your
evaluation of the QRS classification in many cases more
difficult.
4. Zoom settings – Sets the zoom settings of the ECG context
display (lower half of the screen):
Time scales:
6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s, 100 mm/s
Amplitude scales:
5 mm/mV, 10 mm/mV, 20 mm/mV, 40 mm/mV

5. Save checkbox – Indicates whether the active QRS complex

has been saved to the final report. Change the status by click-
ing with the mouse. Check the Save checkbox to save a strip
to the final report.
6. Event display – Identifies whether the active QRS complex be-
longs to an event. Click on the event designation to correct
the assignment. Values displayed in the event display include
the events as evaluated on the Events tab.
7. Heart Rate – Displays the heart rate in beats per minute. The
value is determined as a moving average over 10 QRS com-
plexes with the displayed QRS complex being the last com-
plex. The Heart Rate value cannot be edited.
8. Scroll bar – Displays the various QRS class sections if they do
not all fit onto the screen.
Display in an individual class window
1 2
3 4
Individual class with parameters
For each class the following is displayed:

1. The characteristic of this QRS class assigned by the program,
abbreviated as N (Normal), V (Ventricular), X (Aberrant), P
(Paced, Stimulated) or A (Artifact).
The class characteristics are explained together with the
“Evaluation of the QRS class characteristics“ on page 64.
2. The percentage of the total number of QRS complexes as-
signed to this class.
3. The class number.
4. The number of QRS complexes in this class.

If the class contains multiple QRS complexes, a scroll bar is dis-

played at the bottom edge of the QRS class.
The sequential number of the currently active QRS complex in the
selected QRS class is displayed at the far left of the status bar below
the QRS class section (see “Status display below the QRS class win-
dows” on page 57).
Since the display is always synchronized to the R peak, small devia-
tions within the class are easily recognized, even when quickly
scrolling through the QRS classes.
When a QRS class is selected, you can also use the “left” and “right”
horizontal arrow keys to scroll through the class contents.
QRS zoom display

The QRS zoom display on the left-hand side in the lower workspace
area is used for more precise estimation of the QRS complex and
the P wave shown in the active class.
Highlighted QRS class

If the Quick-Scan function (see “Quick-Scan for quick evaluation and

correction, splitting a QRS Class” on page 67) is not activated, the
QRS zoom display will show an enlarged version of the QRS complex
currently displayed in the highlighted class bin. Use the right mouse
button to open a context menu, which allows you to select the
zoom factor and the displayed channel.
QRS zoom display with context menu for zoom factor and channel selection
For additional information about the QRS zoom display refer to

“Quick-Scan for quick evaluation and correction, splitting a QRS
Class“ on page 67.
ECG context display

The ECG context display in the right-hand side of the lower work-
space area is used for the evaluation of the surrounding environ-
ment of the active QRS complex.
ECG context of the selected QRS complex
The active QRS complex is displayed centered to its R peak, which is

marked by a dashed line. The letters above or below the complexes
designate their current classification. The numbers between the
R peaks show either the RR interval in milliseconds (ms) or its recip-
rocal value, heart rate, in beats per minute (bpm).

You can use your mouse to interact with the screen in the following
ways:
 To toggle between RR interval and Heart Rate, double-click
close to the values.
 To change the time of an R-peak, click and drag the dashed
line.
 To enter an additional R-peak, open the context menu by
right-clicking in the ECG context display and selecting Insert
QRS mark. In this way a Normal beat is inserted. You can
change the classification, if necessary, as explained in the
section “Additional class characteristic “M”“ on page 65.
Regions in the ECG context display

To mark a region in the ECG context display, click on the region to
select it and then right-click on or above the green line in the region
to open the context window.
The newly marked region will be displayed with a line at the bottom.
For regions marked as noise, the line will be red. For regions marked
as AFib, the line will be yellow. Right-clicking a region marker allows
for printing or deleting the marker.
Context menu in the ECG context display
Measuring ECG sections

You can easily measure the duration of selected ECG sections and
the amplitude of beats of interest.
Mark two positions in the ECG context display by clicking on them
while pressing the Ctrl key or, alternatively, using the context menu:
the horizontal axis displays the time difference in milliseconds
whereas the vertical axis displays the amplitude difference in mV.
Context menu in the ECG context display > Measurements

ECG context of the selected QRS complex with marking
To measure time or amplitude, press Ctrl+Shift at the same time

and left-click on the desired starting point. If you hold down the
Ctrl+Shift keys and click on a second point, a line will appear on the
screen connecting the two points. A horizontal line will be drawn if
the horizontal distance is larger than the vertical distance and vice-
versa.
You may edit the time and amplitude measurement lines using the
mouse or keyboard as follows:
 To select a measurement line, left-click at the endpoint of one
of the lines or at the intersection point of two lines. When you
click an endpoint, a double arrow symbol is displayed. When
you click an intersection point between two lines, a quadruple
arrow symbol is displayed.
 To move a time or amplitude line, click the endpoint of the de-
sired line and drag the double-arrow symbol in the direction
you want to move the line.
 To move both the time and amplitude lines, click the intersec-
tion point between the two lines and drag the quadruple-ar-
row symbol in the direction you want to move the lines.
 To move the endpoint of a selected line, click on the endpoint,
hold the Ctrl key, and use the left, right, up, and down arrow
keys.
 To insert or remove repetitive measurement lines, select the
line, hold the Ctrl key, and press the z key.
 To delete a selected measurement line, use the Ctrl+Delete
key combination or context menu.

Channel selection, Inverted waveform display, Colors

If you right-click with the mouse in the ECG context display, a con-
text menu opens where you can carry out Channel selection.
Context menu in the ECG context display and channel selection window
Left-clicking on Channel selection opens another window.

In the Channel selection you can select which channels will be in-
cluded in the ECG display and also select their display polarity.
NOTE:
You can also modify the waveform display colors via the
“Setup > Screen, Scale, and Colors” window, as explained on
page 225.

Evaluation of the QRS class characteristics

Evaluate and, if necessary, correct the QRS classification carried out
by CardioDay.
NOTE:
It is especially important to review the evaluation of the QRS
classes characterized as VENTRICULAR and ABERRANT. If a
beat from an aberrant class occurs close in time to a ventricu-
lar or to another aberrant beat, the aberrant beat is included
in the evaluation of ventricular events.
A class is created from similar QRS complexes with the same class
characteristic. The QRS classes suggested by CardioDay are dis-
played separately. The assigned class characteristic is shown at top
left:
Similar QRS classes on left of window
 Normal (N)
 Ventricular (V)
 Aberrant (X)
 Paced, Stimulated (P)
 Artifact (A)
Class characteristic Description
Normal (N) Supraventricular events are constructed from prema-
ture beats characterized as normal.
Ventricular (V) Ventricular events are constructed from the QRS clas-
ses characterized as ventricular.
Aberrant (X) A beat is classified as aberrant, either if the beat does
not fulfill the criteria for the normal or ventricular beats,
or if only one of both analyzed channels is broad or has
a vector change.
NOTE:
If a beat from an aberrant class occurs close in
time to a ventricular beat or to another aberrant
beat, the aberrant beat is included in the evalua-
tion of ventricular events.

Class characteristic Description

Stimulated (P) The stimulated QRS complexes are grouped in separate
classes if pacemaker impulses have been displayed.
Artifact (A) Artifacts are identified according to certain specific typ-
ical characteristics and are not included in the heart
rate measurement.
Additional class characteristic “1”

All single beats that do not match any previous morphology and
would actually need to form their own class are grouped in a sepa-
rate class window that is labeled with the additional class charac-
teristic “1”.
Additional class characteristic 1
All automatically recognized single artifacts are also grouped in an

additional class with the characteristic A 1. You can reclassify the
artifact classes on the left of the individual class window, but not
the artifact classes with the characteristic “1”.
Additional class characteristic “M”

You can also assign another characteristic to an individual dis-
played QRS complex.
These beats are sorted into the last five class windows according to
their characteristic and labeled with the additional class character-
istic “M” indicating manual editing.
You can repeatedly edit single beats labeled with the additional
class characteristic “M”, but not the entire class.
Additional class characteristics “*” and “M”

Navigate to the desired QRS complex using the scroll bar or left and
right arrow keys.
You can alternatively select a particular QRS complex by double-
clicking in the ECG context display near the R-peak.
Pressing N, V, X, P, or A, or clicking accordingly in the context menu,
assigns the corresponding characteristic to the highlighted QRS
complex.
Correction of the QRS class characteristics

NOTE:
Since the predominant classes are shown first together with
the number of beats within the class, if necessary you can
rapidly correct the assigned characteristic for a large propor-
tion of the QRS complexes, which quickly leads to practicable
results. With a high-quality recording, well over 95 % of all
QRS complexes are within the first eight QRS classes.
Correction of characteristic assigned to a whole class –

the asterisk [*]
Select a QRS class by clicking with the mouse or using the Enter
and Backspace keys. The shading of this QRS class window
changes and the scroll bar is displayed at the lower edge if the QRS
class contains several QRS complexes.
View approximately 10 QRS complexes of the selected QRS class
with the left and right arrow keys or by clicking the scroll bar of the
individual QRS class window.
Evaluate whether the assignment of the class characteristic (N, V, X,
P, A) corresponds with your interpretation.
QRS class window with context menu for changing the QRS class characteristic
You can change the characteristic assigned to a QRS class in two

different ways:
 To toggle through the QRS classifications N, V, X, P, or A in se-
quence, repeatedly press the Delete key.

 To correct the evaluation, right-click on the selected QRS class

window to open a context menu and select the correct evalu-
ation from the context menu. Distorted QRS classes with very
low incidence can usually be easily designated as artifacts.
These are then excluded from the subsequent event analysis.
If you manually change the characteristic assigned to a QRS class,
this is indicated by an asterisk [*] to the right of the class character-
istic.
The asterisk disappears when you key through the class character-
istics and return to the originally assigned characteristic without
conducting a new event analysis. Otherwise, it is permanently dis-
played.
Quick-Scan for quick evaluation and correction, splitting a

QRS Class
By checking the box labeled Quick-Scan, you can activate the su-
perimposed display of all QRS complexes within a class.
The overlapping factor of QRS complexes of the same morphology
is color coded. The channel being displayed is shown in the bottom
left corner of the zoom window.
When the Quick-Scan function is activated, you can highlight a QRS
complex that deviates from the general morphology with a left-click
and rename the complex.
QRS-Zoom display with activated Quick-Scan function and context menu for zoom
factor, channel selection, highlighting, and splitting QRS classes
Using the Quick-Scan function, you can split an existing QRS class
into further classes on the basis of morphological differences.

NOTE:
It is not possible to split classes if the class Overview box is
checked.
Class overview activation checkbox
1. Select the amplitude in the QRS zoom window with the mouse
such that the QRS complexes to output into a new class lie be-
low this position.
2. At this point, right-click to open the context menu and select
the Mark QRS complexes option.
All the QRS complexes with a voltage value below the mouse
position will be marked.
Quick-Scan function of the QRS-Zoom display with context menu for the
selection and splitting of QRS classes, lower voltage value range highlighted
3. If necessary, repeat steps 1 and 2 to select different voltage values.

4. Once you have selected all the complexes to output to a new
class, right-click to open the context menu and select Split class.
The new QRS class will appear to the right of the original class.
Two QRS classes generated by splitting

8 Evaluation and correction on the Events tab
8
The Events tab displays the different arrhythmias that were de-
tected during the recording duration. Their detection and medical
evaluation can be of high diagnostic significance.
Like the QRS complexes, CardioDay automatically classifies events.
The software displays the most significant events first. Similar to the
QRS classification, you must also evaluate and, if necessary, correct
the event classification.
Assigned keys on Events tab

The following shortcut keys are available on the Events tab:
Shortcut key Function
Enter moves to next event
Del deletes marked event
Arrow right/down switches to next event line
Arrow left/up switches to previous event line
Insert reinserts a deleted event—Note: only possible if no
event analysis has been carried out
Backspace moves to previous event
Ctrl+S saves ECG strip to the report
Analysis parameters and event classification

During downloading of the recording, CardioDay carried out the
first event analysis. After the evaluation, if you decide on a different
QRS classification, a new Event analysis is carried out.
The Analysis parameters are threshold values for the event analy-
sis. If these values are exceeded by heartbeats, they are interpreted
as events or special circumstances.

Evaluation and correction on the Events tab
Confirm changing of analysis parameters
When selecting Reanalyze events... from the Extras menu, you are
asked whether you want to change the analysis parameters. When
answering Yes, the Analysis parameters window opens.
Analysis parameters
An event analysis is carried out after every modification of the anal-

ysis parameters.
In addition to thresholds for bradycardia and tachycardia, you can
set the thresholds for R-R Pause, Prematurity SV and Prematurity
V, R-on-T, and for Delayed QRS complex. Also, you can select Sup-
press SVE during AFib episodes.
The R-on-T value, which must be set in milliseconds, refers to an RR
interval of 1 s. In this time interval, R-on-T is detected. The RR inter-
val reference value is automatically adjusted to the current heart
rate.

CardioDay is able to classify the following events:

Event Description
R on T Ventricular QRS complex occurring during the vulnerable
phase of the chamber repolarization.
QRS complexes with the characteristic “V” for “ventricular”.
VE tachycardia Ventricular tachycardia, at least five QRS complexes—
with the characteristic “V” or “X”, if the heart rate is
higher than that set in the analysis parameters.
VE run (4 beats) Four QRS complexes—with the characteristics “V” or “X”
with the heart rate higher or the RR interval shorter than
that set in the analysis parameters.
VE Triplet Three consecutive PVCs—with the RR interval shorter
than that set in the analysis parameters.
VE Couplet Two PVCs at the most within the time set for PVC in the
analysis parameters.
VE Bigeminy At least three alternations between normal beat and PVC
consequently.
PVC Ventricular extrasystole, i.e., a spontaneous QRS complex
which is independent of the P wave with the RR interval
shorter than that set as the Prematurity V analysis pa-
rameter. (CardioDay uses an average value calculated
from previous RR intervals as a reference interval.)
Other vent. Ventricular beats that do not meet the prematurity crite-
ria (Prematurity V), which the user can set in the event
analysis parameters.
R-R pause RR interval longer than or equal to the value set as pause
rhythm parameter in milliseconds.
Bradycardia Heart rate of at least four beats below the value set as
Bradycardia threshold analysis parameter.
N-N delay Atypical and sudden extension of the RR interval—with
the RR interval longer than the set Delayed QRS complex
analysis parameter. (CardioDay uses an average value
calculated from previous RR intervals as a reference in-
terval.)
SVE tachycardia Supraventricular tachycardia, constant fast heart rate—
with the heart rate exceeding the value set as Tachycar-
dia threshold analysis by more than three beats and the
event beginning with a SVE.
SVE Supraventricular extrasystole—with the RR interval
shorter than that set as the Prematurity SV analysis.
(CardioDay uses an average value calculated from previ-
ous RR intervals as reference interval.)
Diary “Diary” includes two kinds of events:
 Patient-generated events each corresponding to the
times when the button on the recorder was pressed.
 User-generated diary events (see chapter “Adding a
Patient diary event” on page 79.

Event Description
Noise Sequence of several artifacts in succession in a single
channel. Occurs only if Noise detection is enabled.
Additional Noise events are marked if one channel is sat-
urated, e.g., if an electrode is loose or disconnected. This
is independent of the automatic Noise detection.
Saved Events or ECG sequences selected automatically or by
the user for saving with the report or separately.
NOTE:
These ECG sequences are processed similarly to the
cardiological events automatically detected during
analysis and are therefore included in this list.
Evaluation and correction of the event classification –

overview
Evaluate the assignment of QRS complexes to an event class car-
ried out by CardioDay and correct if necessary:
 Select an event class by clicking with the mouse on the corre-
sponding line. By pressing Enter, the most important event is
immediately marked and indicated in the respective event line.
 Press Enter to confirm an event classification and move onto
the next event.
 Press Delete to disagree with an event classification. The
event is deleted and the next event is displayed.
 To edit a QRS complex or event, right-click in the ECG context
display to open the context menu and select the appropriate
event classification.

Events tab with context menu for reclassification
 Having finished editing an event class, select a new event

class using the corresponding arrow key or left-clicking.
 Mark interesting events for subsequent printing by first right-
clicking in the ECG context display to open the context menu
and then clicking Save w/ comment or Save w/o comment.
o When clicking on Save w/ comment, a window opens
allowing you to enter a comment for the current event.
The comment can be up to 40 characters long.
o When clicking Save w/o. comment or pressing Ctrl+S,
the event is marked for printing without comment.
o If you select No save, an event automatically marked for
printing will not be printed.
The explanations of the different CardioDay printouts on paper or in
one of several file formats can be found in the section “The Print
tab” on page 153.
Repeat these steps for all event classes of interest. Exit the event
classification by selecting a different working step tab at the bottom
of the screen.

Screen layout and operation of the Events tab

Each event class is summarized in a line in the upper half of the
Events workspace. Under the designation of each event class, the
number of the events found in the corresponding class is displayed.
 To scroll forwards through the individual events, press Enter.
 To scroll backwards through the individual events, press
Backspace.
 To switch between event classes, use the up/down arrow
keys or click with the mouse in the desired event class.
 To display a particular event, click on a point in the event class
line.
 To delete the active event, press Delete.
 To restore a deleted event, press Insert.
In the RR Min/Max window you may, if necessary, correct the short-
est and longest RR intervals.
1 2 3 4 5 6 7 8 9 10 11 12 13
Workspace of the events tab
In the center row of the workspace, the following status information

is available:

1. Sequential number of the event.

2. Display size of the time axis.
Each mouse click switches through 6.25, 12.5, 25, 50, and 100
mm/s.
3. Display size of the amplitude axis.
Each mouse click switches between 5 mm/mV, 10 mm/mV, 20
mm/mV, 40 mm/mV.
4. Indication of whether the current event has been saved for
printing.
Toggle by mouse click.
5. Current average heart rate.
6. Designation of the current event.
7. Length of the VE Tachycardia or SVE Tachycardia episode.
8. Button for the sort criterion, which—together with the diagram
on the top right of the window—changes according to the cur-
rently marked event class.
The sort criterion can be switched for VE Tachycardia, SVE
Tachycardia and Brady between Duration [s] of episode and
heart rate [bpm].
The sort criterion can be switched for PVC between the criteria
“Prematurity” [%] and “Turbulence Slope” [HRT] (for more de-
tailed information refer to “Listing of events in the separate
event classes” on page 76 and to “Heart Rate Turbulence
[HRT]” on page 80.
9. Display of comments automatically generated by CardioDay
for the two most significant events of each event class.
You can also enter comments for any event by right-clicking it
and selecting Save w. Comment, which opens the comment
window.
10. Button to open and close the RR Min/Max window, where the
shortest and longest RR intervals are set.
11. Button for mouse navigation to preceding event, corresponds
to Backspace key.
12. Button to delete event, corresponds to Delete key.
13. Button for mouse navigation to following event, corresponds
to Enter key.

Listing of events in the separate event classes

Event Parameter/Sorting criterion Unit
R-on-T Duration s
VE tachycardia Duration s
VE tachycardia2* HR bpm
VE run (4 beats) HR bpm
VE Triplet HR bpm
VE Couplet HR bpm
VE Bigeminy Duration s
PVC Prematurity** %
PVC2 HRT** TS
Other vent. HR bpm
R-R pause Duration s
Brady Duration s
Brady2* HR bpm
N-N delay Duration s
SVE tachycardia Duration s
SVE tachycardia2* HR bpm
SVE Prematurity %
Within the event classes, the events are listed by default hierarchi-
cally in order of importance.
You can impose a chronological ordering of all event classes by
clicking twice on an event line that has already been selected. To
switch back to the hierarchical order, you need to change the event
line and choose the desired event line again.
The content of the diagram at the top right on the Events tab
changes according to the type of event and the sorting within the
respective event line. The sort criteria and the units of the x-axis can
be taken from the opposite table. (The frequency is always plotted
on the y-axis.)
* For the events Brady, SVE Tachycardia, and VE Tachycardia, you
can toggle the event criterion between Duration [s] and Heart rate
[HR] (marked in the table by a “2” behind the event name, e.g.,
Brady2) by clicking the field for the sort criteria in the status line of
the Events screen. This also changes the units from s to bpm.
** When using the module for the evaluation of Heart Rate Turbu-
lence [HRT], you can toggle the PVC event line from Prematurity to
HRT.

QRS complex and switching tabs

If you are in the Events, HR-Min/Max, Statistics, or Full disclosure
tabs and you double-click the QRS complex, CardioDay switches
into the Classes tab and shows the complex in its class. Most tabs
are linked to each other via the current QRS complex. After selecting
an event, the QRS complex that belongs to it remains active, even if
you switch to the Classes or Full disclosure tab.
When switching from the Classes tab to the Events tab, the pro-
gram jumps back to the last event viewed (or to the first event, if no
event has been viewed yet).
Because the statistical values are displayed in terms of minutes,
these are not linked to individual QRS complexes but to the period
being represented.
Reclassification of events using the + and – keys

You can reclassify all events identified by CardioDay using the con-
text menu of the event classes, which is accessed using the right
mouse button.
Event classifications can also be changed quickly within the event
hierarchy using the + and – keys on the numeric keypad: If, e.g., an
event is marked R-R pause, you can change it to PVC by pressing
the + button.
 + changes the event to the next-highest event class in the hi-
erarchy.
 – changes the event to the next-lowest event class in the hier-
archy.

Events tab with event classes context menu
Designating an event to be an artifact

If an event has been incorrectly identified due to the currently ac-
tive QRS complex only, you can designate this one QRS complex to
be an artifact by pressing Ctrl+a.
To relabel a non-active QRS, switch to the Classes tab.
RR interval or heart rate in the ECG context display

The ECG context display shows, above or below the class character-
istic of the individual QRS complex, either the RR interval in millisec-
onds (ms) or the heart rate in beats per minute (bpm).
To toggle between the two values, place the cursor over one of the
numbers and double-click.
Deleting and renaming event classes

Click on one of the event classes on the left-hand side of the event
histogram designation column to activate the menu that allows you
to delete or rename the currently active event class or to delete all
events.

Events tab, erasing events
When doing this, it is important to enter the period. After the entry,
click Add to enter the period into the list.
You can also Rename selected events.
Adding a Patient diary event

1. To add a patient diary event, click on the plus icon in the Diary
line.
2. The Patient diary window opens where you can enter the de-
sired time and the diary comment.
Window for entering the time of a Patient diary event
3. If you confirm by clicking OK, the patient diary entry will be

displayed in the Diary line.

Heart Rate Turbulence [HRT]

If you have marked the line with the PVC events on the Events tab,
you can switch between the display by prematurity [%] and the dis-
play of any Heart Rate Turbulences [HRT] by clicking in the status
line on the field marked either with “%” or “HRT”. The HRT diagram is
displayed at the top right of the window and toggles accordingly.
Events tab, HRT evaluation
Quantifying of HRT by Turbulence Onset and Slope
Turbulence Onset and Slope in the RR-diagram
For quantifying of HRT, two parameters are calculated:

 Turbulence Onset (TO)
 Turbulence Slope (TS)
Turbulence Onset (TO) is the percentage of difference between the
heart rate immediately following PVC and the heart rate immedi-
ately preceding PVC. It is calculated using the following equation:

TO = ((RR1 + RR2) – (RR-2 + RR-1)) / (RR-2 + RR-1) * 100

In the equation, RR-2 and RR-1 are the first two normal intervals
preceding the PVC, and RR1 and RR2 are the first two normal inter-
vals following the PVC. Initially, TO is determined for each individual
PVC, followed by the determination of the average value of all indi-
vidual measurements. Positive values for Turbulence Onset indicate
deceleration; negative values indicate acceleration of the sinus
rhythm.
The Turbulence Slope (TS) corresponds to the steepest slope of the
linear regression line for each sequence of five consecutive normal
intervals in the local tachogram. The Turbulence Slope calculations
are based on the averaged tachogram and expressed in ms per RR
interval.
The algorithm for HRT quantification can only deliver usable results
if the triggering event was a true PVC (and not an artifact, T wave,
or similar). In addition, it must be ensured that the sinus rhythm im-
mediately preceding and following the PVC is free from arrhythmia,
artifacts, and false classifications. In order to fulfill these require-
ments, we use filters that exclude RR intervals with the following
characteristics from the HRT calculation:
< 300 ms
> 2000 ms
> 200 ms difference to the preceding sinus interval
> 20 % difference to the reference interval (mean of the last 5 sinus
intervals)
In addition, we limit the HRT calculations to PVCs with a minimum
prematurity of 20 % and a post-extrasystole interval that is at least
20 % longer than the normal interval.
Background information / Relevance

HRT—Heart Rate Turbulence—is the physiological, bi-phasic re-
sponse of the sinus node to premature ventricular contractions. It
consists of a short initial acceleration followed by a deceleration of
the heart rate. HRT can be quantified by two numerical parameters,
namely the Turbulence Onset and the Turbulence Slope.
The underlying mechanisms of HRT have not been fully identified.
HRT is most probably an autonomous baroreflex. The premature
ventricular contraction causes a brief disturbance of the arterial
blood pressure (low amplitude of the premature beat, high ampli-
tude of the ensuing normal beat). When the autonomic control sys-
tem is intact, this fleeting change is registered immediately with an
instantaneous response in the form of HRT. If the autonomic control
system is impaired, this reaction is either weakened or entirely
missing.

Setting the minimum and maximum RR intervals

On the Events tab you can additionally evaluate and, if necessary,
correct the minimum and maximum RR intervals. The set values can
be displayed in the report and are used for the calculation of the
average heart rate.
Events tab > RR Min/Max window
Procedure to set the maximum RR interval:

1. Click the Max/RR button in the RR Min/Max window.
2. Press Delete or click the left arrow button until the longest RR
interval is displayed on the example stripe.
3. Click the Accept button or press Enter to accept the value.
Procedure to set the minimum RR interval:
1. Click the Min/RR button in the RR Min/Max window.
2. Press Delete or click the right arrow button until the shortest
RR interval is displayed on the example stripe.
3. Click the Accept button or press Enter to accept the value.

Editing events on the Classes tab

To modify the assignment of an active QRS complex to an event
class, right-click to open the event classes menu and click on the
event class to be assigned. To declare an individual QRS complex to
be an artifact, press the A key.
ECG context of the selected QRS complex with context menu

9 The HR Min/Max tab
9
The HR Min/Max tab gives you an overview of the heart rate trend.
It also displays the time and value of the patient’s minimum and
maximum heart rate during the recording period. You must review
the values suggested by CardioDay and correct them if necessary.
Press Delete to disagree with and delete the suggested minimum or
maximum heart rate value. Press Enter to agree with the minimum
or maximum heart rate value.
Display of “manual” events, i.e., events triggered at the

recorder
In addition to the histogram of the heart rate, this tab displays
events that were marked at the recorder when the event button
was pushed.
The time of a manually triggered event is displayed as a green verti-
cal line (as default).
Display of a manually set event marker

The HR Min/Max tab
Evaluation and correction of the extreme heart rate values

Select the HR Min/Max tab in order to see the heart rate trend.
The heart rate is calculated from RR intervals over one minute.
If a QRS complex was included in the heart rate calculation, a trig-
ger mark is displayed above it.
HR Min/Max tab

The HR Min/Max tab
Adding an undetected QRS complex manually

If there is no marking over any QRS complexes (e.g., in the event of
amplitudes being too low or having too much interference), they
have not been included in the heart rate calculations.
You can add a QRS complex manually if it was not correctly trig-
gered by the system:
1. Double-click the beat to return to the Classes tab.
2. Right-click the QRS complex in which the trigger-mark is missing.
A context menu will open.
3. Select the Insert QRS complex option.
4. Switch back to the HR Min/Max tab to continue with your
evaluation.
Accepting or changing extreme values automatically

calculated
1. Use the Page up and Page down keys to browse forwards
and backwards through the heart rate trend curve.
The blue line in the middle represents the heart rate’s average
values per minute.
The top red line represents the maximum value of the heart
rate per minute. In order to reduce interference, the moving
average of the individual values is taken over 10 beats.
The bottom green line represents the minimum values per mi-
nute, which have been averaged in the same way.
2. Use the tool to the right of the usual toolbar icons to find and
accept the minimum and maximum heart rates.
Tool for finding and accepting the minimum and maximum heart rate
NOTE:
Clicking Minimum/min or Maximum/min in the first line,
the minimum or maximum heart rate averaged over the
respective minute of the recording is found.
Clicking Minimum/short or Maximum/short in the sec-
ond line, the minimum or maximum heart rate will be
averaged over a shorter period, approximately 10 RR in-
tervals. This results in a lower minimum and a higher
maximum heart rate for the respective minute of the re-
cording.

The HR Min/Max tab
3. Select the desired heart rate filter by clicking Minimum/min or

Maximum/min, Minimum/short or Maximum/short.
As a result, in the graph of the heart rate trend, the red line is
positioned on the extreme heart rate value determined by
CardioDay.
The corresponding extreme value is displayed on the Accept
button on the left-hand side.
4. Click the Accept button or press the Enter key to include the
extreme value currently displayed in your report.
The next point is selected automatically.
Example: Due to undetected beats or artifacts misinterpreted
as real beats, it is possible that the software incorrectly deter-
mines extreme heart rate values.
5. Review the determined extreme values.
6. If necessary, select regions with a better detection rate by
clicking on the arrow buttons in the toolbar or pressing the
Delete key to move the marking to the next-highest or next-
lowest value.
7. Include the value finally selected in your report by clicking on
the Accept button or pressing Enter.
Zooming in and out

You can easily change the period shown and the magnification of
the heart rate display (zoom) by using the mouse. The zoom func-
tion is also available in all displays of the Statistics tab.
 Hold the left mouse button and drag the desired region from
the top left to the bottom right.
The marked region is magnified to the entire width of the win-

dow. The smaller you drag the rectangle, the larger the mag-
nification of the data will be.

The HR Min/Max tab
 To reverse the magnified area back to its original size, hold

the left mouse button and drag from the bottom right to the
top left.
When doing this, the mouse pointer can be at any position

of the magnified area and only needs to be dragged a short
distance to the top left.

10 The Statistics tab
10
Select the Statistics tab to evaluate the statistics calculated by
CardioDay.
The sub-tabs at the upper edge of the workspace display the avail-
able statistics. The statistics always relate to the entire recording
time.
Sub-tabs of the Statistics tab
The following statistics can be displayed in sub-tabs, which will be

discussed in separate sections following:
 Mean heart rate
 Mean RR interval
 Diff. RR absolute
 Diff RR > 50 ms distribution
 ST diagrams
 PR trend
 QT analysis
 AFib
Mean heart rate and mean RR interval

The average heart rate, which is derived from the RR intervals over
one minute, is graphically displayed over the measuring period
(middle blue line).
Additionally, the maximum (upper red line) and minimum (lower
green line) heart rates are displayed. Those values are taken from
the heart rate as a moving average over 10 beats.

The Statistics tab
The HR trend calculated over one minute intervals is displayed in

the background of most statistical graphs to aid their interpretation.
This HR trend can be deactivated in Setup > Other options > Mis-
cellaneous.
Statistics tab > Mean heart rate

The Statistics tab
The mean RR interval is the reciprocal value of the mean heart rate.
Statistics tab > Mean RR interval
Diff. RR absolute
In contrast to the Diff. RR>50 ms distribution, the Diff. RR absolute
is used to provide a more quantitative description of the mean devi-
ations between consecutive RR intervals.
Statistical calculation
The Diff. RR absolute shows the mean values of the absolute values
of the differences between the RR intervals of consecutive beats
over one minute.
N RR i - RR i-1
∑
i N

The Statistics tab

The value of the Diff. RR absolute increases with strong arrhythmia.
The sinus rhythm shows higher values during night hours than dur-
ing the day, which can be explained by the fact that the heart is pri-
marily controlled vagally during sleep resulting in lower heart rates,
i.e., large RR intervals and distinct sinus arrhythmia (i.e., large mean
deviations). In the presence of constant heart rates, this value is
lower.
Statistics tab > Diff. Y-T distribution
Diff. RR > 50 ms distribution

The Diff. RR>50 ms distribution tab shows the percentage of the
RR intervals with a difference in length of over 50 ms in relation to
the previous RR interval.
The Diff. RR>50 ms distribution is displayed as a percentage of all
RR intervals in the minute observed.
Number((RR i - RR i-1 ) > 50ms)
100%
Number(RR i )

The Statistics tab
These values are displayed over the measuring period.
Diff RR > 50 ms distribution

In the sinus rhythm, the values are usually under 30%; in the pres-
ence of atrial fibrillation, they are usually over 70% because the
transmission of atrial fibrillation to the main chambers is extremely
irregular and the deviations between successive RR intervals are
therefore often greater than 50 ms.
If the ordinate value of the diagram suddenly increases to 70%,
there is a high probability of intermittent atrial fibrillation or a dis-
tinct arrhythmia in the main chambers of the heart caused by
something else, e.g., a strong supraventricular extrasystole, if a
large number of artifacts on the recording do not offer an alterna-
tive explanation. Intermittent atrial fibrillation can be easily identi-
fied on the diagram. However, we urge you to check the relevant
point in time of the original ECG recording before making any deci-
sions. Values over 70% can also be generated by strong respiratory
sinus arrhythmia, as found, for example, during night sleep.

The Statistics tab
ST diagrams, evaluation and correction of the extreme

values of the ST deviation
The results of the ST analysis are used in particular to identify silent
ischemia.
As it is possible that the software determines false positive regions
of ST deviation, e.g., when the patient changes position, it is recom-
mended all regions be manually evaluated.
The ST diagrams tab shows the ST level (deviation) and ST slope
over the observation period.
Statistics tab > ST diagrams
 The red lines display the limits of the ST deviation in mV.

They are fixed at  0.1 mV. A region is detected when one
of the limits is exceeded for more than 30 seconds.
The voltage level prior to the QRS complex is used as the
reference voltage.
 The bold blue line displays the ST deviations.

The ST deviation is calculated as the average voltage in a
30 ms window beginning 50 ms after the J point.

The Statistics tab
 The thin blue line displays the ST slope.

ST slope is defined as the slope of the regression line of
the ECG signal in a 60 ms window beginning 20 ms after
the J point.
On the ST diagrams tab, you can change the zoom of the display
and mark new regions of relevant ST deviations:
 To zoom, hold the left mouse button and drag the mouse
pointer diagonally over the histogram.
 To mark a new region of relevant ST deviations, hold the left
mouse button and drag the mouse pointer parallel to the time
axis over the histogram.
When you start dragging the mouse, a small circle will appear
around your mouse pointer. As long as the mouse pointer is
inside the circle, you mark a region; when the mouse pointer
leaves the circle, the zoom function is activated.
PR trend
The PR time analysis can help to identify transmission problems, in
particular in the case of a first-degree AV block.
The PR trend tab shows the PR times averaged over a period of one
minute. These are calculated by determining the time of occurrence
of the R peak (T0) for 4 QRS complexes and then adding up the sig-
nals in the period T0 – 240 milliseconds to T0 – 56 milliseconds be-
fore the peak. This makes it easier to distinguish the P signal from
noise. The time of this aggregate signal maximum is used as the
P time to calculate the PR time using T0. The relevant values of one
minute are averaged.

The Statistics tab
Statistics tab > PR trend
QT analysis
NOTE:
If triggering is correct and ECG signals are free of artifacts,
the values of the QTc times are lower than 450 milliseconds.
The occurrence of higher values can indicate prolonged re-
polarization, caused by medication, inherited or acquired
reasons (long QT syndrome), with the risk of severe ventricular
dysrhythmia occurring.
The QT analysis module serves to calculate the QT duration (QStart
to TEnd) and the corrected QT duration for the CardioDay channels.
The automatic measurement of the QT duration can be performed
beat-to-beat or for averaged beats. You can set the number of
beats used for averaging between 3 and 61.
The QT trend, the QT-RR distribution, and the QT histogram can be
calculated and graphically displayed. On each sub-tab you can in-
clude or exclude the channels for analysis.
You can manually correct the measuring points QStart, JPoint, and TEnd
for every beat.

The Statistics tab
QT trend
Statistics tab > QT analysis > QT Trend
On the sub-tab QT trend, the QT durations (continuous curve) and

corrected QT durations (dashed curve) are displayed for every beat
or averaged beats.
For the Secondary y-axis, you can select the RR interval or the
Noise in µV (root mean square of successive differences [rmssd] in
a 20 ms window around TEnd).
Start / Stop analysis

You can select the Analysis channels and the number of Beats for
Averaging. Select None if you do not wish to have averaging. By
doing so, a beat-to-beat analysis is performed. You can set the
number of beats used for averaging between 3 and 61.
You can select whether one diagram per channel or per QT/QTc is
displayed.
Click the Start analysis button. If data of an earlier analysis exist,
these are overwritten.
While CardioDay is performing the analysis, the curves, together
with the even and odd beats, are updated on the screen at regular
intervals.

The Statistics tab
If you click the Stop analysis button, the data calculated up to this
point will be displayed.
The analysis results are saved automatically. They are stored also if
CardioDay is closed so that they will be available after reopening.
Edit measuring points

If you activate the option Edit measuring points, the points QStart,
JPoint, and TEnd are displayed in the ECG context. The active channel
for which you can edit the measuring points is displayed as a
thicker line, and the marker lines of the measuring points are drawn
over the full height of the coordinate system.
To select a channel, click on the ECG waveform of this channel. Now
you can change the position of the measuring points by clicking
and dragging the marker lines with the mouse.
Statistics tab > QT analysis > QT trend > Edit measuring points
Secondary y-axis
In addition to the QT and QTc interval on the primary y-axis, you can
select RR interval, Noise, or Nothing for the secondary y-axis on
the right.
Statistics tab > QT analysis > QT trend > context menu secondary y-axis
QT correction
Corrected QT intervals are labeled with QTc. As correction formulas,
Bazett or Fridericia can be selected.
Statistics tab > QT analysis > QT trend > context menu QT correction

The Statistics tab
QT Bazett formula
QTc =
RR
QT Fridericia formula
QTc = 3
RR
QT-RR distribution
For the selected channels, the QT intervals are plotted against their
preceding RR intervals. The density of the points being at the same
place is color-coded from black, blue, through green to yellow and
finally red.
Statistics tab > QT analysis > QT-RR distribution > context menu display area
The straight of the linear regression of the distribution, the QTo, the
individualized QT correction (QTi), as well as the regression coeffi-
cient are displayed.
If you have zoomed the display on the sub-tab QT trend, you can
limit the display of the QT-RR distribution to the time segment of
this zoom. Right-click in the QT-RR distribution and select “Display
range: xx:xx – xx:xx” in the context menu. The QT-RR distribution is
displayed only for this segment.
Statistics tab > QT analysis > QT-RR distribution

The Statistics tab
QT histogram
You can select via the context menu whether the histogram dis-
plays the distribution of the intervals or that of the interval differ-
ences for QT or QTc.
Statistics > QT analysis > QT histogram
If you have zoomed the display on the QT trend sub-tab, you can
limit the display of the QT histogram to the time segment of this
zoom. Right-click in the QT histogram and select “Display range:
xx:xx – xx:xx” in the context menu. The QT histogram is displayed
only for this segment.
AFib – Detection of atrial fibrillation

On the Statistics tab, the AFib sub-tab displays recording episodes
in which possible phases of atrial fibrillation have been detected.
CardioDay calculates a fibrillation index on the basis of the RR inter-
vals previously detected. The higher the fibrillation index is, the
greater the irregularity of the RR intervals.
The fibrillation index is calculated mainly from the histogram of the
RR interval differences.

Regions in which the fibrillation index achieves higher values indi-
cate the presence of atrial fibrillation. Such regions are highlighted
and editable.
NOTE:
Also, in the case of patients with certain ventricular disrhyth-
mia, the fibrillation index may reach high values, although no
actual atrial fibrillation is present. Thus, if in doubt, perform a
visual inspection of the detected regions in the ECG to validate
the occurrence of atrial fibrillation.

The Statistics tab
Explanation of the displays and color assignments

The upper display shows the calculated fibrillation index as a green
curve and the periods with possible indications of atrial fibrillation
as colored regions.
These regions are editable, and new ones can be created manually.
 To change the position, beginning, or ending of a region, per-
form the following steps:
o Move the mouse over the middle, beginning, or ending
of a region.
o Click and hold the left mouse button and move the
mouse until the position, beginning, or ending have the
desired position.
 To delete a region, mark the region by left-clicking within it
and press the Delete key.
 To create a new region, left-click at the desired beginning,
hold the mouse button and move the mouse to the desired
ending of the region.
The list on the right side itemizes the detected regions of pos-
sible atrial fibrillation numerically and shows detailed informa-
tion such as beginning and end times, duration, and mean fi-
brillation index. The last line of the list shows the total amount
of all regions. You may customize your report to include this
information.
 To mark a region in the fibrillation index, click and highlight

the corresponding item in the list.
The red line indicates the starting point of the ECG displayed in the
lower half of the screen. You can change this point of time by left-
clicking in the upper display.

The Statistics tab
The Statistics tab > AFib tab
 To magnify a section of the upper display, drag a rectangle

from top left to bottom right with the mouse.
 To undo the magnified view, briefly drag the mouse from bot-
tom right to top left.
Context menu options

If you have marked a region with the mouse, you can print and/or
save this region either as a Noise region or as a region of atrial fi-
brillation.
Click on the line marking to open the context menu.
Statistics > AFib > Regions context menu

11 The Report tab
11
The Report tab helps you to write the examination report. The pro-
gram will automatically pull up a standard report, to which you can
make individual adjustments and additions. The report is comprised
of a software-generated Summary and your Diagnosis.
You can select customized report summary templates from a
dropdown list.
If you click the Text modules button or press Ctrl+Space, you can
access the existing text modules.
NOTE:
To create or change a report using an existing report tem-
plate, you need the user or user group right Create report
and/or Change report assigned to your user credentials.
To create, edit, and delete customized report templates, you
need the user or user group right Setup (advanced) assigned
to your user credentials.

The Report tab
The software-generated Summary of the report

NOTE:
We recommend the software-generated summary of the re-
port not be changed.
Report tab
The upper part of the window displays the software-generated

Summary of the analysis results. The Summary will be updated
whenever you switch to the Report tab.
When a report is generated, CardioDay automatically selects the re-
port template depending on the recording type.
The following templates are installed:
Report template Function
Standard Standard report layout
Pacemaker Standard report layout for pacemaker recordings
Export Standard report layout when exporting the report to a
hospital information system
Export PM Standard report layout for pacemaker recordings when
exporting the report to a hospital information system
Export event re- Export of event episodes imported from an event re-
corder corder
Event Recorder Standard report layout for event recordings
Long recordings Standard report layout for recordings of more than 48 hours

The Report tab

Long recordings Standard report layout for pacemaker recordings of
PM more than 48 hours
Export long Standard report layout when exporting the report of re-
recordings cordings of more than 48 hours to a hospital infor-
mation system
Export long Standard report layout when exporting the report of
recordings PM pacemaker recordings of more than 48 hours to a hos-
pital information system
You can select customized report templates by clicking the Tem-

plate field in the upper right corner of the window.
Using the “Variables for customizing the report templates” on page
259, you can edit the content of the software-generated summary
of the report and save your changes for further use. For the neces-
sary explanations, refer to “Customizing and saving report tem-
plates“ on page 236.
The Diagnosis part of the report

NOTE:
To generate the diagnosis, you need the user or user group
right Generate diagnosis assigned to your user credentials.
To edit an existing diagnosis that has already been marked as
Diagnosed, you additionally need the user or user group right
Change report.
Below the Summary, you enter your Diagnosis. Text modules and
an automatic, “intelligent” Word and Phrase auto-completion are
provided to reduce the time consumption of writing your diagnosis.
The text module editor is integrated to allow you to easily retrieve
your saved standard text passages when writing reports. To view
the text passages available, press Ctrl+Space. Select the text pas-
sage required and press Enter (or double-click with the mouse). Al-
ternatively, you may use the hotkey combination previously defined
while generating the text passage to enter the text into your report.
You find additional information on using the text processing tools in
“Setup > Report > Advanced > Text modules” on page 239 and in
“Setup > Report > Advanced > Word- and phrase auto-completion”
on page 241.
After you have written your diagnosis, you can lock it for other users
by putting the checkmark for Diagnosed. The report will now ap-
pear grayed out. After unchecking, the report can be edited again.

The Report tab
NOTE:
Depending on the setting in Setup > Other options > MUSE
connection > Exclude diagnosis on printed report, the text
entered in the diagnosis section is not displayed in the report
that is printed or exported to PDF.
Printing a logo
To print your corporate logo in the head of the report, save the logo
as a bitmap file called “Logo.bmp” in the CardioDay data directory.
The bitmaps will be scaled to size in the report.
To locate the directory, select Help > Version and find the Data
path variable near the bottom of the window.
CardioDay data directory in the Help > Version sub-menu

12 The Full disclosure tab
12
The Full disclosure tab shows the entire ECG line by line.
Full disclosure tab
 ECG segments marked on the Regions tab as noise regions

are shown here on the Full disclosure tab via a red line.
 ECG segments detected as atrial fibrillation are shown here
via a yellow line.
 A red arrow head pointing downwards shows the current time
on the Classes or Events tab.

The Full disclosure tab
You can mark segments by clicking and dragging with the mouse.
By right-clicking on the green line, you open a context menu where
you can designate these segments for printing or mark them as ei-
ther noise regions or as regions of atrial fibrillation.
Full disclosure tab, context menu regions
You can browse through the entire data using either the arrow keys
or the scroll bar on the right of the screen.
 The time of the beginning of each ECG strip is displayed on the
left of the screen.
 The two numbers displayed along the bottom of each ECG
strip correspond to the minimum and maximum heart rates of
the respective line.
 Detected beats are marked by a line above the R peak.
The lines are color-coded as follows: normal beats are green,
pathological beats are red, and beats stimulated by a pace-
maker (not shown in the previous example) are blue.
The color-coded beat representation allows you to quickly see if a
beat belongs to the group of ventricular (red) or supraventricular
(yellow) events. Other events are displayed in black.
Beats not ordered to a particular event group are displayed in the
color ordered to the ECG waveform.

The Full disclosure tab
Use the right mouse button to open the context menu for the
screen magnification, channel, and color selection.
Full disclosure tab, screen magnification and channel selection
NOTE:
The “Setup > Screen, Scale, and Colors” window, as explained
on page 225, opens here if you wish to modify the displayed
colors.
For the channel selection, an additional window opens.
Full disclosure tab, channel selection window
Select the ECG channels to be displayed using the channel selection

window. You cannot select more than two channels for simultane-
ous analysis.
Furthermore, you may invert the polarity of the ECG waveforms us-
ing the Inverted function.

13 The PM (Pacemaker) events tab
13
NOTE:
For the pacemaker analysis, it is necessary that the pace-
maker parameters have been entered when downloading or
reanalyzing. Please refer to the section “Pacemaker parame-
ters and pulse widths“ on page 38 for further information.
The screen layout is the same as on the Events tab, except that the
top half of the workspace shows event classes related to the pace-
maker.
PM (Pacemaker) events tab

The PM (Pacemaker) events tab
Detectable pacemaker event classes

The following pacemaker event classes are displayed:
Pacemaker event Description
Exitblock Ineffective stimulation (exit block)
Undersensing Premature stimulation (undersensing)
Fusion Stimulation in the QRS complex
Oversensing Delayed stimulation (oversensing)
Astim Atrial stimulation
Vstim Ventricular stimulation
AVstim AV-sequential stimulation
A-QRS Atrial stimulation with independent transmission
V-QRS Ventricular stimulation with subsequent QRS complex
Basis for the analysis and evaluation of pacemaker

events
The basis for pacemaker analysis is reliable detection of the pace-
maker’s stimulation impulses and of the R peak in the QRS complex.
Because the P waves in the surface ECG cannot be reliably detected
from beat to beat, the behavior of AAI and dual-chamber pacemak-
ers can only be detected by examining the behavior of the R peak
over time in relation to the stimulation impulse from the chamber
and atrium.
The automatic pacemaker analysis can be improved significantly
with measuring the width of the stimulation impulse during the re-
cording of the pacemaker ECG and using this information to locate
the stimulation.
Analysis algorithms of the stimulation impulse

differentiation
The detection of ventricular stimulation pulses is marked by long
trigger marker lines in the respective ECG context display. The de-
tection of atrial stimulation pulses is marked by short trigger marker
lines.
When analyzing pacemaker recordings, please take into considera-
tion the following analysis algorithms:
Effective stimulation in the ventricle (V-QRS)

If a ventricular stimulation impulse is detected, the program investi-
gates whether a QRS complex is detected within the period of 8 to
200 milliseconds after the stimulation.

The PM (Pacemaker) events tab
Effective stimulation in the atrium (without oesophagus

lead)
If an atrial stimulation impulse is detected, the program investigates
whether a QRS complex is detected in the period of 100 to 300 milli-
seconds after the stimulation.
AV-sequential stimulation (A-Pace, V-Pace) without

differentiation of the width of the stimulation impulse
If two successive stimulation impulses are detected at a period of
less than 300 milliseconds, the first impulse is taken to be the atrial
pacemaker stimulation impulse.
Exit block
 An exit block is assumed to have occurred if no R wave is de-
tected between 8 and 200 milliseconds after a ventricular
stimulation.
 An exit block is assumed to have occurred if no R wave is de-
tected between 8 and 300 milliseconds after an atrial stimula-
tion.
Oversensing
If the stimulation period (Ta) between two ventricular stimulations is
longer than Ta times 1.15, and there is no sensing event between
the stimulations, then oversensing is assumed.
If the escape time or hysteresis time is increased by more than 15%
after a detected QRS complex, then oversensing is assumed.
Undersensing
If, in relation to the last detected ventricular stimulation or the last
detected QRS complex, a QRS complex is detected which occurred
earlier than the minimum stimulation period times 0.85, then under-
sensing is assumed.
Fusion beats
If the start of a QRS complex is detected before the stimulation and
the stimulation occurs within 40 milliseconds after the R peak, this
stimulation is called a fusion.
Independent transmission in DDD pacemakers (A-QRS)

If an atrial stimulation and a QRS complex are detected within a pe-
riod of 100 to 300 milliseconds, this event is interpreted as an inde-
pendent transmission.
Synchronous behavior of DDD pacemakers

If the DDD pacemaker only has ventricular stimulation, then an in-
dependent atrial stimulation was detected by the pacemaker.

14 The Heart rate variability tab
14
This tab displays the Heart rate variability in the time and fre-
quency domain.
Heart rate variability > Lorenz plot and Interval

distribution
The display of the Lorenz plot in the left half of the screen and the
display of the heart rate in the bottom right screen quadrant can be
magnified in the usual way. The zoom function of the heart rate in
the bottom right screen quadrant in particular allows for the selec-
tion of any time interval from the entire recording period (with the
other two diagrams being updated automatically) to enable de-
tailed analyses of the Heart rate variability in the time domain.

The Heart rate variability tab
Statistical calculation of the Lorenz plot

The RR Lorenz plot is generated by determining a coordinate of the
graphic space from each RR interval and its predecessor.
Heart rate variability > RR Lorenz plot
The left half of the screen shows the RR Lorenz plot. Each RR inter-
val on the ordinate is plotted against its previous RR interval on the
abscissa. Furthermore, the frequency distribution of the RR interval
pairs displayed is color-coded (so-called color-coded box counting),
allowing the detection of rhythm problems at a glance.
Relevance of the RR Lorenz plot

With low Heart rate variability, the RR interval pairs arrange them-
selves along the bisecting line. The extension along the bisecting
line is mostly caused by the day-to-night difference in the middle RR
interval. The angle against the bisecting line is created by the aver-
age beat-to-beat variability and, for example, is significantly in-
creased with atrial fibrillation as compared to sinus rhythm.
Statistical calculation of the interval distribution

The upper right screen quadrant displays the absolute frequency
distribution of all RR intervals smaller than or equal to 2000 millisec-
onds in blue. The frequency distribution of all RR intervals not lo-
cated between normal beats is drawn in red.

Below this display, you can select between the display of All Inter-
vals and NN Intervals. The NN Intervals selection only considers
the RR intervals located between normal beats. According to the se-
lection made, the RR Lorenz plot in the left half of the screen and
the absolute frequency distribution in the top right screen quadrant
are updated instantly, so you can see the effect of the selection on
the Heart rate variability in the time domain by switching between
the two.
Relevance of the interval distribution

In addition to the absolute frequency distribution, a number of val-
ues are displayed. The parameters and calculation procedures are
designated according to table 1 of the following guideline: Euro-
pean Heart Journal (1996) 17, 354–381, Guidelines, Heart rate varia-
bility, Standards of measurement, physiological interpretation, and
clinical use. Task Force of The European Society of Cardiology and
The North American Society of Pacing and Electrophysiology.
Value Description
N Number of all considered RR intervals
Duration Total duration of all considered RR intervals in
hours
RR Linear average value of all considered RR inter-
vals in milliseconds
Median Median of all considered RR intervals in millisec-
onds
SDNN Standard deviation of all considered RR intervals
in milliseconds
SDANN Standard deviation of the average RR interval
calculated every five minutes in milliseconds
SD Standard deviation in milliseconds of the stand-
ard deviation of all considered RR intervals cal-
culated every five minutes
HRV-TI Dimensionless triangular index of the Heart rate
variability
NN50 Number of RR intervals of which the difference
from the previous RR interval was larger than 50
milliseconds
PNN50 Percentage of RR intervals of which the differ-
ence from the previous RR interval was larger
than 50 milliseconds
RMSSD Square root of the mean squared differences be-
tween consecutive RR intervals in milliseconds

Value Description
SDNN Ind. or Mean standard deviation of the standard devia-
SDNN Index tions of all considered RR intervals calculated
every 5 minutes
SDSD Standard deviation of the differences of all con-
secutive considered RR intervals in milliseconds
Skew and Power moments of the third or fourth order, clar-
Kurtosis ifying the deviation of the considered RR inter-
vals distribution from the normal distribution ac-
cording to the following schematic illustration:
1
4 2
3
1. leptokurtosis, positive excess

2. normal
3. platykurtosis, negative excess
4. positive skew, left-skewed curve

Deceleration and Acceleration capacity

By clicking the field highlighted, you can toggle between the RR in-
terval distribution, the Deceleration capacity, and the Accelera-
tion capacity.
Deceleration and Acceleration capacity
Heart rate variability > RR histograms

This kind of graphical display allows for a quick overview of the RR
interval distribution over the hours of the day. Wider distributions
with relatively high standard deviations typically occur during hours
with intermittent atrial fibrillation or during hours in which the RR in-
tervals change significantly (stages of falling asleep and waking up).

RR-variability > RR histograms
The RR histograms sub-tab displays the distributions divided in

hours of the day of all RR intervals between 200 milliseconds and
1600 milliseconds in blue. The graphics of the hourly histograms are
auto-scaled, which means that the maximum class frequency is set
as the maximum vertical coordinate.
The darkest shade of blue corresponds to midnight, the lightest blue
to midday.
In the printout, the value of the maximum class frequency for each
hour is displayed at the left border of the graph. The class width,
which is used to calculate the frequency distribution, is 8 millisec-
onds.
On the right border of the graph, the period of the individual distri-
bution is displayed; in the printout the number of RR intervals be-
tween 200 milliseconds and 1600 milliseconds falling into this pe-
riod, as well as the average RR interval and its standard deviation
(x ± s), are also displayed. Furthermore, the class containing the av-
erage RR interval is displayed in red within the blue frequency distri-
butions of the printout.

Heart rate variability > RR-FFT

In the top left screen quadrant, the RR-FFT sub-tab on the Heart
rate variability tab shows the sympathetic innervation index over
the recording period. This coefficient clarifies the effect of respira-
tion on Heart rate variability, which is very strong in healthy people,
e.g., during sleep.
Heart rate variability > RR-FFT
The sympathetic innervation index is calculated from consecutive
time windows of 5-minute duration.
First, the RR interval function is calculated from the time series of RR
intervals. This is achieved by setting each RR interval value against
the elapsed time before it occurs. Only the RR intervals between
consecutive normal beats are used. Extra beats and compensatory
pauses are interpolated also, if they occur in a repetitive manner.
Interposed extra beats are deleted. During this procedure, it does
not matter whether the extra beats are from supraventricular or
ventricular origin. This results in an RR interval sequence that repre-
sents only the variation of the sinus node rate. Disturbances from
extra beats are eliminated.
Second, the RR interval function is sampled at 1024 equidistant
points within each 5-minute time window. The sampled RR interval
values are calculated from the RR interval function using linear in-
terpolation.

This procedure was recommended in the following guideline: Euro-

pean Heart Journal (1996) 17, 354–381, Guidelines, Heart rate varia-
bility, Standards of measurement, physiological interpretation, and
clinical use. Task Force of The European Society of Cardiology and
The North American Society of Pacing and Electrophysiology.
The 1024 RR interval values that result in each time window of 5-
minute duration are normalized: Every RR interval value is replaced
by its deviation from the mean RR interval within the actual window
and then it is divided by the mean RR interval. Because of this divi-
sion, the time dimension of the RR interval values disappears and
the values are without units. After weighting the data using the
Hanning function, a Fast Fourier Transformation (FFT) is carried out
and the periodogram is calculated. In order to diminish the variance
of the spectral estimators, the periodogram is smoothed using a
three points moving average filter.
The resulting spectrum is divided into four spectral bands (ULF, VLF,
LF, and HF) using changeable limit frequencies (menu “Setup > RR-
FFT”).
Spectral bands Frequency limits
ULF below 0.003 Hz
VLF 0.003 Hz to 0.04 Hz
LF 0.04 Hz to 0.15 Hz
HF 0.15 Hz to 0.40 Hz
Because the observing period is only 5 minutes, main attention

should be given to the LF and HF frequency band. In the upper fre-
quency band HF, the modulation of heart rate by the respiration
rate (i.e., the respiratory sinus arrhythmia) appears mainly during
nighttime if there are few other modulations.
Finally, the spectral power in the LF and HF frequency bands is cal-
culated and the logarithm of their ratio ((LF)/(HF)) is the sympathetic
innervation index (Symindex).


Sympathetic Innervation Index  log
P LF




 P HF 


The sympathetic innervation coefficient is positive if the spectral
power prevails in the LF frequency band, which indicates a predom-
inantly sympathetic cardiac innervation.
The sympathetic innervation coefficient is negative if the spectral
power prevails in the HF frequency band, which indicates a pre-
dominantly parasympathetic or vagal cardiac innervation.

Because each sympathetic innervation index is calculated from a

time window of 5 minutes, the bottom left screen quadrant displays
the RR interval function present during the selected 5-minute period.
You can zoom both the display of the sympathetic innervation index
in the top left quadrant and the display of the corresponding RR in-
terval function with a duration of 5 minutes in the usual way.
When selecting a point in time of the RR interval function by double-
clicking with the left mouse button, the display jumps to the ECG
context belonging to this RR interval (which may have been ob-
tained by interpolation). This way the interpolation process of RR in-
tervals caused by extrasystoles can be reconstructed. When chang-
ing to the Full disclosure main tab, the ECG section displayed is po-
sitioned at the start of the selected 5-minute period.
The top right screen quadrant displays the RR interval spectrum,
which was calculated according to the procedure described on the
RR-FFT sub-tab of the Statistics main tab from the scanned, nor-
malized, and weighted RR interval function.
The boundaries between the individual frequency bands are
marked with yellow vertical lines.
A number of values are displayed in the bottom right screen quadrant:
Value Description
Symindex dimensionless value of the sympathetic innervation index
during the selected 5-minute period
f(Pmax) frequency in Hertz where the maximum spectral power oc-
curred
Pmax value of this maximum spectral power
Because the RR interval values considered for the FFT be-
came dimensionless due to the normalization process, the
unit of the spectral power here is [1/Hz].
Total power variance of the interpolated RR interval function in millisec-
onds squared, calculated in the time domain before the nor-
malization process
Power the power present in the entire RR interval spectrum, dimen-
sionless due to the normalization process of the RR interval
VLF spectral power in the VLF frequency band
HF spectral power in the HF frequency band
LF/HF LF-to-HF ratio
LF norm. and power in the frequency band referred to the total power mi-
HF norm. nus the power in the other frequency band in normalized
units (n. u. means normalized)
The following applies:
HFnorm. = HF / (total power – VLF) * 100,
and
LFnorm. = LF / (total power – VLF) * 100

Value Description
Heart rate Average heart rate calculated from the average RR interval of
the minute section in beats per minute
Respiratory If there is an occurrence of a discrete, high spectral power
rate peak in the HF band, this is used to calculate and display the
respiratory rate.
Furthermore, the Report contains further comments on the RR in-
terval spectrum, depending on selection and contents of the report
templates in the RTF files.
Heart rate variability > 24h RR-FFT

The upper half of the screen of the 24h RR-FFT sub-tab of the Heart
rate variability main tab displays the results of the RR spectral
analysis over the entire recording period. If the recording period is
48 hours, the results of the second recording day are displayed in
the lower half of the screen:
Heart rate variability > 24h RR-FFT
Unlike the spectro-temporal analysis of subsequent time segments

of 5 minutes, the analysis over the entire day also allows the detec-
tion of low-frequency components of the spectrum (VLF and ULF
frequency band).
The frequency boundaries of the four frequency bands (ULF, VLF, LF,
and HF) can be set under “Setup > RR-FFT options” (see page 229).
The spectra are calculated in the same manner as the 5-minute

spectra. The recording time, however, is now 24 hours instead of 5

minutes, and a Fourier transformation of the interpolated RR inter-
val function is carried out with 262,144 scan values instead of 1,024.
The following values are displayed on the right-hand side of the
spectra:
Value Description
f(Pmax) Frequency in Hz where the maximum spectral power oc-
curred.
Pmax Value of this maximum spectral power.
Because the normalized RR interval values considered for
the FFT became dimensionless due to the normalization
process, the unit of the spectral power here is [1/Hz].
Total power Variance still calculated in the time domain, before the
normalization process, of the interpolated RR interval
function in milliseconds squared
Power The power present in the entire RR interval spectrum, di-
mensionless due to the normalization process of the RR
interval
ULF, VLF, LF, HF Spectral powers in the corresponding frequency bands
The regression line in the VLF frequency band is calculated by

means of data fitting, minimizing the chi squared value. The equa-
tion of the regression line is displayed. Its slope value is close to the
alpha value suggested in table 2 of the guidelines, if the boundaries
of the frequency bands are selected accordingly.

15 The 12-channel ECG tab
15
NOTE:
Ambulatory ECG data from Holter recorders is not intended to
be used as a substitute for a standard diagnostic quality rest-
ing 12-channel ECG.
The 12-channel ECG tab helps you to evaluate long-term ECG
recordings from the SEER 12, CardioMem CM 3000-12, and
CM 3000-12 BT recorders, and to select an ECG section for
measurement.
This tab is only available after opening 12-channel ECG recordings.
When switching to the 12-channel ECG tab, the current ECG context
of the last QRS complex or event displayed is shown.
Using the 12-channel module, the ECG data channels I, III, and
V1-V6 are acquired. Channel II, avR, avL, and avF will be calculated
using standard formulas of the Einthoven triangle.

The 12-channel ECG tab
Screen structure and operation

The screen of the 12-channel ECG tab is divided (from the top to
bottom) into the title bar, the menu bar, a context sensitive work-
space, the toolbar, the tab bar, and the status bar.
1 2 3
CardioDay screen structure on the 12-channel ECG tab
1. In the workspace area, all 12 ECG channels or a selection are

shown. Those ECG channels shown on the Classes, Events,
and Statistics tabs are displayed with a different color.
2. Channel selection, speed, and channel amplitude can be ad-
justed using the controls at the bottom of the screen.
3. Using the slide control you can change the ECG section dis-
played.
Measuring, editing, and exporting ECG sections

You can measure or edit any ECG section of the recording or export
it in an XML format. You have to mark the corresponding ECG sec-
tion before you can access the desired function.

Creating 12-channel markers

You can mark an ECG section for measuring or for export by setting
a marker. You may also establish the length of the section associ-
ated with the marker. Default is ten seconds.
By clicking the right mouse button you will open a context menu
showing Create Marker: “Marker” (F9).
12-channel tab > Create marker
Use the function keys or click in the context menu to create mark-
ers.
General setup and print setup of 12-channel markers

If the 12-channel markers have not yet been set in the Setup menu
and you want to customize them, you can open a context menu by
right-clicking directly on the marker with a red triangle.
12-channel tab > Marker Setup
For additional information, refer to “Setup > 12-channel markers…”

on page 242.
Automatic creation of markers

With the aid of the file AutoCreateMarker.txt in the data directory of
CardioDay, you can automatically create markers while download-
ing the 12-channel recording.
To locate your data path, select Help > Version and find the Data

For additional information, refer to “Extras > Create 12-channel

markers…” on page 222.
Automatic Measurement
Right-click on the marker to access the Measurement context
menu. Placing the mouse pointer over the menu changes the
display to blue. Clicking on Measurement will open a window with
the measurement area for single beats and the channel list.
12-channel tab > Measurement

The channel list displays the automatically determined measure-

ment results on the right. If you click on a channel, the selected
channel is highlighted to facilitate evaluation. If you double-click
on a channel, only the selected channel is displayed.
12-channel tab, automatically generated values for the channel V4
Editing the automatically generated values

After the automatic measurement, you may edit the generated val-
ues, if required. When you click the Edited measurement sub-tab,
all the values are copied and the original values are saved.

12-channel tab, edited values
By clicking a row in the table of measurement values, the corre-

sponding channel is displayed highlighted and the corresponding
values marked. The vertical line above the zero line on the ECG dis-
play are related to highlighted single channels, and the vertical lines
below the zero line are related to the averaged results of the evalu-
ated QRS complexes. Using these lines, you can carry out the fol-
lowing editing functions:
1. To correct a measurement point, click the vertical line marking
the measurement point and move it using the mouse.
2. If a measurement point cannot be generated automatically,
right-click on the respective spot and select the function in the
context menu.
Convert marker / Show recorder events

By left-clicking the button Convert marker, you convert event mark-
ers into regular 12-channel markers.
By left-clicking the button Show recorder events, you get—in addi-
tion to the other events—a list of events either manually marked by
the patient with the Enter key of the recorder or automatically
marked by the device.

Export of ECG sections, the Marker list

Right-click on the ECG to open a context menu. To export data, go
to the Marker list menu.
12-channel tab > Marker list
Every marker created within the recording is shown on the dis-

played list. Select one or several markers and left-click the Export
button.
An XML file will be created and stored under the pre-set path.
To activate the 12-channel marker export, a specific entry in the
CardioDay.ini is needed with the corresponding setup configura-
tions. For more information on the setup, refer to the CardioDay
V2.5 Installation and Field Service Manual.

16 The Respiration tab
16
NOTE:
The Respiration tab is available only for specific recorders
and recordings where respiration was recorded.
On the Respiration tab:
 the respiration analysis will be started if it was not performed
earlier,
 the results of the analysis will be displayed by interpreting the
signal of impedance changes, and
 the report of the respiration analysis can be separately
printed.

The Respiration tab
The Analysis sub-tab

If the respiratory signals of the recording have not yet been ana-
lyzed, the period to be analyzed is shown as a shaded area. If the
respiratory signals of the recording have already been analyzed, the
results are immediately displayed.
1 2 3 4 5
Prior to analysis
The following status information is displayed in the status bar of the

Analysis sub-tab:
1. Amplitude of impedance axis. (This can be altered with left-
click to 0.2, 0.5, 1, 2, 4, 8, 16, or 32 Ohm.)
2. Time axis setting. (This can be altered with left-click to 1, 2, 3,
5, or 10 minutes.)
3. Display of whether the current event has been highlighted for
printing. (This can be altered with a left-click.)
4. Filter setting. (Using the Filter button, you can display the res-
piratory curve as filtered or unfiltered.)
5. Button to start or cancel the analysis.

The Respiration tab
Specification of the analysis period

The period of night sleep is better suited for the respiratory analysis.
You can specify the desired analysis period by moving the dashed
start or end marking with the mouse while holding down the Ctrl
key. The markings may be set in 15-minute intervals.
Specification of period for the respiratory analysis
Start of analysis
Start the analysis by left-clicking on the Start analysis button.
During the analysis, its progress is displayed as a percentage and
the period under analysis is shown within a dashed frame.
If you click on the Cancel analysis button (previously Start analy-
sis), results will only be available for the period already analyzed.

The Respiration tab
Evaluation and correction of the results of the

respiratory analysis
Results of the respiration analysis
The results are displayed when the analysis is complete.

NOTE:
It is essential that a physician manually validate the
CardioDay respiratory analysis before the results are
used for diagnostic purposes.
The upper part of the window displays an overview of the respira-
tory irregularities (episodes) detected.
The episodes are presented as a histogram at a position that corre-
sponds to the time at which they occurred. A group is defined as
more than 3 episodes occurring within 90 seconds of each other.
The boxes marking the episodes of a group are drawn with wider
lines than those of individual episodes.
Episode label Description
Likely, grouped Episodes recognized as probable, occurring in groups.
All, grouped Episodes recognized as probable or questionable, occurring
in groups.
Likely Episodes recognized as probable.

The Respiration tab
Episode label Description

Questionable Episodes recognized as questionable. These can be reclas-
sified as Likely episodes by left-clicking in the detailed view.
Print Episodes marked to be printed.
You can sequentially go through the episodes individually by press-

ing Enter after each episode. To go backwards, press Backspace.
A highlighted episode can be deleted pressing Delete.
The lower part of the window displays a detailed view of the section
marked with a line in the detailed overview.
The detailed view contains the respiratory curve as well as the
Questionable and the Likely episodes detected, highlighted in yel-
low and red respectively.
You can select an episode by clicking on the yellow or red box. You
can delete a selected episode by clicking the box with the x inside or
by using the Delete key.
While holding Shift+Ctrl simultaneously, you can create a new epi-
sode by left-clicking and dragging the mouse.
Reclassification in the context menu
A right-click will open a context menu in which it is possible to re-

classify an episode.
The Report sub-tab

The report shows the results of the analysis in tabular and graphical
forms.

The Respiration tab
Report of the respiration analysis
The report contains the following information for Likely, grouped,

All, grouped, Likely, Questionable, and All episodes:
 the total number of episodes,
 the maximum number of episodes within a one-hour period, and
 the episode index, which is the total number of episodes di-
vided by the number of hours of the analysis period.
The upper graph shows the number of Likely, grouped, and All,
grouped episodes for every hour of the analysis period.
On the basis of the lower graph, it is possible to compare the follow-
ing different episode classes quantitatively:
 all likely episodes
 all questionable episodes
 all detected episodes
The bars are color-coded as follows:
 green, when number of episodes per hour is fewer than 10
 yellow, when number of episodes per hour is between 10 and 19
 red, when number of episodes per hour is 20 or more

17 The AFib tab – Frequency analysis for
17
detection of atrial fibrillation
NOTE:
In the case of an ECG with pronounced muscle artifacts or
where there is a low signal-noise ratio, e.g., with low P waves,
it is not possible to analyze the fibrillation frequency.
If in doubt, check the result of the QRST cancellation in the
bottom-left window and the detected fibrillation frequency
in the bottom-right window in the respective ECG section.
On the AFib tab, it is possible to carry out an analysis in selected
5-minute ECG sections in order to estimate the atrial fibrillation
frequency. You are free to select the time point at which the respec-
tive ECG section should begin.

The AFib tab – Frequency analysis for detection of atrial fibrillation
The first step is to perform QRST cancellation to remove ventricular

activity (e.g., QRS complex and T wave) as much as possible from
the ECG. The fibrillation frequency and cycle length of the fibrillation
waves are then determined by means of Fourier analysis.
The AFib tab
Like the AFib sub-tab of the Statistics tab, the ECG sections with
possible indications of atrial fibrillation are displayed in the upper
part of the screen.
Display of ECG sections with possible indication of atrial fibrillation
The red line indicates the time at which the current frequency anal-
ysis begins. You can initiate a new frequency analysis by left-click-
ing on the desired starting time. The QRST cancellation and subse-
quent frequency analysis are performed automatically.
You can select the channel for the frequency analysis from the rele-
vant menu bar.

As a result of the frequency analysis, the bottom left-hand part of

the screen displays the ECG signal after QRST cancellation in a dark
color and the complete original ECG in a light color. You can right-
click to hide or display the ECG.
Result of the frequency analysis
By dragging a rectangle from top left to bottom right with the

mouse, you can magnify the displayed section. If you briefly drag
the mouse from bottom right to top left, the whole interval is dis-
played again.
You can also set the period for the section in the bottom left part of
the screen to a value less than 5 minutes in the menu bar.
Results of the frequency analysis, display of 5 seconds of the ECG section
By holding down the Ctrl key and dragging the mouse, you can
measure the ECG manually. The display shows the duration in milli-
seconds, the fibrillation frequency in Hertz, and the amplitude in
millivolts.

A
m
Measuring the ECG
To delete a measurement, hold down the Ctrl key and left-click on

the measurement line.
In the lower right-hand part of the screen, the fibrillation frequency
is displayed in Hertz and the corresponding cycle length of the fibril-
lation waves in milliseconds. The mean heart rate is also shown in
beats per minute and in Hertz.
The spectrum calculated after the QRST adjustment shows the fre-
quency distribution of the atrial activity. The dominant fibrillation
frequency is identified with a red arrow at the most prominent peak
in the spectrum.
Results of the frequency analysis as a spectrum
You can subsequently change this frequency by dragging the

mouse. The values for the fibrillation frequency and the cycle length
are automatically changed in the top right-hand part of the screen.

18 The TWA tab – T Wave Alternans
18
The TWA tab provides a T Wave Alternans analysis of the
complete ECG recording. This reveals beat-to-beat differences
in the morphology of the ST area and T wave.
The beat annotation distinguishes them as even or odd beats.
Screen layout and operation

On the TWA tab, you find windows for the following analysis results:
 the calculated TWA data, the values for noise and heart rate,
each displayed graphically in window 1
 the averaged even and odd beats in window 2
 the ECG in window 3 for the position selected on the time axis
in window 1

The TWA tab – T Wave Alternans
1 2 3
The TWA tab
The calculated data are displayed for every channel selected for
analysis.
The TWA and noise data are calculated with a temporal resolution
of 10 seconds. Both values are shown in µV. The noise value is dis-
played as a negative value to provide a better readability.
The heart rate is shown on the right-hand side of the graph in beats
per minute. The position currently selected is displayed as a red ver-
tical line.
For every channel, the averaged even and odd beats are displayed
to the right of the TWA curve in an overlapping manner in window 2.
The beats shown in window 2 are the moving average over all beats
up to the position of the red line in window 1.
In addition, the TWA value measured up to this time, as well as the
value for noise and heart rate, is displayed numerically.
The positions of the largest deviations between the even and odd
beats in the ST and T areas are displayed by red vertical lines in
window 2.

Window 3 shows one minute of ECG section around the selected

time position on the TWA curve.
Marker shows end of 10-second period over which TWA value is calculated.
A red marker in window 3 shows the end of the 10-second period

corresponding to the red vertical line in window 1.
Select analysis channels

You can select a maximum of 4 channels via the channel selection
symbol.
Channel selection button
Start analysis
Click the Start analysis button. Any earlier analysis data are over-
written.
While CardioDay is performing the analysis, the TWA curves, to-
gether with the even and odd beats, are updated on the screen at
regular intervals. The analysis progress is shown by a red vertical
line.
If you click the Stop analysis button, the data calculated up to this
point will be displayed.
The analysis results are saved automatically.
Evaluation and correction of the TWA analysis

NOTE:
Although the TWA algorithm checks the analysis results for
plausibility, the TWA values calculated automatically must not
be used for diagnostic purposes before they have been vali-
dated by a trained physician or healthcare professional expe-
rienced in Holter ECG and TWA analysis.
The TWA tab in the Setup > Other options menu provides the possi-
bility of setting the following analysis parameters
 Update factor
 Heart rate threshold
 Noise threshold

Once the analysis is complete, the red vertical line is automatically

positioned at the time of the highest TWA value. By clicking the TWA
curve, you can select another time position.
If you wish to select the time of the highest TWA value again, click
the Go to button in the TWA max. position screen area underneath
window 2.
If it should be necessary to select another position for the highest
TWA value, select the new position in the TWA curve and then click
the Set button in the TWA max. position screen area.
The selected maximum TWA position also determines the position
for the TWA ECG printout.
Valid and invalid TWA values

The plausibility of the calculated values is checked by the analysis al-
gorithm. Among other factors, heart rate and noise are crucial for
the reliability of the analysis.
The TWA curve only shows the values presumed as valid. The curve
shows a gap if values are not plausible.
Invalid TWA values among the even and odd beats are displayed
with the value “-1” in window 2.

19 The Episodes tab – evaluation of episodes
19
imported from an event recorder
NOTE:
Event episodes that have been recorded using the CardioMem
CM 3000 L3 recorder are not downloaded directly from the re-
corder but they are imported. For further information, please
refer to the section “Recording > Import…” on page 201.
This tab is only available after opening episodes recorded with an
event recorder.
On the right, the event episodes are listed together with their time and
date of occurrence. The event recorder can detect bradycardia,
tachycardia, atrial fibrillation, and pauses. In addition, the recording
of episodes can be activated manually as well.
On the left, the ECG episode currently highlighted is displayed to-
gether with its pre- and post-event times set in the event recorder.

The Episodes tab – evaluation of episodes imported from an event recorder
The vertical line shows the time at which the event was detected.
The Episodes tab
To select several episodes for printing, hold the Shift key (for con-
secutive items) or the Ctrl key (for non-consecutive items) and click
the entries in the list.
Proceed as follows in order to measure a waveform section.
Keeping the Ctrl key pressed down, left-click on the point at which
you want the measurement to begin and then click on the point at
which the measurement should end.
Measurement of waveform sections
To delete the measurement, right-click on the measuring line and

select this function from the context menu.

20 The Print tab
20
In the print preview, you can examine and, if desired, select a multi-
tude of printouts.
Each of the options available generates a precisely defined printout,
which always has the same layout, resolution, and structure. This
allows a quick review and evaluation of the printouts. The heart rate
over time is required as a comparative value in several of the op-
tions and, therefore, printed several times (in Overview, Event histo-
gram, ST trend, Heart rate variability, PR trend, and TWA).
The individual printing options are described in the following sec-
tions.
The Print tab

The Print tab
Selecting a printer
If you click the Print button, you create your printout on the
Windows default printer.
You can select a different printer as explained in the “Setup >
Printer…” section on page 243. Here, you can select all printers
configured in your Windows installation.
You may also temporarily select one of the available printers by
clicking the black triangle next to the Print button.
Configuring a PDF file destination

If an appropriate printer driver has been installed, CardioDay also
generates files in PDF format.
Setup > File path, file print settings
If a printer file path has been selected, a button labeled PDF is dis-
played to the left of the Print button on the Print tab.
For information about file names and supported printer drivers, re-
fer to the CardioDay V2.5 Installation and Field Service Manual.
Default and customized print selection templates

The content of the report files depends either on the print selection
saved for each recording or on the current defaults.
At first opening, a recording will have the default print selection
which you can edit and save. For all new recordings, again the de-
fault print selection will be displayed.
To customize separate print selections, you can create and edit
your own print selection templates, which you can afterwards se-
lect from a dropdown list.
Print tab, print selection

The Print tab
If you selected additional printouts or removed printouts from the

default print selection, the Template field at the bottom will be
blank and you can enter the name of your new print selection. If
you click the + symbol next to the Template field, a window opens
for entering your name for the current print selection.
Field for naming and saving a customized print selection template
If no template is displayed in the list, the chosen print selection does

not match any existing template. If the recording is reopened, it will
have the print selection set last. Saved templates can be deleted
anytime by pressing the - key or clicking the - symbol next to the
Template field.
NOTE:
The Default print selection template cannot be deleted.
Printed check box

Generally, the evaluation of a recording will be considered complete
once the report is Printed or stored to a MUSE system.
Status indicators like Printed or MUSE are shown in the Status col-
umn on the Recordings tab. See “The Info and Status columns” on
page 46 for information on status indicators.
To change the recording’s status to Printed, first set the Printed
checkbox and then click Print. The Status column for this recording
on the Recordings tab will change to Printed. Printing the report
without setting the checkbox will not update the recording’s status.
Setting the checkbox without printing the report has no effect.
Print tab, Printed checkbox
You can select an alternate print destination other than the config-
ured default from the available Windows print destinations by click-
ing the black triangle next to the Print button (see also “Selecting a
printer” on page 154).
You can also generate a PDF file to the default/configured PDF print
file location by clicking the PDF button (see also “Configuring a PDF
file destination” on page 154). This will add the PDF status indicator
to the Status column for this recording of the Recordings Tab.

The Print tab
25 mm/s ECG strip settings

You can adapt the background grid for the 25 mm/s ECG strips.
There are 6 different color configurations available that you can se-
lect from a drop down menu.
Background grid settings
You can also select the sorting criteria of the strips. If you select By
type, the strips will be displayed in the same hierarchical order as in
the events tab. If you select Chronological, all saved strips will be
displayed in chronological order.
Sorting settings
Furthermore, you can change the amplitude scales for the dis-
played channels.
Amplitude scale settings
General > Report and Overview

You can select to print a Report. A report consists of the automati-
cally generated summary and your diagnosis.
If you use the MUSE Cardiology Information System, you can select
the option Exclude diagnosis on printed report as explained in
“Setup > Other options > MUSE connection” on page 234. Depend-
ing on the setting in Setup > Other options > MUSE connection >
Exclude diagnosis on printed report, the text entered in the diag-
nosis section is not displayed in the report that is printed or ex-
ported to PDF.

The Print tab
If you deselect Report, only the printouts you selected in the print
selection are generated. Check Copy to print an additional copy of
the report component of the print selection.
You can remove the frame that is printed as a default, for example
if you want to print on your own forms.
If you want to print your own forms and would like to remove the
frame from the Report page, uncheck the With frame checkbox.
General > Report
The Overview option prints out the heart rate diagram, as well as in-
formation on minimum and maximum heart rate, on atrial and ven-
tricular arrhythmias, and on Heart rate variability. The overview also
contains a maximum of 8 marked events and descriptive text.

The Print tab
Example of overview printout

The Print tab
Print > Full disclosure

The Full disclosure check boxes print the ECG tracing in the resolu-
tion of your choice. Full disclosure enables you to select from three
time scales. Then you can select a channel and one or more periods.
You can use the Adaption function to adapt the printout to your
needs by changing the amplitude.
Entries for full disclosure
To add a time period to the list, enter a time period in the from and
to fields and click the + button. To delete a time period from the list,
select the period in the list and click the – button. To select a period
for full disclosure printing, select the period in the list and click the
disk button; the list will be included in the full disclosure printing.
NOTE:
If you do not set a recording period, the complete recording
will be printed. In this case, a full disclosure printout is perhaps
time-consuming and can require up to 96 pages per day – de-
pending on the duration of the recording and the resolution.

The Print tab
The printouts have the following appearance:
Sample printout of full disclosure with a resolution of 1 hour per page
The time scales in seconds are displayed above and below the dia-
gram, the time is on the left and the heart rate and most important
event for this minute are on the right. The patient event has the
highest priority.

The Print tab
Print > Saved events

The options listed under Saved events print all events selected for
printing using different resolutions and appearance. You can also
select the sorting criteria of the strips. If you select By type, the
strips will be displayed in the same hierarchical order as in the
events tab. If you select Chronological, all saved strips will be dis-
played in chronological order.
Saved events > Selected resolution and channels
You can select the desired channels at the bottom of the Print tab.

The Print tab
Saved events > Overview 8 or 32 events/page

Overview prints an easily readable but less detailed summary of
events (example for 8 events/page):
Sample printout of a saved event’s overview
Saved events > 25 mm/s

The Saved events > 25 mm/s option prints the selected channels for
the saved events, but presents them in a magnified form and with
additional information.

The Print tab
The channel, time of occurrence of the event, and information re-

garding the resolution are found above each event diagram to-
gether with the event's number and type. The diagram itself also
shows the QRS classification, the RR interval, and the current heart
rate of each QRS complex.
Example of saved events > 25 mm/s printout

The Print tab
Saved events > 1 min + 25 mm/s

Select Saved events > 1 min + 25 mm/s to print the same infor-
mation showing the selected channels:
Sample printout of saved events in 1 min. + 25 mm/s display
In addition, one minute of the context of each event is displayed in a

lower resolution.

The Print tab
Saved events > 10 min + 25 mm/s

The Saved events 10 min + 25 mm/s option prints the selected chan-
nels for the saved events.
Sample printout of saved events in a 10 min + 25 mm/s display

The Print tab
Saved events > Patient diary

On the printout of the patient diary, a list with all available patient
diary events is displayed. Also, “manual” events are displayed that
were marked by pressing the Event button at the recorder.
The events are listed in chronological order with the date, time, and
comments.
Sample printout of patient diary

The Print tab
Print > Statistics

The options under Statistics in the Print window document the
events found and the results determined on the Statistics tab.
Statistics > General > QRS classes

Select Statistics > General > QRS Classes to print an overview of
the first 30 QRS classes, as displayed on the Classes tab.
Sample printout of a QRS classes overview

The Print tab
Statistics > General > Event table

Select Statistics > General > Event table to print a tabular sum-
mary of all events by hour over the entire measuring period.
Sample printout of a table of events occurring within one hour
Statistics > General > Event histogram

Select Statistics > General > Event histogram to print a graphical
summary of the heart rate and a histogram of all events.

The Print tab
The event histograms are displayed as events per minute over the
day of the recording. These histograms can be easily compared with
the heart rate as they are displayed on the same printout.
Sample printout of the heart rate and event histograms

The Print tab
Statistics > General > ST trend

Select Statistics > General > ST trend to print ST deviation and ST
slope for the measuring period.
Sample printout of heart rate and ST diagram

The Print tab
Statistics > General > HR diagram + Min/Max minute

Select Statistics > General > HR diagram + Min/Max minute to
print another graphical summary of the heart rate as well as ECG
for the minutes with the highest and lowest heart rates:
Sample printout of the heart rate and ECG for the minutes with the highest and
lowest heart rate

The Print tab
Statistics > General > PVC + SVE histograms

Select Statistics > General > PVC + SVE histograms to print two
histograms of the percentage share of premature ventricular and
supraventricular extrasystoles:
Sample printout of the histograms showing the percentage share of premature

ventricular and supraventricular extrasystoles

The Print tab
Statistics > General > Heart Rate Turbulence

Select Statistics > General > Heart Rate Turbulence to print the di-
agram of the sum of the Heart Rate Turbulence together with the
numerical values of the RR intervals.
Statistics > General > Heart Rate Turbulence

The Print tab
Statistics > General > AC/DC Capacity

Select Statistics > General > AC/DC Capacity to print the graphs
for the Deceleration and Acceleration capacity.
Statistics > General > AC / DC Capacity

The Print tab
Statistics > Heart rate variability (Standard) >

YT/PNN50
Select Statistics > Heart rate variability (Standard)> YT/PNN50 to
print the average heart rate overview, the average value of the absolute
RR differences, and the percentage share of the QRS complexes with an
absolute RR difference greater than 50 ms.
All figures display average values calculated over one minute.
Sample printout of the absolute RR differences and the share of absolute RR differ-
ences larger than 50 milliseconds, minute values

The Print tab

RR intervals
Select Statistics > Advanced heart rate variability (RR-FFT) > RR
intervals to print the RR interval distribution and a number of sta-
tistical parameters of all beats and of all normal beats over the
measuring period:
Sample printout of the RR interval distribution

The Print tab
Statistics > Advanced heart rate variability (RR-FFT) > RR

Lorenz plot
Select Statistics > Advanced heart rate variability (RR-FFT) > RR
Lorenz plot to print the Lorenz plot of all RR intervals during the
measuring period:
Sample printout of the RR Lorenz plot

The Print tab
Rhythm problems (here, for example, atrial fibrillation) cause a devi-

ation from the ideal shape of a baseball hat with a slope of 45 de-
grees. This RR Lorenz plot is generated by determining a graphical
coordinate from each RR interval and its predecessor. The fre-
quency of occurrence of each coordinate is then displayed in color
on the diagram. This display allows a quick evaluation of whether or
not rhythm problems are present.

The Print tab

Min. sympathy. innervation index
The option Statistics > Advanced heart rate variability (RR-FFT) >
Min. sympath. innervation index prints the RR tachogram and RR
interval spectrum of those 5-minute periods of which the sympa-
thetic innervation index has the maximum negative value. A basic
description on calculating this parameter is given in the section
“Heart rate variability > RR-FFT“ on page 123.
Minimal sympath. innervation index

The Print tab

24 h RR-FFT
The printout shows the graphic represented in the section “Heart
rate variability > RR-FFT“ on page 123.
Statistics > Advanced heart rate variability (RR-FFT) > RR

interval spectra
The RR interval spectra provide an overview of the results of the
spectro-temporal RR interval analysis in subsequent 5-minute time
segments.
RR Interval spectra

The Print tab
The spectral power for each spectrum is auto-scaled to its maximum

value and color-coded according to the color bars used with the RR
delay. The recording start is located at the bottom of the graph. Each
spectrum is displayed according to its starting time, which is shown
on the y-axis. The abscissa shows the frequency range between 0 Hz
and 0.5 Hz.
Orange-red colors indicate a higher spectral density than green and
blue colors.
During periods of physical activity and wakefulness, the higher
power density is found at 0.1 Hz or lower frequencies. During peri-
ods of undisturbed respiratory sinus arrhythmia, the higher spectral
power density is found in the HF frequency band.

The Print tab
Statistics > PR/QT trend > PR trend

This option prints an overview of the PR Trend in addition to an
overview of the average heart rate.
Sample printout of the PR duration

The Print tab
Statistics > PR/QT trend > QT-/QTc trend

This option prints overviews of the QT and QTc intervals in addition
to an overview of the average heart rate.
Sample printout of the QT trend

The Print tab
Statistics > PR/QT trend > QT histogram

This option prints the QT-RR distribution for the QT histogram as
well as for the QT and QTc intervals.
Sample printout of the QT histogram

The Print tab
Print > Respiration > Overview and Marked episodes

The Overview option prints the report table and overview graphics
of the respiration episodes.
Sample Printout Respiration > Overview

The Print tab
The Marked episodes option prints all detected likely and question-
able events that were detected during the respiration analysis pe-
riod.
Sample printout Respiration > Marked episodes

The Print tab
Print > 12-channel ECG

This option prints the selected 12-channel markers that are high-
lighted in the marker list on the 12-channel ECG tab. Note that the
marker type needs to be configured in the marker set up in order
to be active for print.
Sample printout 12-channel ECG

The Print tab
Print > AFib > Statistic

This option prints the calculated fibrillation index with indications of
atrial fibrillation as colored regions. Furthermore, it displays a table
with detailed information about the detected regions.
Sample printout AFib, Statistics

The Print tab
Print > AFib > Frequency analysis

This option prints the calculated fibrillation index with indications of
atrial fibrillation as colored regions as well as the frequency spec-
trum of the maximum frequency of atrial fibrillation that has been
detected.
Sample printout AFib, Frequency analysis

The Print tab
Print > Pacemaker

The options listed under Pacemaker document the events found
and the results of the pacemaker analysis. They print the results de-
termined on the PM events tab.
Pacemaker > Event histogram

Select Pacemaker > Event histogram to print a summary of the
heart rate and a histogram of all events related to pacemaker func-
tioning. The printout is very similar to that of the Statistics > Event
histogram option except that it includes the pacemaker events al-
ready described in the section “The PM (Pacemaker) events tab” on
page 113.
Sample printout of a Pacemaker Event histogram

The Print tab
Pacemaker > Function analysis

The functional analysis of ventricular pacemaker stimulation displays
two frequency distributions in the graph.
Sample printout of the Pacemaker Function analysis

The Print tab
The ordinate shows the absolute frequencies of all events that oc-
curred during the entire recording period using a class width of 8
milliseconds.
The positive abscissa, that is, the right part of the graph, shows the
time interval from the position of the R peak to the next ventricular
pacemaker stimulation impulse detected by CardioDay.
In addition, the minimum stimulation interval of the pacemaker (for
pacemakers with variable stimulation frequency, this value is calcu-
lated from the maximum stimulation frequency), the ventricular es-
cape interval (calculated from the minimum stimulation frequency),
and the hysteresis interval (calculated from the hysteresis fre-
quency) are marked with dashed and vertical blue lines. These lines
could all coincide, for example, in the case of a VVI pacemaker with-
out a programmed hysteresis frequency.
Relevance
If the frequency distribution in the right part of the graph lies before
or during the escape interval in the range of the set stimulation fre-
quency of the pacemaker, then no ventricular oversensing has oc-
curred.
If a significant amount of stimulation impulses occurs within a short
period after the preceding R peak, significant ventricular undersens-
ing has occurred. In this case, the pacemaker gives a significant
number of stimulation impulses even though an R peak occurred
shortly beforehand, which was detected by the Holter ECG but not
by the pacemaker. This can happen, for example, if the pacemaker
ventricular sensing threshold is too high or the contact resistance
between the ventricle electrode and the myocardium is too large.
Events that could be mistaken for ventricular undersensing may
also be caused by false triggering of the evaluation algorithm of
CardioDay. Also to be considered is possible breakage of the ven-
tricular pacemaker electrode, which can sometimes cause an inter-
ruption of the electrode‘s electrical conduction only during certain
movements of the patient.
In pacemakers with variable stimulation frequency, the peak of the
frequency distribution will lie at the most frequently occurring stim-
ulation frequency. It is therefore normal for this peak to lie to the left
of the escape interval (e.g., DDD-R or VVI-R pacemaker mode). This
should not be confused with ventricular undersensing.
If stimulation impulses appear to the right of the escape interval by
any appreciable amount, significant ventricular oversensing has oc-
curred. The interval between the preceding R peak and the next
ventricular pacemaker stimulation impulse is then often longer than
it should be based on the escape interval of the pacemaker. In this
case, the pacemaker is inhibited even though the escape interval

The Print tab
has already passed. This is usually caused by extracardial myopo-

tentials when the pacemaker has a low ventricular sensing thresh-
old, or—also intermittently—when electrode breakage, electrode dis-
location, or pacemaker dysfunction due to other causes is observed.
If the pacemaker has a programmed hysteresis frequency, the pre-
vious considerations should be made using the hysteresis interval
and not the escape interval.
The frequency distribution is shown in green. However, all values
that lie outside the interval specified by the mean ± two standard
deviations are displayed in red.
The positive abscissa also includes an additional abscissa com-
puted in the units of “beats per minute” to allow a better compari-
son of the frequency distribution results with the programmed fre-
quency values of the pacemaker.
The negative abscissa, that is, the left side of the graph, shows the
time interval between the ventricular stimulation impulse and the
next R peak detected in the Holter ECG. This interval should nor-
mally be less than 150 ms. If it is longer, the frequency distribution
will be shifted to the left, because the abscissa is negative. This
means that not every ventricular stimulation impulse led to an
R peak, i.e., a significant amount of exit blocks occurs. This could be
caused, for example, by electrode dislocation, electrode breakage,
or too much contact resistance between the ventricle electrode and
the myocardium. It could also occur if the ventricular stimulation
amplitude is too small, the ventricular stimulation duration is too
short, or the batteries are too weak. In patients whose own ventric-
ular rhythm is inadequate, the ventricular exit block poses a threat-
ening situation.
The frequency distribution is marked in green. All values that corre-
spond to more than a 200 ms interval between the ventricular
pacemaker impulse and the next R wave, i.e., where ventricular exit
blocks are possible, are marked in red. In this case, ventricular exit
blocks are possible.
In the lower half of the page, the statistical parameters mean and
standard deviation for the aforementioned frequency distributions
are shown. Further results refer to the absolute and relative fre-
quencies of the exit blocks and the undersensing and oversensing
events. These are not calculated from the frequency distributions;
they are instead taken from the edited table of pacemaker events.
In summary, the graphical and statistical display of the ventricular
stimulation is intended to provide a quick overview of the correct
functioning of the pacemaker’s ventricular stimulation and to help
in the detection of frequent ventricular exit blocks and ventricular
undersensing and oversensing. The resulting characteristic shift of
the frequency distributions is used to recognize malfunctions of the
pacemaker at a glance.

The Print tab
Print > TWA > Trend

This option prints the TWA values for the selected channels over the
analysis time. The noise value is displayed inverted in the same
graphic. Furthermore, the heart rate trend over time is shown.
Sample printout of the TWA trend

The Print tab
Print > TWA > ECG

This option prints the TWA maximum value as a numerical value
and as a graphic for each available channel. On the second half of
the sheet, the maximum TWA value is displayed in the ECG context.
Sample printout of TWA > ECG

The Print tab
Print > Event Recorder > Selected Marker

This option displays the ECG waveforms of the markers selected on
the Events tab. It is selectable only for event recordings recorded
with a CardioMem CM 3000 L3 recorder.
Sample printout of the markers selected on an Event recorder

Part II
The CardioDay Menus

21 The Recording menu
21
This menu contains file functions such as Open existing recording
or Close recording, as well as the instruction to Exit CardioDay.
Recording > Start
This selection opens the start window with the following options:
 Hookup (1)
 Transfer patient data (2)
 Download recording (3)
 Download long recording (4)
 Open existing recording (5)
Option 2 is used to transfer patient information to the recorder or to
the CompactFlash memory card used with the CardioMem or SEER
12 ECG recorders before beginning the recording.
The options (1) to (5) are explained in more detail in the section
“Start window options” on page 29.
Recording > Open...

This selection opens an existing ECG recording stored on your PC
hard disk without any changes to Signal evaluation and analysis
parameters.
Recording > Reanalyze...

A signal evaluation is repeated. The user opens an existing record-
ing and CardioDay reanalyzes the raw ECG data.

The Recording menu
Recording > Patient data...

This selection allows subsequent modifications or additions to be
made to the patient data of the currently open recording.
Recording > Properties…

The location and technical details of the recorder used for recording
are displayed in the Properties tab.
Recording > Properties… > Properties
An evaluation history of the recording is displayed on the Audit log

sub-tab.
Recording > Properties… > Audit log
Recorder battery information is displayed on the Battery infor-

mation sub-tab.
Recording > Properties… > Battery information

The Recording menu
Recording > Close recording

This selection closes the current ECG recording.
Recording > Import…

This selection allows you to
 open recordings that were downloaded using the
CardioRead remote download software,
 import recordings that were exported from another
CardioDay database,
 import active and archived MARS recordings,
 import recordings that were recorded using the event
recorder CardioMem CM 3000 L3, and
 import recordings in MIT format or other available formats de-
pending on the license purchased.
Recording > Import > File type
First, select the file type of the recording to be imported. Then browse
to or select the folder where the file(s) to import are located. A sim-
ple left click will open the respective folder.
In the list that appears on the right, you can either display the indi-
vidual files or the patient data of the individual recordings. To do so,
select the desired viewing mode.
Click OK to import the highlighted recording.
NOTE:
Only select the Delete file after import option if you do not
want to download recordings longer than 48 hours. For infor-
mation refer to “Opening long recordings” on page 47.
Importing MARS Recordings

To import individual MARS recordings into CardioDay, use the fol-
lowing procedure. For information on importing batch recordings,
refer to the CardioDay V2.5 Installation and Field Service Manual.
1. Select Recording > Import…
2. In the File type field, select All Files (*.*)
3. Select the directory path where the file is located.

The Recording menu
A simple left click will open the respective folder.

4. Review the files on the right side of the screen and select the
file you want to import.
CardioDay supports the import of .nat and .nrt files.
5. Click OK to import the highlighted recording file.
Recording > Monitoring acquisition

Selecting this sub-menu will open the Monitoring acquisition im-
port list, which is part of the Holter Acquisition Service (HAS) for bed-
side monitoring acquisition.
NOTE:
The monitoring acquisition function is intended to import ECG
signals. It is not possible to import pacemaker data, blood
pressure values, or blood gases’ measurements possibly also
recorded by a monitor.
Recording > Monitor Acquisition import list
CardioDay imports ECG data from different GE bedside and teleme-

try monitors and analyzes these data as Holter ECG recordings if
the applicable license option is available and all technical require-
ments are met.
No additional Holter recorder is required. The ECG signals from the
monitors are transferred in blocks of a maximum of 48 hours to the
HAS. The ECG signals can then be selected from the Monitoring Ac-
quisition import list and downloaded to CardioDay.
The list also includes all running examinations, which can be chosen
for immediate import as well. Running examinations are indicated
by a watch symbol next to the patient’s Last name in the list.

The Recording menu
Recording > Monitor Acquisition import list, indication of running recordings
If you import a running examination, this currently active recording

will be exported and a new recording with the configured block size
will start.
The Refresh button updates the list with the latest content.
If more than one CARESCAPE Gateway server is set up to be used
with CardioDay, they will be displayed in a dropdown list in the up-
per right of the screen. If you select one, the corresponding record-
ing list, with all available beds and running recordings, will be
loaded. If a default Gateway is defined on the Setup menu, its list of
available beds and running recordings will be loaded automatically
when the monitoring acquisition window opens. For setup infor-
mation, refer to “Setup > Other options > Monitoring connection” on
page 235.
You can sort the import list by Name, First name, etc., by clicking
the respective column heading. Also, you can filter the import list by
Name, ID, or Unit. If you check the Show matching only check box,
you can view all examination blocks of a patient and import the
blocks you want.
If you mark an examination block and confirm with the Enter key,
CardioDay displays the patient list, from which you can select a free
storage space or overwrite an existing recording. If you are over-
writing an existing recording, you will be warned and asked to con-
firm the deletion.
You can check the entries in the patient data window. If you click
OK, the pre-analysis is started. For additional information, refer to
“Signal evaluation and setting of Analysis parameters before down-
loading the ECG data” on page 34.
Based on a configurable setting on the HAS server, once an import
file reaches a threshold age, it will be deleted from the server.
The default setting for the automatic deletion is set to three days.
The configuration should be performed by the administrator.
For additional information on the installation and configuration
of the HAS refer to the CardioDay V2.5 Installation and Field Service
Manual.
Recording > Delete

This menu opens a window with a list of all ECG recordings currently
available in your CardioDay data folder.

The Recording menu
NOTICE:
IRREVERSIBLE DATA LOSS - Deletion is irreversible. Recordings
cannot be undeleted.
This operation should be performed only by knowledgeable
and approved operators.
NOTE:
You can delete recordings individually or in groups. To do so,
you can, for instance, search for Name and then delete all re-
cordings of a patient.
You may select an ECG recording that you wish to delete by marking it
with the mouse or using the Up and Down arrow keys. If you wish to
select several consecutive recordings simultaneously, hold the Shift
key while selecting the recordings. Once all selections have been
made, the recordings can be deleted by clicking the OK button. Be-
fore actually deleting the recordings, CardioDay asks you to confirm
your decision.
Recording > Exit

This command enables you, after confirmation, to exit CardioDay.

22 The Recorder menu
22
This menu serves for the data exchange between the PC and differ-
ent types of recorder.
 The Hookup function allows you to prepare and start a Holter
recording. Depending on the recorder type, the connection for
patient data transfer and signal quality evaluation can be es-
tablished via Bluetooth or USB cable.
 The Transfer patient data function is used when no signal
quality evaluation is intended during recording preparation.
 The Download recording and Download long recording
functions can be performed via USB cable only.
 The Download event recordings function is only used if an
event recording from the recorder type CM 3000 L3 is availa-
ble.
Recorder > Hookup

From the Hookup window, you can add new recorders (connect a
USB recorder or find additional Bluetooth recorders within range),
manage existing recorders, or connect to an existing recorder.
Once connected to a recorder, CardioDay Hookup also allows you
to:
 transfer patient data from the PC to the recorder prior to
starting the recording,
 synchronize the recorder's internal clock with the PC's clock,
 view ECG data (check the patient skin prep, signal quality, am-
plitude, electrodes, and leadwire continuity) from the recorder
on the evaluation PC prior to starting the recording,
 start the recording,

The Recorder menu
 view ECG data from the recorder online on the evaluation PC

during the recording phase, and
 send an event marker signal to the recorder.
The following table shows which recorder types can be connected
to the Hookup window and which interface is supported for each
type.
Recorder type Bluetooth USB
CardioMem CM 4000 (with enabled Bluetooth Yes No
option)
CardioMem CM 3000-12 BT Yes Yes
SEER 12 No Yes
SEER 1000 Yes No
NOTE:
Bluetooth connection requires the Microsoft Bluetooth stack.
Third-party Bluetooth drivers are not supported. The USB con-
nection is established with a standard Mini-USB cable.
NOTE:
The identifier code for a Bluetooth-connected recorder is
based upon the unique MAC address of the Bluetooth™ mod-
ule implemented within the recorder (MAC = Media Access
Control, unique network identifier). If a recorder is connected
using a USB cable, the first device found is used.
CAUTION:
PROBLEMS WITH WIRELESS DATA TRANSFER – Your own wire-
less data exchange, as well as the proper functioning of other
wireless devices in the vicinity, can be disturbed even if you
use approved devices.
If your computer’s internal Bluetooth module cannot connect
to the recorder, disable the internal module and use the Blue-
tooth USB adapter.
Adding a recorder to the recorder list

The list of recorders in the lower right corner of the Hookup window
is initially empty. Recorders must be added to this list prior to use in
the Hookup window.
NOTE:
If the recorder you want to use is already displayed in the list
below the patient data form, you can skip to the section “Es-
tablishing a connection to a device already in the recorder list”
on page 209.
The method of proceeding depends on the selected Recorder type
and connection method (Bluetooth or USB cable).

The Recorder menu
Hookup > Recorder selection
Adding a CardioMem CM 3000-12(BT)

For the CardioMem CM 3000-12 BT, an online ECG is possible via
Bluetooth or via USB cable. This section explains the connection via
Bluetooth. To connect via USB cable, refer to “Adding a SEER
12(USB) or CM 3000-12(USB) recorder” on page 207.
Hookup > Recorder type and MAC entry field
1. Select CM 3000-12(BT) from the recorder type field at the bot-

tom of the screen.
2. Click the Add recorder button.
3. Enter the MAC address located on the back of the recorder
into the field provided.
4. Click the Search rec. button.
The recorder is now included in the recorder list and is ready
for Connect.
Adding a CardioMem CM 4000(BT)

For the CardioMem CM 4000, an online ECG is possible via Bluetooth
only.
1. Select CM 4000(BT) from the recorder type field at the bottom
of the screen.
3. Enter the MAC address located in the device user interface un-
der the info section into the field provided.
4. Click the Search rec. button.
The recorder is now included in the recorder list and is ready
for Connect.
Adding a SEER 12(USB) or CM 3000-12(USB) recorder

For the SEER 12, an online ECG is possible only via USB. The Cardio-
Mem CM 3000-12 BT can be connected via USB or Bluetooth. This
section explains the connection via USB. To connect the CM 3000-

The Recorder menu
12 BT via Bluetooth, refer to “Adding a CardioMem CM 3000-12(BT)”

on page 207.
1. Connect the recorder to the computer's USB port using a USB
cable.
2. Depending on your recorder type, select SEER 12(USB) or
CM3000-12(USB) from the recorder type field at the bottom of
the screen.
3. Click the Add recorder button
CardioDay reads the MAC address of the recorder. The re-
corder is now included in the recorder list and is ready for
Connect.
Adding a SEER 1000 recorder

1. To add a new SEER 1000 recorder, select SEER 1000(BT) from
the recorder type field.
Hookup > Recorder type
A window opens displaying all SEER 1000 recorders found in

the vicinity. Be sure that Bluetooth is enabled on both the PC
and the recorder, and observe all information provided in the
recorder's manuals. It may take up to a minute to find all of
the detectable SEER 1000 recorders within range. SEER 1000
recorders that have been found will be added to the recorder
selection list.
Hookup > Bluetooth Find device selection window
The New column in the Find device list indicates if a recorder

has not yet been added to the recorder list.

The Recorder menu
3. Select the desired recorder from the list.

It is now included in the recorder list on the screen and is
ready for Connect.
Hookup > Recorder list
Resetting a SEER 1000 recorder if necessary

Once communication with a SEER 1000 recorder has been estab-
lished, a protection key, which is automatically generated from the
administrator password, is downloaded to the recorder. After that,
the recorder can only be accessed by applications that have the
same administrator password. If a recorder needs to be reset, use
the following instructions.
NOTICE:
Resetting the recorder deletes all the data on the recorder
and resets the protection key.
1. Click Add recorder.
2. Select the desired recorder in the list.
3. Click Reset and confirm.
A message box is displayed when the reset is complete.
Establishing a connection to a device already in the

recorder list
If the recorder is already displayed in the list, select the recorder
and click the Connect button.
When you click the Beep button, the currently connected recorder
emits an acoustic signal.
Receiving or sending patient data

If there is patient data already stored in the recorder, you can dis-
play it from recorders of the CardioMem series in CardioDay by
clicking the Receive button.
If the SEER 1000 is used, existing patient data are displayed auto-
matically in the patient data form.
While connected to a recorder, you can transfer new patient data
to the recorder or edit existing patient data. Click the Send button to
transfer the new or modified patient data to the recorder con-
nected.

The Recorder menu
Site and Location

Set the Site and Location for the recording. The Site and Location
assigned to the current user will be available in the drop-down
menu. The default Site and Location of the current user is selected
automatically.
If no default Site and Location is assigned to a user, Unknown is se-
lected by default. You can select any other available Site and Loca-
tion. The selection of Unknown assigns the recording to any Site
and Location and makes it visible to all users. For details, refer to
“Setup > Site and location administration…” on page 243 and to
“Site and Location management for users and groups” on page 253.
Processing MUSE orders

If your CardioDay is connected to MUSE, a MUSE orders button will
be available. For additional information refer to “Setup > Other op-
tions > MUSE connection” on page 234.
Hookup window with Muse Orders button enabled
Clicking the MUSE orders button will open the list of available Holter
MUSE orders which can be transferred to the recorder. To transfer
the data, select the desired patient from the order list. The patient
information will now be automatically displayed in the patient data
form. Select Send to transfer it to the recorder.

The Recorder menu
Muse orders window
After the patient order data has been sent to the recorder, the order
will no longer appear in the MUSE orders list.
Recorder settings for a recording, the Options field

If you use a CardioMem recorder, clicking the Transfer PC time but-
ton will set the clock of the recorder to the current computer time.
If you use a SEER 1000 recorder, the clock of the recorder will be au-
tomatically synchronized to the current computer time.
Clicking the Options button will open a window where you can se-
lect the Recording duration.
The battery state is displayed in the Hookup main screen on the
left-hand side of the electrode placement window. If the symbol is
red, it indicates that the battery does not have enough capacity for
the selected recording duration. The battery will need to be re-
placed.
In addition, for the SEER 1000 recorder, you can also set the Auto-
delete option and view the Battery type displayed. If Autodelete is
checked, recordings will be deleted from the recorder after they
have been downloaded to CardioDay.
Viewing ECG waveforms and checking the signal quality

Next to the patient data you can see the online ECG for signal eval-
uation. At the bottom right, you can select the channels to be dis-
played as well as set the speed and the amplitude.

The Recorder menu
Recorder > Hookup ECG
Furthermore, for the SEER 1000 recorder, the electrode placement

guide is displayed. The recorder automatically detects the type of
cable being connected and shows the correct positioning of the
electrodes.
If an electrode is not connected, or if the signal quality is insuffi-
cient, this is indicated by a red blinking in the torso and at the re-
spective channel (colored marking of the electrodes).
When you click the Full screen button, the display will hide the pa-
tient demographic frame and the waveforms will occupy the entire
horizontal screen area.
Clicking the Split screen button will return to the split screen con-
taining the patient demographic form.
Print diary
When you select Print diary, a page can be printed on which the
patients can note their performed activities during the recording
duration.

The Recorder menu
Hookup > Print diary
Recorder > Transfer patient data

The method for transferring patient data varies depending on the
type of recorder being connected:
 The recorders of the CardioMem CM 3000 and the SEER 12 se-
ries use memory cards that can be removed. For downloading
recording and patient data, a CompactFlash card reader is re-
quired.
 The recorders of the CardioMem CM 4000 and the SEER 1000
series have non-removable memory cards. For downloading
recording and patient data, the recorder is connected to the
PC via the integrated USB interface.
Before starting the recording, the Patient data can be transferred

to the memory of the recorder.
If you select Transfer patient data, the patient data window opens.
When CardioDay is connected to an Electronic Medical Record (EMR)
with GDT interface, the data of patients transferred from this system
may already be entered in the patient data window and are not ed-
itable.
If your CardioDay is connected to MUSE, you can receive orders
from MUSE. Clicking the MUSE Orders button will open the list of

The Recorder menu
MUSE orders from which you select a patient. The patient selected
is automatically included, together with the existing data, in the cor-
responding entry fields of the form. After this, the patient selected is
not listed anymore in the MUSE Orders list.
Window for patient data transfer
Clicking the Options button will open a window where you can
set the Recording duration. In addition, for the SEER 1000 recorder,
you can also set the Autodelete option and the Battery type. If
Autodelete is checked, recordings will be deleted from the recorder
after downloading to CardioDay. For details, refer to “Setup > Site
and location administration…” on page 243 and to “Site and Loca-
tion management for users and groups” on page 253.
Recorder > Download recording or Download long

recording
You can find the information in Chapter 3, “Downloading ECG data”.
Recorder > Download event recording

NOTE:
Event recordings that have been recorded using the
CardioMem CM 3000 L3 recorder are not downloaded directly

The Recorder menu
from the recorder but are imported. For further information,

please refer to the section “Recording > Import…” on page 201.
Event recordings that have been recorded using the CardioMem CM
100 XT recorder can be downloaded directly from the recorder:
1. Select the Event recorder symbol to open the Import record-
ings window.
2. Select CM 100 XT from the File type menu.
3. Review the Recorder information and the Current setup.
4. Select OK.
The recorded events will be downloaded.

23 The Export menu
23
This menu allows you to export data using the Print to file or HRV
data export functions.
Export > Print to file …

CardioDay can export the selected printout options for ECG recordings
in portable document format (PDF). The setting for File printer name
in the menu Setup > File path (see page 228) determines which for-
mat is created. The contents of the archived files depend either on
the print selection saved for each recording or on the current de-
fault. For additional information, refer to “Default and customized
print selection templates” on page 154.
NOTE:
You may select a single recording or a number of recordings
simultaneously.
You may select an ECG recording by marking it with the mouse or
using the Up and Down arrow keys. If you wish to select several
consecutive recordings simultaneously, hold the Shift key while se-
lecting the recordings.

The Export menu
Export > HRV data export

Heart rate variability data, for both the time and frequency domains,
are stored in two separate files in the patient’s subdirectory.
HRV data export window
Before exporting the data, you may select in which time range
within the complete recording you are interested.
Also, you may determine whether or not the QRS trigger times for
the complete recording are stored in a QRS.TXT file. If this box is
ticked, a *.txt file is created which lists the time, the class character-
istic, a possible link to an event, and the heart rate for each QRS
complex.
The Export ECG data (MIT Format) option serves for storing the raw
data of the complete recording in the MIT data format. In this pro-
cess, two files are stored in the CardioDay data directory: <patient
name>.dat and <patient name>.hea.
In the same way, you can export data also in the CSV format and
the XML format.

24 The Archive menu
24
The Archive menu enables easy archive administration of your raw
data recordings and analysis results (Archive, Restore, Delete).
Once the data has been archived, you need to restore it before it
can be reviewed again.
For information on Archive configuration settings, refer to “Setup >
Other options > Archive” on page 230.
Selecting for archiving

Open the Archive menu and select the recordings to be archived
from the recording list. If you enter a patient’s name, the respective
line is found automatically.
The data will be compressed and stored in the directory set as the
archive file path. For information on the archive file path refer to
“Setup > Other options > Archive” on page 230.
Select for archiving

The Archive menu
Selecting for Restoring

If you want to retrieve data from your archive, you will need to re-
store them first. For the Restore function, you can select via Filter
the search criteria Last name, Patient ID, and Referring Physician.
You can also select different time values as search criteria for the
recording to be restored: the time a recording was started (Start of
recording), the time a recording was archived (Archive), or the time
a recording was analyzed (Analysis).
Select for restoring
Select a recording from the Restore recordings list and click OK.
The recording will be restored in your CardioDay database.
Deleting recording(s) from the archive

Single or multiple recordings can be deleted from the archive.
Select the Archive > Delete menu to display the archived recordings.
For the Delete function, you can select via Filter the search criteria
Last name, Patient ID, and Referring Physician. You can also select
different Time values as search criteria for the recording to be re-
stored: the time a recording was started (Start of recording), the
time a recording was archived (Archive), or the time a recording
was analyzed (Analysis).
Select one or multiple recordings and click Delete. When prompted
to confirm the deletion, click OK.

25 The Extras menu
25
In the Extras menu, you can start a reanalysis of events without
changes to the QRS classification, you can start a printout of the
current screen, and you can create the 12-channel markers.
Extras > Reanalyze events...

When you select this option, you are first asked if you wish to change
any analysis parameters. If you answer with yes, a window opens
allowing you to make the appropriate changes. If you answer with
No, the event analysis is carried out with the original parameter settings.
Extras > Print screen

This option is not a hard copy of the current screen contents. Instead,
this menu option enables you to first preview and then print a hard
copy associated with the current screen contents.
For example, if you are currently on the Report tab, then the printout
will be the report. If, on the other hand, you are currently on the
Classes tab, then the window will open with an ECG in a fixed set-
ting of 25 mm/s.
Settings for the screen printout in the print selection
In the left part of the line below the waveform representation, you
can choose the view of the print selection: By entering a value in the
Zoom field or by clicking the blue symbols you can set the enlarge-
ment or reduction in percent.

The Extras menu
Please enter how many Page(s) you want to print.
NOTE:
If you call up this option by clicking the Print screen symbol in
the tool bar, the screen content will be printed without print
preview.
Extras > Create 12-channel markers…

In this dialog, you can edit an AutoCreateMarker.txt file used by
CardioDay for the 12-channel module. The purpose of this file is to
create markers in 12-channel recordings automatically. A marker
definition consists of seven fields, as explained by an example in the
dialog.
To locate your data path, select Help > Version and find the Data
Please note:
 Only one marker can be defined for a given time/time offset.
 The absolute/calculated marker time must be within the
scope of the recording.

The Extras menu
Create 12-channel marker
Example:
(The “;” character is used to denote the start of a comment.)
; Create marker at 04:00 AM
;| Use reference time field
;| | 5 s pre / post time
;| | | Centered
;| | | | Perform measurement
;| | | | | Color
;| | | | | | Name in marker list
;| | | | | | |
04:00 n 5 m y red Marker1
“n” stands for No.
“y” stands for Yes.

26 The Setup menu
26
The Setup menu allows you to configure certain features of
CardioDay.
Setup > Screen, Scale, and Colors

NOTE:
If some of the screen text is not visible, the most likely cause is
that the font size option of your Windows desktop is set to
large fonts. In this case, please change the setting to small
fonts.
If you notice that the ECG grid shown in the Classes window
on your screen is not scaled correctly, carry out the steps de-
scribed below.
Unfortunately, there is no general solution for plotting a standard-
ized grid on the computer screen. Factors, which influence the final
size, include the size and resolution of the screen at hand. To solve
this problem, CardioDay offers the possibility of scaling the grid so
that standardized sizes, such as 25 mm/s and 1 mV/cm, result. To
scale the grid, go first to the Setup > Screen > Scale menu.
Before you adapt the scale you can select between two different
box sizes.
 The icon with the larger box will lead to a box measure of
1 mV and 400 ms (for a 25mm/s and 10 mm/mV display).
 The icon with the smaller boxes will lead to a box measure of
0.5 mV and 200 ms (for a 25mm/s and 10 mm/mV display).
By adjusting the zoom factor you can increase or decrease the size
of the box and the waveform displayed on the screen.

The Setup menu
Window to calibrate the grid size
Using the mouse, move the slide control displayed until you meas-
ure, for the larger box selection, 10 mm x 10 mm or for the smaller
box selection 5 mm x 5 mm.
Once the scale has been adjusted, the settings are automatically
saved. The scale does not need to be readjusted each time the pro-
gram is started. However, if you connect a new screen to your com-
puter or change the resolution in any way, then you will need to
manually recalibrate the scale factor again.
This sub-menu also gives you the opportunity to change the colors of
the individual ECG, the background grid, and, if present, the imped-
ance plethysmogram curve. Alternatively, you may select a default
color set.
Setup > Screen options

The Setup menu
NOTE:
Most of the screenshots presented in this manual were gener-
ated using default 2.
With regards to the ECG display, you may select colors for the
ECG waveforms, the background grid, the vertical trigger markers,
and individual colors for the various QRS morphologies, i.e., color-
coded beats.
Select Colors
If you select the With anti-aliasing option for smoothing the ECG
waveforms, any “staircase” effects will be eliminated on the Clas-
ses and Events tabs.
If you select the Show scale option to include the scaled grid, the
ECG is displayed in front of a grid corresponding to the criteria set
for time and amplitude.
With regards to the statistic diagrams, you may select the colors of
4 curves. Furthermore, you may choose the color of the selectable
background heart rate curve in the Other options menu.
Setup > Screen color selection

The Setup menu
Setup > File path…

This option allows you to set the following:
 The directory to which patient data are exported
 The directory from which patient data are imported
 The format, character set, and line length of the import/export
data file
The format refers to different export locations like MUSE, GDT
interface, or WorklistCommander. For additional information,
refer to the CardioDay V2.5 Installation and Field Service Man-
ual.
 The directory for Print to file results

 The name of the file printer/driver (e.g. integrated PDF Printer
or pdfFactory)
 The file name format, extension, and name variables of the
print file
Window for setting directory paths

The Setup menu
Enter the directory paths for exchanging patient information data in

the top two lines of the window.
The Patient data import/export format option allows to set the de-
sired path for import and export by selecting a number. For infor-
mation refer to the CardioDay V2.5 Installation and Field Service
Manual.
The Print to file parameters can be entered here. These files can be
generated one by one for single printouts clicking the PDF button.
(For additional information, refer to “Configuring a PDF file destina-
tion” on page 154.) Also, you can generate several files at a time by
using the Export > Print to file menu.
Setup > RR-FFT options

This menu opens a window that allows you to adjust the fre-
quency limits used by the Heart rate variability fast Fourier trans-
form (RR-FFT) calculations on the Heart rate variability
tab and by the sympathetic innervations index calculations in
the FFT area of the Statistics tab.
Setup > RR-FFT options
Setup > Other options

The Other options window has tabs that provide access to the fol-
lowing options:
 Archive
 Miscellaneous
 TWA
 MUSE connection
 Monitoring acquisition connection

The Setup menu
Setup > Other options > Archive

The Archive tab allows you to set where and how the archived re-
cordings will be stored.
NOTE:
Recordings that are not yet printed or diagnosed can be ar-
chived manually.
Setup > Other options > Archive
Field Description
Path Defines the location where the archived recordings
will be stored.
Low resolution archiv- Reduces file sizes by lowering the resolution of ar-
ing chived files. However, if a recording is archived
with this setting enabled, the quality of the wave-
form data is affected. It will not be possible to re-
store the waveform data to its original fidelity.
Automatically delete Deletes recordings from the CardioDay database
archived recordings after they have been successfully archived. If re-
quired, archived recordings that have been deleted
can be restored from the archive.
Automatically archive Defines those statuses for which recordings are
recordings marked in automatically archived. Options are printed, diag-
the status column as nosed, and exported to MUSE. When a recording's
status changes to match all of the selected status
values, it will be archived automatically.

The Setup menu
Setup > Other Options > Miscellaneous

The Setup > Other options > Miscellaneous tab allows you to
change additional settings for your individual evaluation procedure.
Setup > Other options > Miscellaneous
Statistics
Using the Heart rate as background check box, you can select
whether or not the heart rate trend curve should be blended into the
statistic diagrams. The Waveform color button allows you to select
the color of the heart rate curve.
Heart rate diagram

Check the With minimum and maximum heart rate check box to
include the minimum and maximum heart rate curves with the ac-
tual heart rate trend curve. The heart rate trend is the average
heart rate measured over a 1-minute interval. The minimum heart
rate curve shows the minimum value calculated as a moving aver-
age over 10 beats during the same 1-minute interval. The maxi-
mum heart rate curve shows the maximum value, again calculated
as a moving average over 10 beats during the same 1-minute pe-
riod.
If you check the not for B/W printouts check box, minimum and
maximum heart rate will not be displayed in black and white
printouts.

The Setup menu
Event display
The With marker frame check box determines whether a box will
be drawn around the section of the ECG that corresponds to the
event selected on the Events tab. The Frame color button deter-
mines the color of that box.
ECG strip
The Default time axis field determines the default display speed
when opening or downloading a recording. This setting becomes
active the next time a recording is opened or downloaded.
Event sorting
This option allows you to set which criterion, either Duration or
Heart Rate, you want to use for sorting the events VE Tachycardia
and SVE Tachycardia with keyboard navigation of the Events tab.
Open dialog
When this option is selected, the cursor automatically jumps to the
first recording in the list of patients that has not been marked as
printed. If not selected, the cursor jumps to the top of the list.
Title bar
When this option is selected, the default parameter set used for the
analysis, along with the patient name, is displayed in the title bar at
the top of the window.
ECG analysis
For your ECG analysis, you can select on the following options:
 SVE Tachycardia need not begin with an SVE event
 SVE’s within an SVE Tachycardia are marked as SVE’s
Recording cache
This option determines the Number of cache files.
For better performance, a number of recordings can be cached in
an uncompressed format on the hard disk. A default of 6 is already
set. In this case, the last 6 recordings are loaded in an automatically
generated intermediate disk location to enable faster access. De-
pending on your hard disc storage capacity, you can select a higher
value.
Setup > Other options > TWA

The Setup > Other options > TWA tab allows you to set parameters
for the TWA analysis.

The Setup menu
Setup > Other options > TWA
Set the Update factor for the averaging of the even and odd beats.
Default is 1/8. The higher the denominator, the slower the averaged
ECG follows changes in the incoming signal.
Set the maximum Heart rate threshold and Noise threshold. If the
heart rate or noise exceeds the corresponding value, no analysis is
performed for this section.

The Setup menu
Setup > Other options > MUSE connection

The Setup > Other options > MUSE connection tab allows you to
configure the connection between CardioDay V2.5 and the MUSE
Cardiology Information System.
As a prerequisite for receiving MUSE orders in CardioDay, the MUSE
API (Application Programming Interface) needs to have been pur-
chased and licensed.
Also, the communication with the MUSE API needs to be configured.
For additional information refer to the CardioDay V2.5 Installation
and Field Service Manual.
Setup > Other options > MUSE connection
Enter the necessary information in the following fields:

 Host: Host name or IP address by which the MUSE API can be
accessed.
 Port: Port by which the MUSE API can be accessed. Default
port: 8100.
 Name: User name of the MUSE account under which the com-
munication with the MUSE API takes place.
 Password: Password of the MUSE account under which the
communication with the MUSE API takes place.
 Site number: ID of the MUSE site from which the examination
orders are to be retrieved.

The Setup menu
 Exclude diagnosis on printed report: If enabled, the diagnosis

text entered on the Report tab will be excluded from the
printed or pdf report. A message will be printed instead of the
diagnosis.
 Excluded diagnosis hint message: You can select and/or
write the hint message that is displayed instead of the diag-
nosis text if the diagnosis has been excluded from the printed
report using the previous setting.
Consult with your local GE Healthcare Service Representative or
MUSE System Administrator for proper MUSE system configuration
settings.
Setup > Other options > Monitoring connection

The Setup > Other options > Monitoring connection tab allows you
to identify the Name, Host, and Port of up to 10 servers used by the
Holter Acquisition Service (HAS). If desired, one of the servers can be
set as default in order to automatically load the recording list when
importing monitoring data as described in “Recording > Import…” on
page 201.
Other configurations can be done by the administrator using the
HAS tool. For further information, refer to the CardioDay V2.5 Instal-
lation and Field Service Manual.
Setup > Other options > Monitoring acquisition connection

The Setup menu
Setup > Report

The report is comprised of two parts, Summary and Diagnosis.
The Summary is software-generated according to the report tem-
plate for the respective recording type. You should not edit the sum-
mary manually.
The report templates available for customizing are listed in the
Setup > Report menu. You find the necessary information in “Cus-
tomizing and saving report templates” on page 236. You can further
customize the summary using script programming as explained in
“Setup > Report > Advanced > Narrative report” on page 240.
The Diagnosis, below the Summary, is entered manually. You can
use the text processing tools explained in “Setup > Report > Ad-
vanced > Text modules” on page 239 and in “Setup > Report > Ad-
vanced > Word- and phrase auto-completion” on page 241.
Customizing and saving report templates

When a report is generated, CardioDay automatically selects the re-
port template based on the recording type and the report’s pur-
pose, e.g., whether the recording is a pacemaker recording and
whether the report is to be exported to a hospital information sys-
tem.
Using the variables listed in the appendix of this manual, you can
edit the content of the report summary. You can store additional
customized report templates for further use.
Summary of the Report
Every Setup > Report sub-menu opens a window where you can
open the respective template as RTF file with Microsoft WordPad.

The Setup menu
Setup > Report
The following default report templates are installed:

Standard Standard report layout
Pacemaker Standard report layout for pacemaker recordings
Export Standard report layout when exporting the report to a
hospital information system
Export PM Standard report layout for pacemaker recordings when
exporting the report to a hospital information system
Export event re- Export of event episodes imported from an event re-
corder corder
Event Recorder Standard report layout for event recordings
Long recordings Standard report layout for recordings of more than 48
hours
Long recordings Standard report layout for pacemaker recordings of more
PM than 48 hours
Export long Standard report layout when exporting the report of re-
recordings cordings of more than 48 hours to a hospital information
system
Export long Standard report layout when exporting the report of
recordings PM pacemaker recordings of more than 48 hours to a hospi-
tal information system
NOTE:
The report templates supplied with CardioDay V2.5 for the
software-generated summary of the report have been thor-
oughly validated. When inserting or changing variables in a
report template, take special care in verifying the correct dis-
play of those values.
For customizing the report templates, they are selected in the Re-
port menu and opened with Microsoft WordPad. You can also open
the file in Microsoft Word in order to use tables, which makes it eas-
ier to align the content.

The Setup menu
Example of an RTF template file
All files contain descriptive text (e.g., Number of QRS complexes:) and a
$-variable with optional control characters (e.g., $QRS_NO:6). During
printout, the variables are replaced by their corresponding actual value.
Up to two figures separated by a colon can be added to the variable
as format instructions. This allows you to specify the minimum
number of print characters to be used in printing and the number of
digits after the decimal point.
In any of the files, you can change the descriptive texts and use
the $-variables as required to specify and arrange the contents of
the tables.
The example
Number of QRS complexes: $QRS_NO:6
would be presented in the report as
Number of QRS complexes: 123456
if the real number of recognized QRS complexes was 123,456.
Save the template file when it suits your needs.
You can save the customized template under another name as an
RTF file. The template saved will be displayed in the dropdown list in
the upper right part of the Report tab. You have to switch between
tabs once before you can select the new template from the
dropdown list.
NOTE:
Additionally, you can program the templates as described in
“Setup > Report > Advanced > Narrative report” on page 240.

The Setup menu
Setup > Report > Advanced...

The Advanced sub-menu comprises tools to assist you in entering
your Diagnosis. The sub-menu has options to insert Text modules
or to activate Word and phrase auto-completion.
Also, you can include a narrative report section through the use of
the Script Programming function.
Text modules button next to the Diagnosis part of the Report
Setup > Report > Advanced > Text modules

To define your own customized text modules, use the Text modules
menu.
If you select the Setup > Report > Advanced... menu, a window for
your entries opens.
Setup > Report > Advanced > Text modules
To define a new module, first define an appropriate abbreviation or

mnemonic, then use the Tab key to exit the field.
The program automatically assigns a hotkey combination to this text
module and places the cursor in the editor section of the form, allow-
ing you to enter the actual text.

The Setup menu
 To complete, store the text entered by clicking .

 To enter a new text module, click the “+” icon.
 To remove a module, click the “– ” icon.
Setup > Report > Advanced > Narrative report

NOTE:
For this option, you need experience in script programming.
The results of your script are not included in the software-
generated summary of the report until you enter the $NARRA-
TIVE variable into the respective template.
Setup > Report > Advanced > Narrative report
Script programming allows you to generate formulated text for the

software-generated summary of the report. To do so, you insert
variables into the Script text portion of the window. This programs
the template to display certain information dependent upon the

The Setup menu
outcome of programmed conditions. For a list of the variables you

can insert, see the appendix of this manual.
Select the Type of recording.
On the Script sub-tab, you program your report.
On the Preview sub-tab, you can evaluate the print result and the
text generated using the variables.
Setup > Report > Advanced > Word- and phrase auto-completion
If your reports contain recurring text, it is practical to use Word and
phrase auto-completion.
Setup > Report > Advanced > Word- and phrase auto-completion
If you select the Activate or Collect options, the software stores the
entered text and automatically inserts it the next time you start to
type the text in a report.
The inserted text will disappear as soon as you type a character
that does not match the stored text.

The Setup menu
Setup > 12-channel markers…

You can set the parameters for the 12-channel markers in this dialog:
12-channel marker setup
Marker setup:
 a Default text to name this specific marker
 Pre- and post-trigger period
You can also select:
 Print immediately,
 Automatic measurement,
 Color, and
 Prompt for text input.

The Setup menu
By left-clicking the Print setup button, you open a dialog in which you
can set printing options for each page separately.
Marker setup, Print settings for 12-channel markers
Setup > Printer…

This menu item opens the normal Windows printer selection win-
dow, where you can select a printer for CardioDay other than the
default Windows printer.
Setup > Rebuild list of recordings

It is only necessary to create a new list of existing recordings if the
contents of the recordings’ subfolders have been changed manu-
ally. Normally, it is not necessary to use this menu command.
This procedure may take several minutes to complete, depending
on the number of recordings and the speed of the computer/net-
work.
Setup > Site and location administration…

The Site and location administration window allows the adminis-
trator to manage different sites and locations within CardioDay.
You can set up to 254 different sites and 65535 locations per site.
The location setup limit is 254,000 locations.

The Setup menu
Link and add correct title
Add site
1. At the Site and location administration window, click the Add
site button.
The Add site window opens.
2. Enter the Site number (1 to 254) and Site name.
3. If you are sending the report to a MUSE system, you can enter
the Path for MUSE export to set the location of the report
when using the Export button.
NOTE:
If you enter the Path for MUSE export here, the Path for
MUSE export set in the Setup > File path… menu will not
be used.
4. Click the folder symbol to add the path.
If no export path is entered, a default export path is used. See
“Setup > Other options > MUSE connection” on page 234.
Add site
5. Click the Add button.

The site will now be displayed in the Site and location admin-
istration window.

The Setup menu
Add a location
1. Highlight the Site in the Site and location administration win-
dow to which you want to add a location to.
2. Click the Add location button.
The Add location window opens.
Add location
3. Enter the Location number (0 to 65534), Location name and

the Location abbreviation.
4. Click the Add button.
The location will now be displayed in the Site and location ad-
ministration window under the selected site.
Editing a Site or Location

You can edit a site or location by selecting the corresponding site or
location and pressing the Edit button. The Edit site or Edit location
window will open and you can edit the Number, Name, Path for
MUSE export, or Location abbreviation.
Disabling a site or deleting a location

Sites can be disabled and locations deleted.
If a site should be disabled, proceed as follows:
1. Select the site.
2. Remove the checkmark from the checkbox Enabled.
The site will still be visible in the list but shows a red symbol
that indicates that this site is no longer enabled. Disabled sites
can no longer be assigned to any user and cannot be seen by
any user.
If a location should be disabled, proceed as follows:
1. Select the location
2. Click the Delete button.
The location will now be removed from the list. It will no longer
be visible in the Site and location administration window and
the location can no longer be assigned to a user.

The Setup menu
If a site/location is assigned to a user who has no other site / loca-

tion assigned, the disable/delete functionality will not be active. An
error message will explain that this operation is not possible.
NOTE:
Disabling sites or deleting locations will hide recordings as-
signed to the site or location for users that do not enable No
site/location filtering as explained in “Site and Location man-
agement for users and groups” on page 253.
Importing Sites and Locations from MUSE

Sites and locations can be set up identically in the MUSE System
and CardioDay by importing CSV files containing site and location
information from the MUSE system.
1. Click the Import from CSV files… button.
A file browsing dialog opens.
2. Select the CSV file that contains the site information and click
Import.
NOTE:
It is assumed that for each site that is defined in the sites CSV
file, a CSV file containing the locations for this site is located in
the same folder. The location CSV files should be named
MuseLocationData_Site<SITENUMBER>.CSV.
Setup > User administration…

NOTE:
The User administration menu is only accessible if you are
logged into CardioDay as administrator.
In the User administration dialog, you can create and delete
user and group accounts, assign user rights to existing accounts
and change the password for local user accounts. Sites and loca-
tions can be assigned to a user or to a user group.
Overview
With local CardioDay user accounts and CardioDay user group
accounts, two kinds of user accounts can be distinguished in
CardioDay. Both types only differ in the mechanism used to grant
a set of CardioDay user rights.
 Local CardioDay user accounts
The local user accounts are stored and managed by
CardioDay in the CardioDay database independently of
the Windows user accounts. Each user account has to be
created by a CardioDay administrator manually.
A user can log on to CardioDay using the user name and
password of a particular local CardioDay user account.

The Setup menu
 CardioDay user group accounts – Single Sign-on (SSO)

The user group accounts are also stored and managed by
CardioDay in the CardioDay database but are related to Win-
dows groups defined on the Active Directory Server(s) that
is/are managing the Windows Domain(s) of the Windows user
accounts running CardioDay.
For logon via a user group account, a user is identified on
CardioDay by using his Windows user name and password
(SSO).
CardioDay uses the names of the Active Directory groups of
this Windows user account to associate it with a CardioDay
user group account. One of the users Active Directory group
names has to correspond with the pattern of the CardioDay
user group account. Local Windows groups are not evaluated.
A configured local CardioDay user account or a CardioDay group
account can be marked with the Auto logon flag in the CardioDay
user administration.
If this flag is set, CardioDay does not prompt for user name and
password once one of the following conditions is true:
 The Windows user name of the user that is running CardioDay
matches with the user name of a local CardioDay account.
NOTE:
This feature is activated only if the workstation that is
running this CardioDay instance is not joined in a Win-
dows Domain.
 The Windows user account running CardioDay can be au-
thenticated via a CardioDay user group account.
If none of these conditions apply, the user has to enter user name
and password when starting CardioDay.
User administration for a new installation

By default, you will be prompted for User name and Password
when CardioDay starts:
User login

The Setup menu
On a new installation, type the following to log on as Administrator:

User name: Administrator
Password: 14012013
NOTE:
The Administrator user name is localized. Depending on the
system’s local settings, you may have to type a different
name, e.g., Administratör for Swedish, Administrateur for
French, etc.
CardioDay allows you to automatically log on local users or domain
groups (Single Sign-On) and to assign specific user rights to them.
Two user profiles are predefined and cannot be deleted:
 The Administrator profile has all user rights including user ad-
ministration.
 The Guest users profile has, by default, no rights assigned.
This profile is applied if the User logon window is skipped by
clicking the Cancel button.
Adding a new user account

To add a user account to CardioDay, proceed as follows:
1. Log in as Administrator.
2. Select Setup > User administration… to open the User ad-
ministration window.
User administration window
3. Click New user.

The Setup menu
Create new user window
4. Enter a User name.

The User name is not case sensitive.
5. Enter a Password with at least 8 characters. Repeat the pass-
word in the Repeat password field.
The password is case sensitive.
This password must be entered in the User logon window un-
der the following conditions:
o CardioDay is launched and the Auto Logon option is dis-
abled (see step 8).
o The Setup > Change user… menu is selected to switch
the current CardioDay user.
6. Click OK to close the New user window and return to the User
administration window.
7. Select the user rights for the new user or check Select all to
grant all user rights. Refer to "Selectable user rights" on page
251 for details.
8. Check Auto Logon to skip the User logon window when the
user launches CardioDay.
NOTE:
The Auto Logon feature for users is disabled on domain
computers.
9. Check Administrator if you want to grant additional user cre-
ation/administration rights to a user.
10. If required, repeat steps 3 through 9 to configure additional
users.
11. After you have configured all the new users, click OK to acti-
vate the changes.

The Setup menu
Adding a new group account (for domain computers

only)
To add a domain group to CardioDay, proceed as follows:
1. Log in as Administrator.
2. Select Setup > User administration… to open the User ad-
ministration window.
3. Click New group.
Create new group
4. Enter a Group name.

The group name is not case sensitive and must correspond to
an Active Directory group name.
NOTE:
If multiple domains are present in the network and
group members from other domains need to use
CardioDay, prepend the domain name followed by a
backslash, e.g., “Domain2\Group1”.
5. Click OK to close the Create new group window and return to
the User administration window.
6. Select the rights for the group members or check Select all to
grant all rights. Refer to "Selectable user rights" on page 251
for details.
7. Check Auto Logon to skip the User logon window when group
members launch CardioDay.
NOTE:
If Auto Logon is unchecked, group members must enter
their Windows user name and password in the User lo-
gon window when CardioDay is launched.
8. Check Administrator to grant the additional user administra-
tion permission to the group members, if applicable.
9. If required, repeat steps 3 through 9 to configure additional
domain groups.

The Setup menu
10. After you have configured all the new domain groups, click OK
to activate the changes.
Guest user rights on failed or canceled authentication

If the user cannot provide valid user credentials and cancels the
login procedure, CardioDay will grant the access to CardioDay on a
minimum user right level, depending on the Guest users configura-
tion.
The CardioDay administrator can change the minimum user rights
level by configuring the rights of the CardioDay Guest users.
Changing the default administrator password after

installation
NOTE:
Systems and recorders with mismatched protection keys will
be restricted from communicating and will not be able to
transfer patient/study information.
Error message when passwords do not match
For security reasons, it is highly recommended that the default

password of the CardioDay administrator be changed.
If the SEER 1000 App is used in combination with CardioDay, please
make sure to use the same administrator password in both CardioDay
and the SEER 1000 App. The configured administrator password will
be stored on the recorder as a protection key when patient data is
transferred to it.
Selectable user rights

To assign user rights to a CardioDay user or group, you have to be
logged in as an administrator. In CardioDay, each local CardioDay
user and CardioDay group account can be associated with a set of
user rights.
Check the user right in the list to allocate this right to the user or
user group currently marked.

The Setup menu
User administration > Assigning user rights
The following user rights are available:

Permission Enables
Open recording Recording > Open… menu,
Open toolbar button
Download recording Recorder > Download recording,
Recorder > Download long recording,
Recorder > Download event recording menus,
Download toolbar button,
Download recording,
Download long recording buttons on the Start
window
Import recording Recording > Import…,
Recording > Monitoring acquisition… menus
Reanalyze recording Recording > Reanalyze… menu (only enabled for
the currently opened recording. If the user/group
has additional Administrator right, the menu is al-
ways enabled)
Save parameter set Save as default button in the “Signal evaluation
and analysis parameters” window
Transfer patient data Recorder > Transfer patient data… menu,
Pat. Data toolbar button
Edit patient data All fields on the window opened with the Recording
> Patient data menu
Delete recordings Recording > Delete… menu
Print to file Export > Print to file… menu
Archive Entire Archive menu

The Setup menu
Permission Enables
Data export Export > HRV data export…,
Export > MIT export…,
Export > CSV export,
Export > XML export menus
(MIT / CSV / XML exports must be manually config-
ured in cardioday.ini)
Setup Setup > Screen > Colors,
Setup > RR-FFT…,
Setup > Rebuild list of recordings menus
Setup > Other options… menu (Miscellaneous tab
only)
Classes > Context menu> Colors
Classes > Channel selection>Save as default
Setup (advanced) Setup > Screen > Scale,
Setup > File paths…,
Setup > Report,
Setup > 12 channel markers… menus
Setup > Other options… menu (all tabs, Setup per-
mission must be enabled as well, Archive permis-
sion must be enabled to show the Archive tab)
Report > Select template
Print > Store template, Delete template
Print PDF and Print buttons on the Print tab
Edit analysis Editing in the Classes and Events tab,
Extras > Create 12 channel markers… menu for 12
channel recordings
Create report Editing in the Report tab
Change report Diagnosed checkbox on the Report tab
Hookup Recorder > Hookup… menu,
Hookup toolbar button,
Hookup button on the Start window
Administrator Setup > User administration menu
This list of user rights is predefined and cannot be changed.
Site and Location management for users and groups

NOTE:
To assign a site and location to a CardioDay user or group,
administrator rights are needed.
In CardioDay, each local CardioDay user and CardioDay group ac-
count can be associated with selected sites and locations. For fur-
ther details, refer to “Setup > Site and location administration…” on
page 243.
If a user is assigned to certain sites and locations, this user will only
be able to see recordings in the recording list or archive and restore
recording data matching these specific sites and locations.
To assign a site and location to a user or group perform the follow-
ing steps:

The Setup menu
1. On the Users tab, select the user or group.

2. On the Sites tab, select the site and corresponding location to
assign this site/location to the user or group selected on the
Users tab.
User administration
The first site and location selected for a certain user is auto-
matically set as the default.
3. To change the default selection, select another site and loca-
tion and select Default.
4. Select Select all to assign all of the sites and locations to the
user or group.
5. Select No site/location filtering to enable the user access to
all recordings on all sites and locations.
NOTE:
During an upgrade installation from a previous CardioDay
version, the No site/location filtering option is automatically
enabled for all existing users.
Setup > Change user

The Change user option allows a different user to log on to
CardioDay. When you change users, the CardioDay login
window opens, and the user must enter a valid CardioDay user
name and password.
NOTE:
The Change user action will log out the current user and close
any recordings that may be open at the time of logout. Any
unsaved changes in the open recording will be saved.

27 The Help menu
27
The Help menu displays the contents of the operator manual.
Help > Contents

This option helps to quickly find an answer in the online operator’s
manual.
Help > Quick start guide

This option helps to quickly find an answer in the online quick start
guide.
Help > About

This sub-menu lists the CardioDay program version, the serial number,
the UDI (Unique Device Identification), and the Host ID, as well as the
copyright notice.
Help > Version

This sub-menu lists the software versions of all the executable (EXE)
programs and DLL files (Dynamic Link Libraries) used in conjunction
with CardioDay.
This window also displays the following:
 The configured program and data directory paths
 The software key serial number
 The characteristics of your computer's hard drives
 The maximum number of concurrent users
 The Host ID, which is required for licensing

The Help menu
Help > Options

This sub-menu lists all the available optional features of
CardioDay. The ones that are marked with an X are activated
in your CardioDay. Note that not all the listed options might be
available for purchase in your region.

Part III
Appendices
A Variables for customizing the report templates
A
NOTE:
The report templates supplied with CardioDay V2.5 for the
software-generated summary of the report have been thor-
oughly validated. When inserting or changing variables in a
report template, take special care in verifying the correct dis-
play of those values.
For the necessary information, refer to “Customizing and saving re-
port templates” on page 236.
The variables are grouped as follows:
 “Patient data“, page 260
 “General data“, page 260
 “Analysis parameters“, page 261
 “Pacemaker-related analysis parameters“, page 261
 “Event data and measured values“, page 262
 “Heart rate variability parameters“, page 266
 “Heart Rate Turbulence and Deceleration capacity“, page 267
 “Combined variables“, page 267
 “Pacemaker data“, page 269
 “Information on the recording“, page 269
 “Information on recordings from an event recorder“, page 270

Variables for customizing the report templates
Patient data
Variable Meaning
$NAME Patient’s surname
$FORENAME Patient’s first name
$AGE Patient’s age
$ADDRESS Patient’s address
$BIRTH_DATE Patient’s date of birth
$GENDER Patient’s sex
$ID Patient’s ID as entered in recorder
$PHONE Patient’s telephone number
$REFERRED_BY Referring doctor
$PROCESSED_BY Operator
$TECHNICIAN_ID Technician (Patient data window)
$INSURANCE Patient’s medical insurance company
$INSURANCE_NO Patient’s insurance number
$INDICATION Indication of referring doctor
$MEDICATION Medication prescribed by referring doctor
$COMMENTS Comments of the evaluator
$VISIT_ID Visit ID
$ORDER_NUMBER Order number from MUSE or HL7
General data
Variable Meaning
$EVDATE Date of evaluation (date only)
$RECDATE Date of recording
$EVDATE_W Date of evaluation (including day of the week)
$DURATION Duration of recording
$START Time recording commenced
$USERNAME Name of the user name currently logged-in in
CardioDay
$CARDIODAYOPTION Option code in the SSA license file
$TOC Report contents
$DIAGNOSED_BY Name of the CardioDay user who sets the status
of the recording to “diagnosed”, actualization at
every change
$CREATED_BY Name of the CardioDay user who has down-
loaded the recording or has reanalyzed it

Analysis parameters
Variable Meaning
$PARAM_SET Parameter set used for analysis
$BRAD_LIMIT Threshold value for bradycardia detection
$SENSE1 (Download) amplification channel 1
$SENSE2 (Download) amplification channel 2
$VTACH_LIMIT Threshold value for VE tachycardia detection
$SVTACH_LIMIT Threshold value for SVE tachycardia detection
$SVT_MIN_BEATS Minimum beat count for SVE tachycardia
$PRE_SV Percentage above which an SV is considered
premature
$PRE_V Percentage above which a PVC is considered
premature
$PAUSE Minimum duration of pauses (anything below this
value is an arrhythmia)
$QRS_DIFF Type of QRS form differentiation
$R_ON_T Threshold for R-on-T detection (max. interval, no
searches beyond this value)
$DELAY_QRS Percentage of the current to average RR interval,
above which a QRS complex is considered de-
layed
$ST_CH1 Channel number of the first ST analysis channel
$ST_CH2 Channel number of the second ST analysis chan-
nel
$CH1_LEAD Designation of the 12-channel lead displayed in
the first channel
the second channel
the third channel
the fourth channel
Pacemaker-related analysis parameters

Variable Meaning
$PM_HYST Pacemaker hysteresis
$PM_MODE Pacemaker type
$PM_RATE Basic rate of pacemaker

Event data and measured values

Variable Meaning
$QRS_NO Total number of all detected QRS complexes
$BEAT_N_COUNT Total number of N beats
$BEAT_N_PERCENT Percentage of N beats
$BEAT_N_MAX_HOUR_COUNT Max. hourly count of N beats
$BEAT_N_MAX_HOUR_TIME The hour of the max. count of N beats
$BEAT_V_COUNT Total number of V beats
$BEAT_V_PERCENT Percentage of V beats
$BEAT_V_MAX_HOUR_COUNT Max. hourly count of V beats
$BEAT_V_MAX_HOUR_TIME The hour of the max. count of V beats
$BEAT_X_COUNT Total number of X beats
$BEAT_X_PERCENT Percentage of X beats
$BEAT_X_MAX_HOUR_COUNT Max. hourly count of X beats
$BEAT_X_MAX_HOUR_TIME The hour of the max. count of X beats
$BEAT_P_COUNT Total number of P beats
$BEAT_P_PERCENT Percentage of P beats
$BEAT_P_MAX_HOUR_COUNT Max. hourly count of P beats
$BEAT_P_MAX_HOUR_TIME The hour of the max. count of P beats
$PVC_PERC Percentage of PVC
$SVE_PERC Percentage of SVE
$BEATS_ALL_V_EVT Total count of beats in ventricular events
$BEAT_PERC_ALL_V_EVT Total percentage of beats in ventricular
events
$BEATS_ALL_SV_EVT Total count of beats in supraventricular
events
$BEAT_PERC_ALL_SV_EVT Total percentage of beats in supraventricular
events
$PQR_NO Total count of paced beats
$PQR_PERC Total percentage of paced beats
$AQRS_PERC PM analysis: percentage of atrial stimulation
with own transition
$VQRS_PERC PM analysis: percentage share of ventricular
stimulation with subsequent QRS complex
$BPM_MEAN Mean heart rate (HR)
$BPM_MAX Maximum HR, calculated over 1 minute
$BPM_MAX_TIME Time of maximum HR
$BPM_MAX_MAX Maximum short-time HR
$BPM_MAX_MAX_TIME Time of Max. short-time HR

Variable Meaning
$BPM_MIN Minimum HR, calculated over 1 minute
$BPM_MIN_TIME Time of minimum HR
$BPM_MIN_MIN Minimum short-time HR
$BPM_MIN_MIN_TIME Time of minimum short-time HR
$DUR_RR_MIN Duration of shortest RR interval
$TIME_RR_MIN Time of shortest RR interval
$DUR_RR_MAX Duration of longest RR interval
$TIME_RR_MAX Time of longest RR interval
$BEATS_ALL_BRADY Count of beats in bradycardia
$BEAT_PERC_ALL_BRADY Percentage of beats in bradycardia in relation
to the total number of QRS complexes
$DUR_ALL_BRADY Duration of all bradycardia
$DUR_PERC_ALL_BRADY Percentage of duration of all bradycardia
$BEATS_SLOW_BRADY Count of beats in the slowest bradycardia
$BPM_SLOW_BRADY HR in the slowest bradycardia episode
$TIME_SLOW_BRADY Time of slowest bradycardia episode
$DUR_SLOW_BRADY Duration of the slowest bradycardia episode
$BEATS_LONG_BRADY Count of beats in the longest bradycardia
$BPM_LONG_BRADY HR in the longest bradycardia episode
$DUR_LONG_BRADY Duration of the longest bradycardia episode
$TIME_LONG_BRADY Time of longest bradycardia episode
$DUR_L_DEL Duration of longest N-N delay
$TIME_L_DEL Time of longest N-N delay
$DUR_L_PAUSE Duration of longest pause
$TIME_L_PAUSE Time of longest pause
$BEATS_ALL_VT Count of beats in VE tachycardia
$BEAT_PERC_ALL_VT Percentage of beats in VE tachycardia in rela-
tion to the total number of QRS complexes
$DUR_ALL_VT Duration of all VE tachycardia
$DUR_PERC_ALL_VT Percentage of duration of all VE tachycardia
$BEATS_L_VT Count of beats in the longest VE tachycardia
$BPM_L_VT HR in the longest VE tachycardia episode
$DUR_L_VT Duration of longest VE tachycardia episode
$TIME_L_VT Time of longest VE tachycardia episode
$BEATS_FAST_VT Count of beats in the fastest VE tachycardia
$DUR_FAST_VT Duration of the fastest VE tachycardia epi-
sode
$BPM_FAST_VT HR in fastest tachycardia episode

Variable Meaning
$TIME_FAST_VT Time of fastest tachycardia episode
$BEATS_ALL_SVT Count of beats in SVE tachycardia
$BEAT_PERC_ALL_SVT Percentage of beats in SVE tachycardia in re-
lation to the total number of QRS complexes
$DUR_ALL_SVT Duration of all SVE tachycardia
$DUR_PERC_ALL_SVT Percentage of duration of all SVE tachycardia
$BEATS_L_SVT Count of beats in the longest SVE tachycardia
$BPM_L_SVT HR in the longest SVE tachycardia episode
$DUR_L_SVT Duration of longest SVE tachycardia episode
$TIME_L_SVT Time of longest SVE tachycardia episode
$BEATS_FAST_SVT Count of beats in the fastest SVE tachycardia
$DUR_FAST_SVT Duration of the fastest SVE tachycardia epi-
sode
$BPM_FAST_SVT HR in fastest SVE tachycardia episode
$TIME_FAST_SVT Time of fastest SVE tachycardia episode
$SVT_GE4_NO Total count of supraventricular tachycardia
episodes (count ≥ 4 beats)
$BEATS_ALL_SVT_GE4 Total count of beats in supraventricular tach-
ycardia episodes (count ≥ 4 beats)
$BEAT_PERC_ALL_SVT_GE4 Total percentage of beats in supraventricular
tachycardia episodes (count ≥ 4 beats)
$DUR_ALL_SVT_GE4 Total duration of supraventricular tachycar-
dia episodes (count ≥ 4 beats)
$DUR_PERC_ALL_SVT_GE4 Total percentage of duration of supraventric-
ular tachycardia episodes (count ≥ 4 beats)
$BEATS_L_SVT_GE4 Count of beats in longest supraventricular
tachycardia episode (count ≥ 4 beats)
$BPM_L_SVT_GE4 Heart rate of longest supraventricular tachy-
cardia episode (count ≥ 4 beats)
$TIME_L_SVT_GE4 Time of longest supraventricular tachycardia
episode (count ≥ 4 beats)
$DUR_L_SVT_GE4 Duration of longest supraventricular tachy-
$BEATS_FAST_SVT_GE4 Count of beats in fastest supraventricular
tachycardia episode (count ≥ 4 beats)
$BPM_FAST_SVT_GE4 Heart rate of fastest supraventricular tachy-
$TIME_FAST_SVT_GE4 Time of fastest supraventricular tachycardia
episode (count ≥ 4 beats)
$DUR_FAST_SVT_GE4 Duration of fastest supraventricular tachycar-
dia episode (count ≥ 4 beats)
$BEATS_ALL_RUN Count of beats in VE runs

Variable Meaning
$BEAT_PERC_ALL_RUN Percentage of beats in VE runs in relation to
the total number of QRS complexes
$BPM_FAST_RUN HR in the minute with the fastest VE run
$TIME_FAST_RUN Time of fastest salve VE run
$BEATS_ALL_TRI Count of beats in VE triplets
$BEAT_PERC_ALL_TRI Percentage of beats in VE triplets
$SVTRIP_NO Number of SVE Triplets
$BEATS_ALL_COU Count of beats in VE couplets
$BEAT_PERC_ALL_COU Percentage of beats in VE couplets in relation
to the total number of QRS complexes
$SVCOUP_NO Number of SVE Couplets
$BEATS_ALL_BIG Count of beats in VE bigeminy
$BEAT_PERC_ALL_BIG Percentage of beats in VE bigeminy in rela-
tion to the total number of QRS complexes
$DUR_ALL_BIG Duration of all VE bigeminy
$DUR_PERC_ALL_BIG Percentage of duration of all VE bigeminy
$BEATS_L_BIG Count of beats in the longest VE bigeminy
$SVE_ISO_NO Number of isolated SVEs
$STA_MEAN Mean ST level
$STA1_MEAN Mean ST level, first analysis channel
$STA2_MEAN Mean ST level, second analysis channel
$STA_MAX Maximum ST level
$STA_MAX_TIME Time of maximum ST level per minute
$STA1_MAX Maximum ST level, first analysis channel
(maximum ST deviation, first analysis channel)
$STA1_MAX_TIME Time of maximum ST level, first analysis chan-
nel (corresponding time)
$STA2_MAX Maximum ST level, second analysis channel
$STA2_MAX_TIME Time of maximum ST level, second analysis
channel
$STA_MIN Minimum ST level
$STA_MIN_TIME Time of minimum ST level per minute
$STA1_MIN Minimum ST level, first analysis channel (mini-
mum ST deviation, first analysis channel)
$STA1_MIN_TIME Time of minimum ST level, first analysis chan-
nel
$STA2_MIN Minimum ST level, second analysis channel
$STA2_MIN_TIME Time of minimum ST level, second analysis
channel
$STA_ABS_MAX Maximum absolute ST level

Variable Meaning
$STA_ABS_TIME Time of maximum absolute ST level
$STA1_ABS_MAX Maximum absolute ST level, first analysis
channel
$STA1_ABS_TIME Time of maximum absolute ST level, first analy-
sis channel
$STA2_ABS_MAX Maximum absolute ST level, second analysis
channel
$STA2_ABS_TIME Time of maximum absolute ST level, second
analysis channel
$STS_MAX Maximum ST slope
$STS_MAX_TIME Time of maximum ST slope per minute
$STS_MIN Minimum ST slope
$STS_MIN_TIME Time of minimum ST slope per minute
$STS_MEAN Mean ST slope
$AFIB_DUR Duration of all AFib episodes in minutes
$AFIB_PERC Ratio of the duration of all AFib episodes to
the complete recording duration
$AFIB_EPI_CNT Number of AFib episodes
$AFIBEPILIST List of AFib episodes
$MARKEDEVENTSLIST List of events selected for printing as shown
in the Print line of the Events tab
$MARKERLIST List of markers created in 12 channel record-
ings
Heart rate variability parameters

These parameters are described in more detail in “The Heart rate
variability tab” on page 117.
 The variables with “NN” at the end refer to all intervals be-
tween normal beats.
 The variables with “ALL” at the end refer to all intervals.
Variable Meaning
$RR_N_NN or Number of considered RR intervals
$RR_N_ALL
$RR_DUR_NN or Total of considered RR intervals in hours
$RR_DUR_ALL
$RR_MEAN_NN or Linear average value of considered RR intervals in
$RR_MEAN_ALL ms
$RR_MEDIAN_NN or Median of considered RR intervals in milliseconds
$RR_MEDIAN_ALL

Variable Meaning
$SDNN_NN or Standard deviation of all considered RR intervals
$SDNN_ALL in ms
$SDANN_NN or Standard deviation in milliseconds of the average
$SDANN_ALL RR interval calculated every five minutes
$RR_SD_NN or Standard deviation in milliseconds of the average
$RR_SD_ALL RR interval calculated every five minutes
$RR_TI_NN or Dimensionless triangular index of Heart rate vari-
$RR_TI_ALL ability
$NN50_NN or Number of RR intervals of which the difference
$NN50_ALL from preceding RR interval was greater than 50
milliseconds
$PNN50_NN or Percentage of RR intervals of which the difference
$PNN50_ALL from preceding RR interval was greater than 50
milliseconds
$RMSSD_NN or Square root of the mean squared differences be-
$RMSSD_ALL tween consecutive RR intervals in milliseconds
$SDNN_INDEX_NN or Mean standard deviation in milliseconds of the
$SDNN_INDEX_ALL standard deviation of all considered RR intervals
calculated every five minutes
$SDSD_NN or Standard deviation of the differences of all con-
$SDSD_ALL secutive considered RR intervals in milliseconds
$RR_SKEW_NN or Skewness
$RR_SKEW_ALL
$RR_KURTOSIS_NN or Kurtosis
$RR_KURTOSIS_ALL
Heart Rate Turbulence and Deceleration capacity

Variable Meaning
$HRT_N Number of VES used for calculating HRT
$HRT_TO HRT Onset
$HRT_TS HRT Slope
$DC_N Number of Anchor intervals used for calculating
the deceleration capacity
$DC_VAL Value of the deceleration capacity
$DC_RISK Risk as derived from the value of the deceleration
capacity
$AC_N Number of Anchor intervals used for calculating
the acceleration capacity
$AC_VAL Value of the acceleration capacity

Combined variables
Many variable names are composed of an abbreviation of the value
concerned and a suffix separated by the “_” symbol. Examples of
combined variables are shown below.
The suffixes have the following meaning:
Suffix Meaning
NO Total number of the events concerned
MAX_NO Maximum number of the events concerned over
one hour
MAX_HOUR Hour in which this number of events occurred
MIN_NO Minimum number of the events concerned over
one hour
MIN_HOUR Hour in which this number of events occurred
Events that can be used with these suffixes are abbreviated as fol-
lows:
Prefix Meaning
$DEL_ N-N Delay episodes
$SVT_ Supraventricular tachycardias
$BIG_ VE Bigeminy
$BRA_ Bradycardia episodes
$COU_ VE Couplets
$ESC_ Other ventricular beats
$PAU_ Pauses
$R_T_ R-on-T events
$RUN_ VE Runs
$NOI_ Noise detected by the program
$SVE Supraventricular events
$TRI_ VE Triplets
$PVC_ Premature ventricular contraction
$VTA_ Number of ventricular tachycardias
The following are examples of completely combined variable names

and their meaning:
Variable Meaning
$DEL_NO Number of N-N delay episodes
$SVT_MAX_NO Max. number of supraventricular tachycardias
over one hour
$BIG_MAX_HOUR Hour in which most VE bigeminies occurred1

Variable Meaning
$BRA_MIN_NO Min. number of bradycardia episodes over one
hour
$COU_MIN_HOUR Hour in which least number of VE couplets oc-
curred1
1 In the event of several hours with the same maximum and mini-
mum frequency, the first hour will be shown first.
Pacemaker data
Abbreviations of pacemaker events used with suffixes:
Prefix Meaning
$APA_ Atrial stimulus
$AQR_ Atrial stimulus with resonated QRS complex
$AVP_ AV stimulus
$EXI_ Exit block episodes
$FUS_ Fusion beats
$UND_ Undersensing episode
$OVE_ Oversensing episode
$VPA_ Ventricular stimulus
$VQR_ Ventricular stimulus with resonated QRS complex
Information on the recording

Variable Meaning
$ECG_FOLDER Full path of the ECG directory
$ECG_FILE_NAME Name of the ECG raw data file
$ECG_FILE_DATE Date of the ECG raw data file
$ECG_FILE_SIZE Size of the ECG raw data file
$RECORDER_TYPE Model name of the recorder used for the record-
ing
$RECORDER_SN Serial number of the recorder used for the record-
ing
$RECORDING_ID Unique number automatically assigned by the re-
corder
$RECORDING_ID2 Recording number automatically assigned
$ECG_SAMPLE_RATE Sampling rate used for the recording in samples per
second
$NO_OF_CHANNELS Number of the ECG channels stored in the record-
ing
$NOISE_RANGE_DUR Total duration of noise regions in hh:mm:ss.
$NOISE_RANGE_PERC Percentage of NOISE_RANGE_DUR of the ana-
lyzed recording duration

Variable Meaning
$ANALYSED_DUR Overall duration of the regions analyzed in
hh:mm:ss
$ANALYSED_PERC Percentage of ANALYSED_DUR in the recording duration
$EVAL_DATE Date of evaluation
$EVAL_TIME Time of evaluation
$EXPORT_FILENAME File name used for export of a pdf file
$SITE_NUMBER Number of site
$SITE_NAME Name of site
$LOCATION_NUMBER Number of location
$LOCATION_NAME Name of location
$LOCATION_ABBREVI- Abbreviation of location
ATION
Information on recordings from an event recorder

Variable Meaning
$TMS_TRANSM_TIME Time of data transmission
$TMS_PRE_TIME Pre-event time in seconds
$TMS_POST_TIME Post-event time in seconds
$TMS_BRADY_TRIG Bradycardia threshold
$TMS_TACHY_TRIG Tachycardia threshold
$TMS_AF_TRIG Detection of atrial fibrillation
$TMS_PAUSE_TRIG Pause in milliseconds
$TMS_VT_TRIG VT detection

B Definitions
B
Term Definition
Active QRS complex The QRS complex displayed centered in the
ECG context display of the Classes and
Events tabs is called the active QRS complex.
The display is synchronized regularly to the
R peak, which is symbolized by a vertical
thin blue line through the R peak in the ECG
context display.
Analysis channel The recorder channel used for the analysis.
CardioDay uses the best recorded channel.
Analysis parameters Analysis parameters used to detect events
or conditions for events from the sequence
of QRS complexes by using thresholds spe-
cific to the individual patient group.
Class window The QRS class windows or bins in the upper
part of the workspace on the Classes tab.
They display the QRS complexes of the de-
tected QRS classes.
ECG context display This window displays the context of the cur-
rent complex. The current complex is dis-
played in the center. Its R peak is marked
with a blue line. The letter over the com-
plexes designate their classification, the
numbers between the R-peaks represent ei-
ther the RR interval milliseconds or its recip-
rocal value, the heart rate, in beats per mi-
nute (bpm). The display can be toggled by
double-clicking in it.
ECG episode Several consecutive QRS complexes with or
without clinical significance.
Evaluation The medical evaluation of the CardioDay
analysis results required for the QRS classifi-
cation and the event classification.

Definitions
Term Definition
Event analysis The event analysis investigates the chrono-
logical dependencies of consecutive evalu-
ated QRS complexes using defined rhythm
parameters. It detects the cardiological
events, subject to medical evaluation.
Event class Collection of similar events in one class for
common editing. The collection criteria, for
example, are defined in the analysis param-
eters.
Event display The event display shows whether the cur-
rent QRS complex is part of an already
found event.
Event Cardiologically significant occurrence of one
or several atypical or incomplete QRS com-
plexes.
Heart rate display The heart rate display for the current con-
text. The value is determined either from the
moving average of the last 10 QRS complexes
or over one minute.
Patient data All data stored on one recording storage slot
for evaluation of the ECG recording.
Patient ID A unique row of letters and numbers identi-
fying the patient. You can use the ID from
the patient management system, if availa-
ble.
QRS class Collection of all similar QRS complexes in
one class for common editing. Similarity cri-
teria are not limited to optical properties;
they are calculated from properties of QRS
complexes concerning time and frequency.
QRS classes are often simply called “clas-
ses”.
QRS zoom display The zoom window displays a magnified im-
age of the current complex. Use the right
mouse button to select the magnification
and the channel displayed. The number at the
bottom left of this window indicates the
number of the displayed channel.
Sensitivity The trigger threshold for QRS recognition
can be set to the ECG data being recorded if
required.
Signal evaluation As pre-analysis of the recording, a part of
the ECG is read, which is used by the pro-
gram to check the recording quality and se-
lect optimum analysis parameters (which
channel, which amplification). This process is
called signal evaluation.
Tab Tabs are used to divide edition options into
several partial views of a window. Clicking on
a tab activates the corresponding partial
view.

C System limitations
C
Event analysis parameter Setting
Tachycardia threshold SV 30 – 220 bpm
Tachycardia threshold V 30 – 220 bpm
Bradycardia threshold 20 – 100 bpm and less than tachycardia
threshold V
Pause 1000 – 9999 ms
Prematurity SV 10 – 99 %
Prematurity V 10 – 120 %
R on T (relative to 1s) 100 – 400 ms
Delayed QRS complex 100 – 200 %
Refractory period 190 – 400 ms
Pacemaker basic rate 40 – 150 bpm
Pacemaker hysteresis rate 20 – 150 bpm
Pacemaker maximum rate 40 – 200 bpm
RR-FFT Frequency Limits Setting

Lower frequency limit VLF 0 – 0.5 Hz
Lower frequency limit LF 0 – 0.5 Hz
Lower frequency limit HF 0 – 0.5 Hz
Upper frequency limit HF 0 – 0.5 Hz

GETEMED Medizin- und
Informationstechnik AG
Oderstr. 77
14513 Teltow, Germany
Tel: +49 3328 3942-0
Fax: +49 3328 3942-99
DISTRIBUTOR:
GE Medical Systems
Information Technologies, Inc.
Distributor World Headquarters:

GE Medical Systems
Information Technologies, Inc.
8200 West Tower Avenue
Milwaukee, WI 53223, USA
Tel: +1 414 355 5000
1 800 558 5120 (US Only)
GE Medical Systems Information Technologies, Inc., a General Electric Company, going

to market as GE Healthcare.
www.gehealthcare.com

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GE Healthcare

CardioDay® V2.5 Holter ECG Analysis Software

CardioDay and CardioMem are trademarks owned by GETEMED.

Revision Publication Date Description

A 2016-08-19 Internal costing release.

B 2016-08-31 Internal maintenance release.

E 2019-07-15 New feature: “Site and location filter”

2 CardioDay® V2.5 2092513-004 Revision E

3 Downloading ECG data ...................................................................................... 27

2092513-004 Revision E CardioDay® V2.5 3

4 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 5

6 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 7

21 The Recording menu ......................................................................................... 199

8 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 9

Part III Appendices

A Variables for customizing the report templates ......................................... 259

10 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 11

due to artifacts, it is necessary to reclassify a single beat or a partic-

12 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 13

Prescription Device Statement

Regulatory and Safety Information

Definition of Safety Conventions

14 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 15

16 CardioDay® V2.5 2092513-004 Revision E

Supply and Accessory Information

2092513-004 Revision E CardioDay® V2.5 17

Product and Package Information

18 CardioDay® V2.5 2092513-004 Revision E

Capable of being recycled

Labels on the product package

The packaging label contains handling, cautionary information, and

2092513-004 Revision E CardioDay® V2.5 19

20 CardioDay® V2.5 2092513-004 Revision E

2092513-004 Revision E CardioDay® V2.5 21

22 CardioDay® V2.5 2092513-004 Revision E

CardioDay is state of the art software for Holter ECG evaluation.

2092513-004 Revision E CardioDay® V2.5 23

 Part II explains all of the main CardioDay application menus:

24 CardioDay® V2.5 2092513-004 Revision E

Downloading and evaluating

Recorder memory card types

2092513-004 Revision E CardioDay® V2.5 27

Program start, User login

For authentication and to assign user rights, CardioDay prompts the

28 CardioDay® V2.5 2092513-004 Revision E

software programs (iOS App, PC App, CardioDay, and Cardio-

Start window options

 The Hookup feature can be used, depending on the recorder

 The Transfer patient data feature allows you to enter and

2092513-004 Revision E CardioDay® V2.5 29

If there is at least one free recording slot for an additional re-

 The Open existing recording feature allows you to open a re-

Selecting the recording slot for the patient’s ECG recording