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Physicians and many cardiology patients are certainly familiar with conventional ambulatory cardiac monitoring to detect heart arrhythmias, but a Maryland-based company's new software advances take telemedicine a step further – detecting dangerous heart rhythms and producing an electrocardiogram for immediate physician review.

"What we're doing today is actually attaching an EKG file to e-mail and sending it directly to your doctor. The breaking-new-ground part is creating for you a direct connection to your physician," explained Richard Trader, founder and director of the Cardiophonics Telemedicine Center in Timonium, Md., near Baltimore. The time saved could mean a life saved, he emphasized.

Trader founded Cardiophonics in 1986 to develop telemedicine applications for cardiology. While the always-open center does monitor 200 to 300 ambulatory patients monthly, it also is licensed by the federal Food and Drug Administration to develop and manufacture telemedicine modules and software. Through the years, the company has introduced technological improvements to ambulatory monitoring, with the latest being "Listen to the Beat!" This new software, which was designed for the company's pager-size cardiac event recorder called Cardiophonics® 1000, features a digital algorithm that senses an a-fib event even if the patient doesn't. The patient may then send a recorded EKG to the center via phone or e-mail, and the center forwards the digital file immediately to the attending physician via e-mail.

A physician assistant and former director of the intensive-care unit at Sinai Hospital in Baltimore, Trader said the Cardiophonics 1000 equipped with Listen to the Beat! is a far cry from the loop monitors and even the more advanced continuous monitors in use today. The new software "triggers on certain events. They could be different types of arrhythmias, whether your heart's running fast or whether your heart's running slow. They would trigger the monitor to save data at that point in time. … In general, about 40 percent of a-fib patients are asymptomatic. They don't know they have it. So the reason for the algorithm is to trigger even without the patient's knowledge."

An instant EKG certainly makes the new system beneficial, but an added bonus is its convenience. "Many times, providers and screening centers cannot provide an EKG test for arrhythmias like atrial fibrillation very easily outside the office. The EKG equipment, the definitive test for any arrhythmia, is expensive, bulky and the patient has to disrobe for the test," Trader said.

What's more, the system could be used in an office setting. "In fact, due to the complexity, the majority of facilities do not include EKG testing in their stroke screening programs, even though atrial fibrillation is a major risk factor and the cause of 20 percent of our strokes and disability in the United States," he added.

Yet the Cardiophonics 1000 amplifies the EKG signal it's measuring, which "allows us to get an EKG off of any two points on your body. Normally, you'd wear it on the chest because you wouldn't want something dangling off the fingers. But for stroke screening or if you just wanted to send an EKG, there are two little electrodes that just clip on your fingers and we're able to get an EKG off of that," Trader explained, adding, "I've actually gotten them off the earrings of my wife! It turns out pierced earrings are a great conductor of EKG signals."

The Cardiophonics 1000 and its software are used exclusively by his company, although Trader acknowledged with a laugh that he's "thought about" device sales. That's because the nature of medicine is changing as patients demand improved communication from their doctors.

"What's happening today in medicine more and more is that patients are getting to the point where they're demanding almost instant care from their physician and, in many cases, they want to be able to e-mail to their doctor to get office appointments or get prescriptions," Trader said. He cited Harris Interactive studies that revealed that 70 percent of patients would change physicians to be treated by a physician who would e-mail them. "Our vision is that not only will you e-mail your subjective symptoms, like your dizziness, but within that same e-mail you'd also forward your EKG for your doctor to look at in real time. That's the breakthrough," he said.

Cardiophonics also features a Windows-based cardiac event receiver designed for laptop or PC platforms. The receiver provides one- or two-channel reception, full digital recording review by e-mail, EKG editing and printing to any Windows-based printer. Cardiophonics patient services and equipment not only monitor for a-fib, but also for pacemaker operation, allowing early detection of a pacemaker malfunction.

February 2007

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