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Analysis was performed by a philips remote clinical support (cs) which included interviewing the customer.During the discussion, the cs explained the possibility of ecg double counting when tall p-waves are present, as they may be misinterpreted as r-waves or t-waves by the system algorithm.The cs explained that a simple way of verify double counting is to compare the heart rate displayed on the monitor with the patient's actual pulse rate.For example, if the patient's pulse rate is approximately 100 bpm while the displayed heart rate is 200 bpm, this strongly suggests double counting.To minimize the likelihood of double counting, the cs advised ensuring the monitor receives the best possible ecg signal.Specifically: the t-wave amplitude should be less than one-third of the r-wave amplitude.The p-wave amplitude should be less than one-fifth of the r-wave amplitude.The rse recommended selecting the ecg lead that provides a tall, monophasic r-wave with a t-wave smaller than the r-wave and a p-wave smaller than the t-wave.If necessary, the primary ecg lead selection should be changed to a more representative lead with these characteristics.If necessary, change the primary lead to better representative lead with these characteristics.Furthermore, the rse advised that if using mx40 at rev.C.01.20 or later, the qrs detection can be adjusted at the central station.(picix rev.C) - instructions for use - 452299165051, page 5-7-15 of the rev.C star_arrhythmiamonitoring dec 2020.The customer reported that the issue has not recurred since these recommendations were provided and stated they will refer clinical staff to the previously shared reference materials should the issue occur again.Based on the information available in the case, the cause of the reported problem was confirmed to be a user issue.The reported problem was not confirmed.If additional information is received, the complaint file will be reopened for further investigation.
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