Artifacts in pulse transit time measurements using standard patient monitoring equipment

Frank C. Bennis*, Carola van Pul, Jarno J. L. van den Bogaart, Peter Andriessen, Boris W. Kramer, Tammo Delhaas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



Pulse transit time (PTT) refers to the time it takes a pulse wave to travel between two arterial sites. PTT can be estimated, amongst others, using the electrocardiogram (ECG) and photoplethysmogram (PPG). Because we observed a sawtooth artifact in the PTT while using standard patient monitoring equipment for ECG and PPG, we explored the reasons for this artifact.


PPG and ECG were simulated at a heartrate of both 100 and 160 beats per minute while using a Masimo PPG post-processing module and a Philips patient monitor setup at the neonatal intensive care unit. Two different post-processing modules were used. PTT was defined as the difference between the R-peak in the ECG and the point of 50% increase in the PPG.


A sawtooth artifact was seen in all simulations. Both length (59.2 to 72.4 s) and amplitude (30.8 to 36.0 ms) of the sawtooth were dependent on the post-processing module used. Furthermore, the absolute PTT value differed up to 250 ms depending on post-processing module and heart rate. The sawtooth occurred because the PPG wave continuously showed a minimal prolongation during the length of the sawtooth, followed by a sudden shortening. Both artifacts were generated in the post-processing module containing Masimo algorithms.


Post-processing of the PPG signal in the Masimo module of the Philips patient monitor introduces a sawtooth in PPG and derived PTT. This sawtooth, together with a large module-dependent absolute difference in PTT, renders the thus-derived PTT insufficient for clinical purposes.

Original languageEnglish
Article number0218784
Number of pages10
Issue number6
Publication statusPublished - 21 Jun 2019




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