Electrocardiographic Device Research Articles

Abstract 125: Automated External Defibrillator Shock Advisement Performance Among Multiple Human Electrocardiographic Rhythms and Devices

Background: Automated external defibrillators (AEDs) perform rhythm analysis in order to facilitate defibrillation. The effectiveness of AEDs is dependent on the accuracy of their rhythm classification, which includes differentiation of shockable rhythms from non-shockable rhythms Independent (i.e. non-industry) evaluation of the performance of AEDs against real-world ECG could lead to improvements in their performance. Objective: To evaluate the sensitivity and specificity characteristics of commercial AEDs with respect to quantitative properties of the ECG waveform in several rhythm presentations using real world ECG data. Methods: We conducted a prospective simulation study evaluating three commercially available AEDs from Defibtech, Phillips, and Zoll on the determination of ECG rhythm shockability. Performance was evaluated for 181 human ECG recordings (101 ventricular fibrillation-VF, 55 PEA, and 25 asystole) ranging widely in signal characteristics, obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. We used a commercially available digital-to-analog converter (National Instruments USB-6001) to inject the recordings into each AED through a direct lead-wire interface, recording shock advisement decisions in a best-out-of-three approach for each device/rhythm pairing. We calculated the sensitivity and specificity for discriminating VF and non-VF rhythms for each device and overall. VF signal characteristics were calculated, including peak frequency, median amplitude, and peak amplitude, and the VF quantitative waveform measures AMSA and median slope. Results: The 101 VF trials featured signals with mean peak frequency 10.02 Hz(IQR 4.80 Hz), mean AMSA 9.13(IQR 7.29), mean median slope 6.72 (IQR 3.66). The sensitivities were: Defibtech 99.0%; Philips 97.0%; Zoll 98.0%. The specificities were: Defibtech 98.7%; Philips 96.2%; Zoll 97.4%. Defibtech recorded 5 discordant advisements and Philips and Zoll recorded eight each. The overall sensitivity was 98.0%, and the specificity 97.4%. Conclusion: Evaluated against a wide variety of real-world signal presentations, commercial AEDs demonstrated a high degree of sensitivity and specificity for shockable ECG rhythms.

Which part of the P-QRS-T is best when developing linear ECG-lead transformations for the performance assessment of patch based electrocardiographic devices?

This paper presents a novel common functional observer scheme for three systems with unknown inputs. The scheme uses three observers in cascade with two logic switches. The existence conditions of the scheme are investigated and presented in terms of the original system matrices. Significantly, the conditions allow the observers to be designed independently of each other which greatly simplify the design process, and also serve as a basis of comparison for future development of common functional observer schemes. A numerical example is given to illustrate the effectiveness of the proposed scheme.

Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care.

To validate a smartphone-operated, single-lead electrocardiography (1L-ECG) device (AliveCor KardiaMobile) with an integrated algorithm for atrial fibrillation (AF) against 12-lead ECG (12L-ECG) in a primary care population. We recruited consecutive patients who underwent 12L-ECG for any nonacute indication. Patients held a smartphone with connected 1L-ECG while local personnel simultaneously performed 12L-ECG. All 1L-ECG recordings were assessed by blinded cardiologists as well as by the smartphone-integrated algorithm. The study cardiologists also assessed all 12L-recordings in random order as the reference standard. We determined the diagnostic accuracy of the 1L-ECG in detecting AF or atrial flutter (AFL) as well as any rhythm abnormality and any conduction abnormality with the simultaneously performed 12L-ECG as the reference standard. We included 214 patients from 10 Dutch general practices. Mean ± SD age was 64.1 ± 14.7 years, and 53.7% of the patients were male. The 12L-ECG diagnosed AF/AFL, any rhythm abnormality, and any conduction abnormality in 23, 44, and 28 patients, respectively. The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for AF/AFL of 100% (95% CI, 85.2%-100%) and 100% (95% CI, 98.1%-100%). The AF detection algorithm had a sensitivity and specificity of 87.0% (95% CI, 66.4%-97.2%) and 97.9% (95% CI, 94.7%-99.4%). The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for any rhythm abnormality of 90.9% (95% CI, 78.3%-97.5%) and 93.5% (95% CI, 88.7%-96.7%) and for any conduction abnormality of 46.4% (95% CI, 27.5%-66.1%) and 100% (95% CI, 98.0%-100%). In a primary care population, a smartphone-operated, 1L-ECG device showed excellent diagnostic accuracy for AF/AFL and good diagnostic accuracy for other rhythm abnormalities. The 1L-ECG device was less sensitive for conduction abnormalities.

Improved accuracy and confidence with multiple-lead recordings from a single-lead mobile electrocardiographic device.

Mobile electrocardiograms (mECGs) utilizing smartphone applications are an emerging technology. Typically, a Lead I rhythm strip is recorded. However, interpretation can be difficult in patients with sinus rhythm and low amplitude P-waves (SR-LAP) or atrial flutter (AFL). We hypothesized that patients could independently obtain multi-lead tracings using a commercial mECG device, and that cardiologists who interpreted the multi-lead tracings would make more accurate diagnoses and have more confidence in their interpretation compared to a single lead only. Thirty sets of recordings were obtained from 10 patients with either SR-LAP or AFL that was not apparent on Lead I on a standard ECG. Patients recorded Lead I, Lead II, and Lead V1 tracings using AliveCor's KardiaMobile mECG device. Twenty-nine cardiologists reviewed each patient's Lead I tracing, multi-lead tracings (Leads I, II, V1), and 12-lead ECG. Accuracy was noted and each cardiologist rated their level of confidence in their interpretation. All patients were able to record their own single and multi-lead tracings. Single lead, multi-lead, and the 12-lead ECG yielded 36.4%, 84.3%, and 97.7% agreement with the established diagnosis, respectively (P<.01 for each comparison). Overall mean confidence scores (out of a score of 5) were 2.95, 3.50, and 4.47 for single lead, multi-lead, and the 12-lead ECG, respectively (P<.01 for each comparison). Patients were able to record their own multi-lead mECG tracings. Compared to a single lead recording, multi-lead mECGs significantly improved cardiologists' diagnostic accuracy and confidence in their interpretation approaching that of a standard 12-lead ECG.

Ambulatory ECG monitoring in the age of smartphones.

Ambulatory electrocardiography (ECG) allows for extended monitoring of arrhythmias in a real-world setting. This article reviews the currently available ambulatory ECG devices and their differences in design, function, indications, efficacy, cost, and optimal use in clinical practice.

Reconstruction of the 12‐lead ECG using a novel MR‐compatible ECG sensor network

Current electrocardiography (ECG) devices in MRI use non-conventional electrode placement, have a narrow bandwidth, and suffer from signal distortions including magnetohydrodynamic (MHD) effects and gradient-induced artifacts. In this work a system is proposed to obtain a high-quality 12-lead ECG. A network of N electrically independent MR-compatible ECG sensors was developed (N = 4 in this study). Each sensor uses a safe technology - short cables, preamplification/digitization close to the patient, and optical transmission - and provides three bipolar voltage leads. A matrix combination is applied to reconstruct a 12-lead ECG from the raw network signals. A subject-specific calibration is performed to identify the matrix coefficients, maximizing the similarity with a true 12-lead ECG, acquired with a conventional 12-lead device outside the scan room. The sensor network was subjected to radiofrequency heating phantom tests at 3T. It was then tested in four subjects, both at 1.5T and 3T. Radiofrequency heating at 3T was within the MR-compatibility standards. The reconstructed 12-lead ECG showed minimal MHD artifacts and its morphology compared well with that of the true 12-lead ECG, as measured by correlation coefficients above 93% (respectively, 84%) for the QRS complex shape during steady-state free precession (SSFP) imaging at 1.5T (respectively, 3T). High-quality 12-lead ECG can be reconstructed by the proposed sensor network at 1.5T and 3T with reduced MHD artifacts compared to previous systems. The system might help improve patient monitoring and triggering and might also be of interest for interventional MRI and advanced cardiac MR applications.

Clinical Applicability of a Textile 1-Lead ECG Device for Overnight Monitoring.

Even for 1-lead electrocardiography (ECG), single-use gel conductive electrodes are employed in a clinical setting. However, gel electrodes show limited applicability for long-term monitoring due to skin irritation and detachment. In the present study, we investigated the validity of a textile ECG-belt suitable for long-term measurements in clinical use. In order to assess the signal quality and validity of the ECG-belt during sleep, 242 patients (186 males and 56 females, age 52 (interquartile range 42–60) years, body mass index 29 (interquartile range 26–33) kg·m−2) with suspected sleep apnoea underwent overnight polysomnography including standard 1-lead ECG recording. The single intervals between R-peaks (RR-intervals) were calculated from the ECG-signals. We found a mean difference for average RR-intervals of −2.9 ms, a standard error of estimate of 0.39%, as well as a Pearson r of 0.91. Furthermore, we found that the validity of the ECG-belt decreases when lying on the side, which was potentially due to the fitting of the belt. In conclusion, the validity of RR-interval measurements using the ECG-belt is high and it may be further improved for future applications by optimizing wear fitting.

Detección automática de la Fibrilación Auricular a través de un Smartwatch

La fibrilación auricular es la arritmia cardiaca más frecuente en la práctica clínica. La prevalencia se sitúa en torno al 0,4 - 1 % de la población general. Aumenta con la edad, llegando hasta el 8% a partir de los 80 años. Esta arritmia es la principal causa a nivel mundial de accidente cerebrovascular (20-30% de los casos son debidos a la fibrilación auricular), insuficiencia cardíaca o muerte súbita. Muchas veces , es clínicamente silente o se manifiesta con síntomas vagos como las palpitaciones, que pueden atribuirse erróneamente a ansiedad y retrasar el diagnóstico. La instauración temprana de anticoagulación (en determinados casos) reduce, de forma significativa la incidencia de fenómenos tromboembólicos. ABSTRACT Automatic detection of atrial fibrillation using a Smartwatch Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The prevalence is around 0.4 — 1% of the general population. It increases with age, reaching up to 8% from 80 years. In cardiology, the standard for the diagnosis of a cardiac arrhythmia is based on the performance of an electrocardiogram (ECG). From the monitoring of KardiaBand ™ and SmartRhythm ™, AliveCor launches the first platform for Apple Watch series 4, which combines an electrocardiography device approved by the FDA and certain analysis algorithms with artificial intelligence models, which help to detect the atrial fibrillation.

Testing MD-Link, a Low-Cost Mobile Electrocardiography Monitoring Device, in Patients With Irregular Heartbeat: Protocol for a Cross-Sectional Study.

BackgroundHaving mobile devices that provide patients with the ability to record and monitor the electrical activity of their heart enhances patient self-care and the early detection of irregular heartbeat (cardiac arrhythmia), yet few such devices exist in Vietnam. Challenges exist for introducing mobile electrocardiography (ECG) monitoring devices in Vietnam, including patient accessibility and affordability. A low-cost mobile ECG monitoring device designed and developed in Vietnam, which allows patients to easily measure their heart’s electrical activity and navigate recordings, may be a solution.ObjectiveThe aim of this project is to assess the usability of the MD-Link system, a newly developed mobile handheld 1-lead ECG device, in detecting patients with irregular heartbeat. We will compare its outputs to the standard printed outputs of a 12-lead electrocardiogram generated by the Nihon Kohden Cardiofax S Electrocardiograph Model ECG-1250K.MethodsWe will conduct a cross-sectional study in two stages, including the measurement of ECG signals of patients using the MD-Link and the Nihon Kohden Cardiofax S and analysis of the selected standard outputs collected from the ECG recordings of the MD-Link and the Nihon Kohden Cardiofax S. The MD-Link consists of (1) a mobile device (eg, a smartphone); (2) a lead wire with 2 disposable electrodes; and (3) an easy-to-use mobile app interface enabling the upload and accurate display of ECG recordings to patients and their clinicians. Our research team, consisting of members from Dartmouth College; the Institute of Health, Population and Development; Hanoi University of Science and Technology; and physicians and nurses from Thanh Chan Clinic, will assist in carrying out this project.ResultsWe will proceed with a publication plan that includes a project report and, ultimately, articles for peer-reviewed journals. We also hope to disseminate our work at relevant conferences to provide more coverage and exposure to the MD-Link mobile device. Recruitment and data collection were completed in January 2018. Data analysis started in February 2018 and is ongoing. Results are expected mid-2019.ConclusionsAt the end of this project, we will have developed and tested the MD-Link, a low-cost mobile ECG monitoring device, with some supportive comparisons to standard ECG devices commonly used in heart clinics or hospitals in Vietnam. Our long-term goal is for the MD-Link to be easily accessible, affordable, and to fit into a patient’s daily routine, thus improving the care and treatment of patients with cardiovascular diseases (CVDs).International Registered Report Identifier (IRRID)RR1-10.2196/8762

Identifying the Prevalence of the Life-threatening Atrial Fibrillation Using a Smartphone-Based Wireless Electrocardiography Device: An Observational Study

Background: Atrial Fibrillation (AF) is one of the most common types of arrhythmia across the world. Yet, many cases remain undiagnosed making it difficult to estimate the exact prevalence of AF. Aims: This observational study was done to understand the feasibility of a hand-held electrocardiography (ECG) device – SanketLife – in detecting AF cases. Materials and Methods: In the study, ECG data collected from the device for a period of 2 months were evaluated to detect AF cases. The device took 12-lead and single-lead ECG recordings in various health-care settings including self-monitoring done by patients at their homes and in diagnostic laboratories using the device for screening as well as hospitals using the device in their outpatient departments. The reports were saved in SanketLife Cloud and evaluated anonymously by a certified ECG expert and the findings were further confirmed by a cardiologist to evaluate AF or any other findings in the ECG. Results: SanketLife effectively captured AF cases and demonstrated the feasibility of using such a device in any care setting being clinical or home monitoring. Conclusion: The study concluded that the device can be used for regular monitoring by patients suffering from chronic AF. In health-care settings ranging from primary care to tertiary care, the device can be beneficial.

Diagnostyka elektrokardiograficzna w warunkach SOR za pomocą mobilnego jednoodprowadzeniowego urządzenia EKG

Introduction. Electrocardiography (ECG) is one of the basic diagnostic tests used in emergency departments and by emergency medical services. Life-threatening arrhythmias can be detected using a single-lead ECG. Therefore, single- -lead ECG devices can be used for arrhythmia detection, as their availability steadily increases. Kardia Mobile from Alive- Cor is an example of such a device, recording a single-lead ECG and automatically detecting atrial fibrillation (AF) — the most common complex supraventricular tachyarrhythmia. The aim of our study was to evaluate the utility of a single-lead mobile ECG device in detecting AF in medical practice of emergency services. Material and methods. Study included 118 patients (62 women and 56 men) who were hospitalized in a hospital emergency department and consented to examination with Kardia Mobile immediately after a standard 12-lead ECG. Results of both tests were subsequently compared. Ultimately, 121 different pairs of ECG recordings were analyzed (in 3 cases an additional ECG recording was performed after an electrical cardioversion). Results. Sinus rhythm was identified in 99 patients and 22 were diagnosed with AF using a 12-lead ECG (reference). Kardia Mobile correctly detected AF in 19 of 22 patients with AF (sensitivity: 86.4%) and absence of AF in 96 of 99 people without AF (specificity: 97%). Conclusions. Kardia Mobile device is effective in automated detection of AF among patients hospitalized in the emergency department.

A 2.3 &lt;inline-formula&gt; &lt;tex-math notation="LaTeX"&gt;$\mu$ &lt;/tex-math&gt; &lt;/inline-formula&gt;W ECG-On-Chip for Wireless Wearable Sensors

This brief presents an ultra-low power single chip solution for electrocardiography (ECG) signal acquisition and processing in wearable ECG sensors. The chip contains a low noise preamplifier with embedded band-pass function, a programmable gain buffer, a 12-bit successive approximation ADC, a novel morphological filter based QRS detector, 8-Kb on-chip SRAM, a control unit and MCU interfaces. The chip was designed and implemented in 0.35- ${\mu }\text{m}$ standard CMOS process. The analog core operates from 0.8 V to 1.8 V, while the digital circuits and SRAM operate from 1.5 V to 3.6 V. The chip has a total core area of 5.74 mm2 and consumes $2.3~{\mu }\text{W}$ . Small size and low power consumption make this chip suitable for usage in wearable ECG sensors. Apart from presenting the measurement results, we also successfully demonstrate a prototype wearable ECG device, for long term cardiac monitoring using the proposed ECG-on-chip.

Updates to IEC/AAMI ECG standards, a new hybrid standard

The current set of IEC particular standards that pertain to electrocardiograph (ECG) devices, namely, 60601-2-25, 60601-2-27, and 60601-2-47, which define requirements and testing for the essential performance and basic safety of diagnostic ECG, ECG monitoring and ambulatory ECG systems, respectively. These standards have been harmonized with the corresponding AAMI standards, namely EC11, EC13 and EC38. Together these standards have been in existence for decades and have evolved separately even though the technology used in these three clinical applications is very similar. A work proposal was initiated in the ISO/IEC Joint Work Group 22 (JWG22), which over sees the revision of these standards, to update the standards by creating a single new hybrid standard. The goal of this work is a joint endeavor between ISO and IEC to combine the three separate particular standards that cover ECG device and to harmonize the similar requirements that are common across all three types of devices into one set of general requirements. The requirements that separate specific to meeting the intended use and essential performance for each of the 3 types of devices (diagnostic, patient monitoring, and ambulatory ECG recording) will continue to remain as separate requirements.Furthermore, manufactures of ECG devices have also been required to meet standards for disposable electrodes (AAMI EC12), ECG cables and leadwires (AAMI EC53), and arrhythmia analysis performance reporting (AAMI EC57). In addition to the primary goal, a secondary goal for the JW22 work is to also incorporate these three AAMI standards into the ECG hybrid standard. This paper describes the work being done and highlights key updates, and explains the rationale for approaches and changes being made. The Joint Work Group is currently in the process of updating the committee draft of the new hybrid standard before requesting comments from National Standard Committees participating in JWG22.

Design and Development of Intelligent Electrodes for Future Digital Health Monitoring: A Review

Electrodes are sensors used in electrocardiography (ECG) monitoring system to diagnose heart diseases. Over the years, diverse types of electrodes have been designed and developed to improve ECG monitoring system. However, more recently, with the technological advances and capabilities from the Internet of Things (IoT), cloud computing and data analytics in personalized healthcare, researchers are attempting to design and develop more effective as well as flexible ECG devices by using intelligent electrodes. This paper reviews previous works on electrodes used in electrocardiography (ECG) monitoring devices to identify the key ftures for designing and developing intelligent electrodes in digital health monitoring devices.

OP169 Usability Evaluation Of A Portable Dry-Electrode Electrocardiography Device In Vietnam

Introduction:According to the Vietnamese Cardiovascular Association, one-fifth of Vietnam's population is suffering from cardiovascular disease (CVD) – now the leading cause of death in the country that accounts for about one-third of total deaths every year. Yet affordable and convenient solutions to monitor and detect CVDs remain limited and not available nation-wide. This study aimed to investigate the usability of a portable dry-electrode electrocardiography (ECG) device, paired with a mobile phone, in supporting ECG service delivery in Vietnam.Methods:An evaluation study was designed to combine a portable dry-electrode ECG device to measure and a mobile phone to receive and record ECG signals. Healthy young college students were invited to participate in the study. Three rounds of ECG measurement were administered for each of the participants. Usability of the device was assessed through the reliability of the measures and feasibility of use during intervention. Standard error of measurement (SEM) and intra-class correlation coefficient (ICC) estimations were used for reliability, while structured questionnaire administered before and after measures was used for feasibility assessments.Results:A total of 234 participants enrolled in the study. No major difference was found in SEMs between trials one and two (4.96 percent, 90% CI: 4.61 − 5.37) and two and three (4.14 percent, 90% CI: 3.85 − 4.48). A slight improvement was observed in ICC of trials two and three (0.95, 90% CI 0.94 − 0.96) in comparison to one of trials one and two (0.94, 90% CI: 0.92 − 0.95). The SEM and average ICC of all trials were 3.41 (90% CI: 3.17 − 3.69) and 0.96 (90% CI: 0.95 − 0.96) respectively. Forty-five percent of participants thought the device would be suitable for their parents while 69 percent thought the device would benefit their grandparents the most.Conclusions:High consistency of measures demonstrated that the device is reliable to provide ECG service delivery. The study also showed great potential of device usage in primary health care of Vietnam.

Validation of a smartphone-based electrocardiography in the screening of QT intervals in children.

OBJECTIVE:A 12-lead electrocardiography is a critical component for the screening of long QT syndrome; however, besides, an electrocardiograph, trained personnel are also necessary which limits the screening capability of conventional electrocardiographs. The development of smartphone electrocardiography technologies provides a potential alternative platform for electrocardiography screening for selective purposes such as arrhythmias and QT interval abnormalities. The aim of this pilot study was to assess the reliability of a smartphone-based electrocardiography device in the measurement of QT and corrected QT intervals in children.METHODS:In all participants, 10-s smartphone electrocardiography tracing from AliveCor device and a standard 12-lead electrocardiograph were obtained simultaneously. Two pediatric electrophysiologists performed the measurements of QT and corrected QT intervals in a blinded manner with Bazett’s formula. The results were compared statistically.RESULTS:A total of 285 children (mean age 9.8±4.9 years) who presented to our clinic were included in the study. The mean QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 343±40 ms and 340±41 ms, respectively. The mean corrected QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 419±28 ms and 415±33 ms, respectively. There was high correlation between the QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson’s correlation coefficient: 0.83 [p<0.001]) and significant correlation between the corrected QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson’s correlation coefficient: 0.57 [p<0.001]).CONCLUSION:AliveCor recordings can accurately detect QT intervals and can potentially be used for the screening of congenital long QT syndrome in children.

Analysis of Patent Management on Health Care Product: Information of Electrocardiograph Devices

Development of health care product nowadays becomes primer uses to support levelness of heart disease. A dynamic system of usefulness has referred to a potential market that occurs as a complementary effort in the health sector. Differentiation of product devices especially for electronic cardiograph has many impacts on technology innovation, in term of market-oriented. Analysis patent management is used as a tool to see technology that has already performed and is also used by industries, based on capturing market needs, to deliver more competitiveness model of the product. This paper aims to find relevant information through a database of an international patent on health care products for market orientation through the portfolio, licensing, status, competitor, innovation, and monitoring emerging market with the patent database that registered on World Intellectual Property Organization (WIPO). The methodology that applies in paper using software Total Patent to see more information related on the utilization of electronic cardiograph devices such as potential useful through leading patent-issuing authorities with composition results 247 documents of 113,612,014 patents that registered. The results showed that most of the inventions and patent applicants and beneficiaries are from the United States, Europe, and Asia-Pacific and the captive market distributed in Asian and South American area.

The short-term effect of smoking on fetal ECG

Background: The number of women who smoke during pregnancy is significant even today. The harmful effects of smoking during pregnancy are well known but there are no data on the effects of smoking on fetal electrocardiography (ECG). The lack of data is in connection with the difficulties of recording fetal ECG through the maternal abdomen.Method: Third trimester pregnant women who were not able to give up the harmful passion of smoking despite repeated attempts of persuasion were recruited in the study on voluntary basis. The fetal ECG was recorded non-invasively through the maternal abdomen before, during and after smoking, then the data were processed offline. The electrophysiological measurements were performed by a self developed ECG device, which allowed the examination of the morphological differences in “true-to-form” fetal ECG in addition to studying the variability of fetal heart rate. The study involved nine pregnant women. The observed changes are presented through case studies of those pregnant women who showed the most significant anomalies.Results: Compared with the resting state fetal heart rate was increased during smoking. The short-term variability of fetal heart rate was narrowed, while the mother’s heart rate did not change significantly – which was an indication of direct fetal stress. No explicit ischemic signs were detected in fetal ECG during smoking, however, in the increasing period of the fetal heart rate, the T wave morphology changed slightly, then it returned to normal.Conclusions: Demonstrable by the electrophysiological methods, smoking has a direct effect on fetal cardiac function. The fetal heart rate variability shows a pattern during smoking which is a typical sign of stress conditions among adults. The results may have educational consequences as well. Understanding those, hopefully will help pregnant women give up this harmful addiction.

Automated Epileptic Seizure Detection Based on Wearable ECG and PPG in a Hospital Environment.

Electrocardiography has added value to automatically detect seizures in temporal lobe epilepsy (TLE) patients. The wired hospital system is not suited for a long-term seizure detection system at home. To address this need, the performance of two wearable devices, based on electrocardiography (ECG) and photoplethysmography (PPG), are compared with hospital ECG using an existing seizure detection algorithm. This algorithm classifies the seizures on the basis of heart rate features, extracted from the heart rate increase. The algorithm was applied to recordings of 11 patients in a hospital setting with 701 h capturing 47 (fronto-)temporal lobe seizures. The sensitivities of the hospital system, the wearable ECG device and the wearable PPG device were respectively 57%, 70% and 32%, with corresponding false alarms per hour of 1.92, 2.11 and 1.80. Whereas seizure detection performance using the wrist-worn PPG device was considerably lower, the performance using the wearable ECG is proven to be similar to that of the hospital ECG.

How Useful are Handheld ECG devices?

Patients without clinical knowledge must be able to use mobile electrocardiography (ECG) devices to collect healthcare data outside a clinical setting safely and effectively. We conducted a simulated use test to assess usability from a patient perspective, with 18 ECRI employee volunteers who were familiar with smartphones, but unfamiliar with the two devices being evaluated. The largest a priori concerns were how long it would take to collect a valid ECG reading and how easy it was to share data captured by the devices. Overall the systems (ECG device plus smartphone app) were rated similarly in terms of usability, and none took so much longer than the others that it could be considered less useful. However, the testing did reveal some significant usability problems with each system. Moreover, it is unclear how the data produced by these devices, which needs to be reviewed by a clinical expert, will impact communication between patients and providers. More research is needed to understand how having patients use medical devices with smartphone apps could impact the workflow and communications of the primary care or specialty physicians to whom the data produced by these devices will be sent.