Creation of a training and test dataset with the disposition and transposition of overlaying electrocardiographic electrodes when recording electrocardiograms-12

BACKGROUND: Electrocardiography is one of the simplest, most widely used, inexpensive, and informative methods in functional diagnostics; yet, if performed poorly, its diagnostic value is sharply reduced. Several attempts were made to systematize errors and deviations in electrode application, but all concerned the most common options (rearrangement of red and yellow electrodes, yellow and green electrodes, and chest electrodes above or below the standard scheme). AIM: To create an electrocardiogram dataset with different options for transpositions and dispositions of electrodes during electrocardiogram recording. MATERIALS AND METHODS: The study included patients aged 1875 years (27 males and 22 females). All patients provided informed consent for electrocardiogram registration. During one visit, the cardiogram was recorded on the device Modular system for recording and remote transmission of electrocardiograms (EASY ECG) for each patient. RESULTS: In all, 488 electrocardiograms were recorded in 49 patients. The results obtained indicate a significant variability of the electrocardiogram pattern. Visual analysis of the electrocardiograms revealed no difficulties in determining the transposition associated with rearranging the leads on the arms (RY) in the thoracic C1C2. The placement of thoracic electrodes in contact cheek-to-cheek dispositions with the transfer of thoracic leads above or below two intercostals was reliably determined compared with the Wilson scheme. The transpositions of the yellow and green limb electrodes and the change in the position of the thoracic ones when they are lined up in a straight line, bullied between the ribs (curved), and confused in places C5 and C6 are difficult to determine even when comparing two cardiograms next to each other, with the correct and transpositional superposition of the electrodes. The initial changes on the electrocardiograms, physique type, breast size, or the presence of an implant most likely determine it. CONCLUSION: An electrocardiography dataset was obtained using various electrode dislocation variants. The dataset consists of a series of electrocardiograms obtained for each patient with several electrode placement options and contains both normal and pathological electrocardiograms

Accuracy of ECG Lead Placement by UK Paramedics

Background The use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. Methods Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science & Technology’s Clinical Guidelines for recording a standard 12-lead electrocardiogram (2017) with a tolerance of 19 mm being deemed acceptable based upon previous studies. Results 52 eligible participants completed the study. Measurement of electrode placement in the craniocaudal and mediolateral planes showed a high level of inaccuracy with 3/52 (5.8%) participants able to accurately place all chest leads. In leads V1 - V3, the majority of incorrect placements were related to vertical displacement with most participants able to identify the correct horizontal position. In V4, the tendency was to place the lead too low and to the left of the pre-determined position whilst V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6 although vertical displacement was more likely than horizontal displacement. Conclusions Our study identified a high level of variation in the placement of chest ECG electrodes which could alter the morphology of the ECG. From a patient safety perspective, we would advocate that paramedics leave the chest electrodes in situ to allow hospital staff to assess the accuracy of the placements

Improving accuracy of derived 12-lead electrocardiography by waveform segmentation

A number of methods have been proposed to reduce number of leads for electrocardiography (ECG) measurement without decreasing the signal quality. Some limited sets of leads that are nearly orthogonal, such as EASI, have been used to reconstruct the standard 12-lead ECG by various transformation techniques including linear, nonlinear, generic, and patient-specific. Those existing techniques, however, employed a full-cycle ECG waveform to calculate the transformation coefficients. Instead of calculating the transformation coefficients using a full-cycle waveform, we propose a new approach that segments the waveform into three segments: PR, QRS complex, and ST, hence the transformation coefficients were segment-specific. For testing, our new segment-specific approach was applied to six existing methods: Dower’s method with generic coefficients, Dower’s method with individual (patient-specific) coefficients, Linear Regression (LR), 2nd degree Polynomial Regression (PR), 3rd degree PR, and Artificial Neural Network (ANN). The results showed that the new approach outperformed the conventional full-cycle approach. It was able to significantly reduce the derivation error up to 74.50% as well as improve the correlation coefficient up to 0.66%

Heart rate detection from the supratrochlear vessels using a virtual reality headset integrated PPG sensor

An increasing amount of virtual reality (VR) research is carried out to support the vast number of applications across mental health, exercise and entertainment fields. Often, this research involves the recording of physiological measures such as heart rate recordings with an electrocardiogram (ECG). One challenge is to enable remote, reliable and unobtrusive VR and heart rate data collection which would allow a wider application of VR research and practice in the field in future. To address the challenge, this work assessed the viability of replacing standard ECG devices with a photoplethysmography (PPG) sensor that is directly integrated into a VR headset over the branches of the supratrochlear vessels. The objective of this study was to investigate the reliability of the PPG sensor for heart-rate detection. A total of 21 participants were recruited. They were asked to wear an ECG belt as ground truth and a VR headset with the embedded PPG sensor. Signals from both sensors were captured in free standing and sitting positions. Results showed that VR headset with an integrated PPG sensor is a viable alternative to an ECG for heart rate measurements in optimal conditions with limited movement. Future research will extend on this finding by testing it in more interactive VR settings

Accuracy of ECG chest electrode placements by paramedics: an observational study

Background The use of the 12-lead ECG is common in sophisticated prehospital Emergency Medical Services but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. Methods Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science & Technology’s Clinical Guidelines for recording a standard 12-lead electrocardiogram (2017) with a tolerance of 19mm being deemed acceptable based upon previous studies. Results 52 eligible participants completed the study. Measurement of electrode placement in the vertical and horizontal planes showed a high level of inaccuracy with 3/52 (5.8%) participants able to accurately place all chest electrodes. In leads V1 - V3, the majority of incorrect placements were related to vertical displacement with most participants able to identify the correct horizontal position. In V4, the tendency was to place the electrode too low and to the left of the pre-determined position whilst V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6 although vertical displacement was more likely than horizontal displacement. Conclusions Our study identified a high level of variation in the placement of chest ECG electrodes which could alter the morphology of the ECG. Correct placement of V1 improved placement of other electrodes. Improved initial and refresher training should focus on identification of landmarks and correct placement of V1

Desarrollo y puesta en funcionamiento de un dispositivo inalámbrico wearable para realizar ECG de 12 derivaciones

El electrocardiógrafo de 12 derivaciones apenas ha sufrido variaciones desde su creación a finales del s.XIX, hace más de un siglo. Aún hoy, sigue siendo una de las más importantes herramientas diagnósticas en Cardiología y un elemento imprescindible para el médico. El desarrollo tecnológico de la última década ha traído importantes avances incorporados a nuestro uso diario: acceso ubicuo a internet, bluetooth, mejores baterías y uso generalizado de smartphones y tablets. La primera parte de este trabajo describe del proceso de creación de un electrocardiógrafo personal, utilizando las tecnologías actuales, por un equipo multidisciplinar incluyendo al autor. Dicho dispositivo unifica en una sola pieza en forma de parche, los 10 electrodos de un electrocardiógrafo normal, eliminando de esta manera los cables y los posibles errores en su colocación, además del tiempo utilizado para ello. La segunda parte del trabajo analiza la implementación de dicha tecnología en pacientes reales de un hospital. Esto permite comparar este nuevo wearable con los sistemas actuales, plantear su adaptación, coexistencia o incluso su posible sustitución, teniendo en cuenta: equivalencia en la medición, compatibilidad en su colocación y aceptación del usuario. Método: Para ello se revisó un estudio realizado en 100 pacientes de edades comprendidas entre 18 y 74 años, de ambos sexos en una proporción del 50% y diferentes constituciones físicas; obteniéndose una equivalencia del 96% con respeto al ECG estándar. Conclusión: Un dispositivo personal individual que unifica todos los electrodos en un solo parche es clínicamente equivalente a uno convencional, además de otras ventajas observadas como adaptabilidad a diferentes tallas, aceptación del paciente, ahorro de tiempo, lectura inmediata y posibilidad de telemetría.The 12-lead electrocardiograph has hardly undergone variations since its creation in the late nineteenth century, more than a century ago. Even today, it remains one of the most important diagnostic tools in Cardiology and an essential element for the doctor. The technological development of the last decade has brought important advances incorporated into our daily use: ubiquitous access to the internet, bluetooth, better batteries and widespread use of smartphones and tablets. The first part of this work describes the process of creating a personal electrocardiograph, using current technologies, by a multidisciplinary team including the author. This device unifies in a single piece in the form of a patch, the 10 electrodes of a normal electrocardiograph, thus eliminating the cables and possible errors in their placement, in addition to the time used for it. The second part of the work analyzes the implementation of such technology in real patients of a hospital. This allows to compare this new wearable with the current systems, to propose its adaptation, coexistence or even its possible replacement, taking into account: equivalence in the measurement, compatibility in its placement and acceptance of the user. Method: To this end, a study conducted in 100 patients aged between 18 and 74 years, of both sexes in a proportion of 50% and different physical constitutions, was reviewed; obtaining an equivalence of 96% with respect to the standard ECG. Conclusion: An individual personal device that unifies all electrodes in a single patch is clinically equivalent to a conventional one, in addition to other advantages observed such as adaptability to different sizes, patient acceptance, time savings, immediate reading and possibility of telemetry

An alternative method for correct placement of electrocardiogram electrodes V1 and V2

Misplacement of the precordial electrodes V1 and V2 is a common technical error when performing an electrocardiogram. Misplacement may affect interpretation and analysis of an electrocardiogram and is a both a patient safety issue and a cost issue because some conditions may be missed, and false findings may lead to delay in other diagnostics pending a cardiac work-up. The traditional methods to identify the fourth intercostal space has a success rate found in literature between 6% to 90%, with an average success rate less than 50%. An alternative method, the 1/2 – 1/4 method was investigated in this thesis. It was done by attaching the electrodes V1 and V2, by the new method measuring one quarter up on the sternum, in non-urgent patients at St. Olav’s University Hospital, receiving a diagnostic computed tomography of the chest as part of their standard care. The placement of V1 and V2 was confirmed by computer tomography imaging. Fifty consecutive patients were included in the trial. The CT images were also investigated to see if the anatomical proportions of the 1/2–1/4 method were valid. In the electrode trial, 44% had both V1 and V2 placed in the fourth intercostal space. Ninety-two percent of the electrodes were either in the fourth intercostal space or within one intercostal space away from the fourth. The anatomical review of the method found correct location in 95,7% of the patients. Computer tomography imaging appears to be an accurate method to verify electrode placement