The reliability and accuracy of a noncontact electrocardiograph system for screening purposes.

BACKGROUND: Electrocardiography (ECG) requires the application of electrodes to the skin and often necessitates undressing. Capacitively coupled electrodes embedded in a normal chair would be a rational alternative for ECG screening. We evaluated the reliability and accuracy of ECG electrodes imbedded in a chair cushion. METHODS: Two independent clinicians compared ECG recordings obtained using skin electrodes with recordings obtained using capacitively coupled electrodes that were embedded in a chair cushion in an anesthesiology premedication room, a cardiology outpatient ward, and a cardiology day ward. We analyzed the data to compare the sensitivity and specificity for the diagnosis of cardiac arrhythmias. RESULTS: ECG recordings were obtained from 107 patients. Heart rate was accurately measured using the capacitively coupled electrodes, but motion artifacts made the identification of P and T waves unreliable. Signal quality was poor for patients with low body weight, patients wearing clothing containing mixed fibers, and patients wearing sweaty shirts. CONCLUSIONS: Heart rate was accurately measured, and some cardiac arrhythmias were correctly diagnosed using capacitive ECG electrodes. Capacitive electrodes embedded into an examination chair are a promising tool for preoperative screening. Improved artifact reduction algorithms are needed before capacitive electrodes will replace skin electrodes.

Closed-Loop Control of Humidification for Artifact Reduction in Capacitive ECG Measurements.

Recording biosignals without the need for direct skin contact offers new opportunities for ubiquitous health monitoring. Electrodes with capacitive coupling have been shown to be suitable for the monitoring of electrical potentials on the body surface, in particular ECG. However, due to triboelectric charge generation and motion artifacts, signal and thus diagnostic quality is inferior to galvanic coupling. Active closed-loop humidification of capacitive electrodes is proposed in this work as a new concept to improve signal quality. A capacitive ECG recording system integrated into a common car seat is presented. It can regulate the micro climate at the interface of electrode and patient by actively dispensing water vapour and monitoring humidity in a closed-loop approach. As a regenerative water reservoir, silica gel is used. The system was evaluated with respect to subjective and objective ECG signal quality. Active humidification was found to have a significant positive effect in case of previously poor quality. Also, it had no diminishing effect in case of already good signal quality.

UnoViS: the MedIT public unobtrusive vital signs database.

While PhysioNet is a large database for standard clinical vital signs measurements, such a database does not exist for unobtrusively measured signals. This inhibits progress in the vital area of signal processing for unobtrusive medical monitoring as not everybody owns the specific measurement systems to acquire signals. Furthermore, if no common database exists, a comparison between different signal processing approaches is not possible. This gap will be closed by our UnoViS database. It contains different recordings in various scenarios ranging from a clinical study to measurements obtained while driving a car. Currently, 145 records with a total of 16.2 h of measurement data is available, which are provided as MATLAB files or in the PhysioNet WFDB file format. In its initial state, only (multichannel) capacitive ECG and unobtrusive PPG signals are, together with a reference ECG, included. All ECG signals contain annotations by a peak detector and by a medical expert. A dataset from a clinical study contains further clinical annotations. Additionally, supplementary functions are provided, which simplify the usage of the database and thus the development and evaluation of new algorithms. The development of urgently needed methods for very robust parameter extraction or robust signal fusion in view of frequent severe motion artifacts in unobtrusive monitoring is now possible with the database.

Usefulness of bioimpedance spectroscopy for detection of hypotensive episode during dialysis.

Using statistical methods, this study investigates whether bioimpedance spectroscopy (BIS) and plasma electrolytes can be used to identify risk of intradialytic hypotension (IDH) based on information obtained during the first half of the dialysis treatment only. Data obtained from 40 patients included information on blood pressure, parameters defined from BIS, plasma electrolytes, and relevant clinical data. Patients were divided into three groups based on their intradialytic decrease in systolic blood pressure (SysBP) and associated symptoms and interventions: (1) Stable SysBP, (2) Asymptomatic unstable SysBP, and (3) symptomatic unstable SysBP. Retrospective analysis showed a significant reduction in extracellular fluid of 0.64 ± 0.62 L and potassium (K) concentration of 0.24 ± 1.67 mM in parallel with a decrease in SysBP of ≥25 mm Hg/hr. Data analysis using mixed-model procedure revealed that unstable patients compared with stable patients were characterized by higher extracellular resistance (p = 0.014) and K concentration (p = 0.009). Discriminant analysis using relative changes in extracellular resistance, potassium, and pH resulted in correct identification of 85% of the patients at risk. This study indicates that combining BIS and plasma electrolytes analysis may be a promising method to provide more accurate monitoring of IDH.

Impedance measurement system for determination of capacitive electrode coupling.

Capacitive electrodes have been studied as an alternative to gel electrodes, as they allow measurement of biopotentials without conductive contact with the patient. However, because the skin interface is not as precisely defined as with gel electrodes, this could lead to signal deformation and misdiagnoses. Thus, measurement of a capacitive coupling of the electrodes may allow to draw conclusions about the applicability of such systems. In addition, combining capacitive biosignal sensing with an impedance measurement unit may enable bioimpedance measurements, from which additional information on the hydration status can be extracted. A prototype system is introduced which measures impedance over capacitive electrodes in parallel with biopotential measurements. Also presented are the first results on characterization of the skin electrode coupling achieved with the system.

Non-contact monitoring techniques - Principles and applications.

This work gives an overview about some non-contact methods for monitoring of physiological activity. In particular, the focus is on ballistocardiography, capacitive ECG, Infrared Thermography, Magnetic Impedance Monitroing and Photoplethymographic Imaging. The principles behind the methods are described and an inside into possible medical applications is offered.

Triboelectricity in capacitive biopotential measurements.

Capacitive biopotential measurements suffer from strong motion artifacts, which may result in long time periods during which a reliable measurement is not possible. This study examines contact electrification and triboelectricity as possible reasons for these artifacts and discusses local triboelectric effects on the electrode-body interface as well as global electrostatic effects as common-mode interferences. It will be shown that most probably the triboelectric effects on the electrode-body interface are the main reason for artifacts, and a reduction of artifacts can only be achieved with a proper design of the electrode-body interface. For a deeper understanding of the observed effects, a mathematical model for triboelectric effects in highly isolated capacitive biopotential measurements is presented and verified with experiments. Based on these analyses of the triboelectric effects on the electrode-body interface, different electrode designs are developed and analyzed in order to minimize artifacts due to triboelectricity on the electrode-body interface.

ECG on the road: robust and unobtrusive estimation of heart rate.

Modern automobiles include an increasing number of assistance systems to increase the driver's safety. This feasibility study investigated unobtrusive capacitive ECG measurements in an automotive environment. Electrodes integrated into the driving seat allowed to measure a reliable ECG in 86% of the drivers; when only (light) cotton clothing was worn by the drivers, this value increased to 95%. Results show that an array of sensors is needed that can adapt to the different drivers and sitting positions. Measurements while driving show that traveling on the highway does not distort the signal any more than with the car engine turned OFF, whereas driving in city traffic results in a lowered detection rate due to the driver's heavier movements. To enable robust and reliable estimation of heart rate, an algorithm is presented (based on principal component analysis) to detect and discard time intervals with artifacts. This, then, allows a reliable estimation of heart rate of up to 61% in city traffic and up to 86% on the highway: as a percentage of the total driving period with at least four consecutive QRS complexes.

A capacitive ECG array with visual patient feedback.

Capacitive electrocardiogram (ECG) sensing is a promising technique for less constraining vital signal measurement and close to a commercial application. Even bigger trials testing the diagnostic significance were already done with single lead systems. Anyway, most applications to be found in research are limited to one channel and thus limited in its diagnostic relevance as only diseases coming along with a change of the heart rate can be diagnosed adequately. As a consequence the need for capacitive multi-channel ECGs combining the diagnostic relevance and the advantages of capacitive ECG sensing emerges. This paper introduces a capacitive ECG measurement system which allows the recording of standardized ECG leads according to Einthoven and Goldberger by means of an electrode array with nine electrodes.

Clinical proof of practicability for an ECG device without any conductive contact.

Heart rhythm disturbances are common symptoms of several heart disorders. One of the most effective screening methods is the traditional electrode-based ECG. However, this examination can be both time- and resource-consuming. Capacitive-coupling ECG (cECG) screening--working without any conductive electrical contact with the patient--might help to shorten the time required for diagnosis. In this study, we examine the practicability of employing a non-contact capacitive ECG in a clinical setting. A total of 30 volunteer patients aged over 50 years without pacemakers were included in our trial, after obtaining their written informed consent and their medical history. A cECG as well as a conventional, conductive ECG were recorded simultaneously. In addition to mathematical analysis, ECG data were manually evaluated by two clinicians blinded to the recording method and patient conditions. Data from 30 patients were collected during our study, seven of whom had experienced myocardial infarction. The obtained cECG signals showed a high correlation with the simultaneously recorded Einthoven lead II of the conventional ECG. The values for heart rate, PQ and QT time periods correlated particularly well. Significant differences were observed with regard to QRS duration. Data recorded in the supine position contained less motion artefacts and, in particular, there were fewer breathing artefacts compared to data collected from those in a sitting position. Owing to the easy and quick application of the cECG system, the feedback from the examined patients was consistently positive. In conclusion, recording cECG data in a sitting position provided sufficient quality for screening purposes. Further studies will be needed for the evaluation of cECG appropriateness in diagnosing heart disease.