Capacitive ECG Monitoring in Cardiac Patients During Simulated Driving.

OBJECTIVE: This study aims to compare the informative value of a capacitively coupled electrocardiogram (cECG) to a conventional galvanic reference ECG (rECG) in patients after a major cardiac event under simulated driving conditions. Addressed research questions are the comparison and coherence of cECG and rECG by means of the signal quality, the artifact rate, the rate of assessable data for differential diagnosis, the visibility of characteristic ECG structures in cECG, the precision of ECG time intervals, and heart rate (in particular, despite possible waveform deformations due to the cardiac preconditions). METHODS: In a clinical trial, cECG and rECG data were recorded from ten patients after a major cardiac event. The cECG and rECG data were blindly evaluated by two cardiologists with regard to signal quality, artifacts, assessable data for differential diagnosis, visibility of ECG structures, and ECG time intervals. The results were statistically compared. RESULTS: The cECG presented with more artifacts, an inferior signal quality, and less assessable data. However, when the data were assessable, determination of the ECG interval lengths was coherent to the one obtained from the rECG. CONCLUSION: When the signal quality is sufficient, the cECG yields the same informative value as the rECG. SIGNIFICANCE: For certain scenarios, cECG might replace rECG systems. Hence, it is an important research question whether a similar amount of information can be obtained using a cECG system.

Improved electrode positions for local impedance measurements in the lung-a simulation study.

Impedance spectroscopy can be used to analyze the dielectric properties of various materials. In the biomedical domain, it is used as bioimpedance spectroscopy (BIS) to analyze the composition of body tissue. Being a non-invasive, real-time capable technique, it is a promising modality, especially in the field of lung monitoring. Unfortunately, up to now, BIS does not provide any regional lung information as the electrodes are usually placed in hand-to-hand or transthoracic configurations. Even though transthoracic electrode configurations are in general capable of monitoring the lung, no focusing to specific regions is achieved. In order to resolve this issue, we use a finite element model (FEM) of the human body to study the effect of different electrode configurations on measured BIS data. We present evaluation results and show suitable electrode configurations for eight lung regions. We show that, using these optimized configurations, BIS measurements can be focused to desired regions allowing local lung analysis.

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.

Ambient and Unobtrusive Cardiorespiratory Monitoring Techniques.

Monitoring vital signs through unobtrusive means is a goal which has attracted a lot of attention in the past decade. This review provides a systematic and comprehensive review over the current state of the field of ambient and unobtrusive cardiorespiratory monitoring. To this end, nine different sensing modalities which have been in the focus of current research activities are covered: capacitive electrocardiography, seismo- and ballistocardiography, reflective photoplethysmography (PPG) and PPG imaging, thermography, methods relying on laser or radar for distance-based measurements, video motion analysis, as well as methods using high-frequency electromagnetic fields. Current trends in these subfields are reviewed. Moreover, we systematically analyze similarities and differences between these methods with respect to the physiological and physical effects they sense as well as the resulting implications. Finally, future research trends for the field as a whole are identified.

Development of a wearable multi-frequency impedance cardiography device.

Cardiovascular diseases as well as pulmonary oedema can be early diagnosed using vital signs and thoracic bio-impedance. By recording the electrocardiogram (ECG) and the impedance cardiogram (ICG), vital parameters are captured continuously. The aim of this study is the continuous monitoring of ECG and multi-frequency ICG by a mobile system. A mobile measuring system, based on 'low-power' ECG, ICG and an included radio transmission is described. Due to the high component integration, a board size of only 6.5 cm×5 cm could be realized. The measured data can be transmitted via Bluetooth and visualized on a portable monitor. By using energy-efficient hardware, the system can operate for up to 18 hs with a 3 V battery, continuously sending data via Bluetooth. Longer operating times can be realized by decreased transfer rates. The relative error of the impedance measurement was less than 1%. The ECG and ICG measurements allow an approximate calculation of the heart stroke volume. The ECG and the measured impedance showed a high correlation to commercial devices (r=0.83, p<0.05). In addition to commercial devices, the developed system allows a multi-frequency measurement of the thoracic impedance between 5-150 kHz.

Capacitive ECG recording and beat-to-beat interval estimation after major cardiac event.

Today, heart diseases are the most common cause of death in the U.S.. Due to improved healthcare, more and more patients survive a major cardiac event, e.g. a heart attack. However, participation in everyday activity (e.g. driving a car) can be impaired afterwards. Patients might benefit from heart activity monitoring while driving using a capacitive ECG (cECG). However, it is unknown whether cECG is an appropriate monitoring tool for such patients. In this work, first results from a study including 10 patients having survived at least one major cardiac event are presented. It is shown that cECG can be used to diagnose heart rhythm deviations and estimate beat-to-beat intervals similar to conventional ECG.

Bioelectrical impedance spectroscopy as a fluid management system in heart failure.

Episodes of hospitalization for heart failure patients are frequent and are often accompanied by fluid accumulations. The change of the body impedance, measured by bioimpendace spectroscopy, is an indicator of the water content. The hypothesis was that it is possible to detect edema from the impedance data. First, a finite integration technique was applied to test the feasibility and allowed a theoretical analysis of current flows through the body. Based on the results of the simulations, a clinical study was designed and conducted. The segmental impedances of 25 patients suffering from heart failure were monitored over their recompensation process. The mean age of the patients was 73.8 and their mean body mass index was 28.6. From these raw data the model parameters from the Cole model were deduced by an automatic fitting algorithm. These model data were used to classify the edema status of the patient. The baseline values of the regression lines of the extra- and intracellular resistance from the transthoracic measurement and the baseline value of the regression line of the extracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of peripheral edema. The rate of change of the imaginary impedance at the characteristic frequency and the mean intracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of pulmonary edema. To classify the data, two decision trees were considered: One should detect pulmonary edema (n(pulmonary) = 13, n(none) = 12) and the other peripheral edema (n(peripheral) = 12, n(none) = 13). Peripheral edema could be detected with a sensitivity of 100% and a specificity of 90%. The detection of pulmonary edema showed a sensitivity of 92.31% and a specificity of 100%. The leave-one-out cross-validation-error for the peripheral edema detection was 12% and 8% for the detection of pulmonary edema. This enables the application of BIS as an early warning system for cardiac decompensation with the potential to optimize patient care.

Robust sensor fusion of unobtrusively measured heart rate.

Contactless vital sign measurement technologies often have the drawback of severe motion artifacts and periods in which no signal is available. However, using several identical or physically different sensors, redundancy can be used to decrease the error in noncontact heart rate estimation, while increasing the time period during which reliable data are available. In this paper, we show for the first time two major results in case of contactless heart rate measurements deduced from a capacitive ECG and optical pulse signals. First, an artifact detection is an essential preprocessing step to allow a reliable fusion. Second, the robust but computationally efficient median already provides good results; however, using a Bayesian approach, and a short time estimation of the variance, best results in terms of difference to reference heart rate and temporal coverage can be achieved. In this paper, six sensor signals were used and coverage increased from 0-90% to 80-94%, while the difference between the estimated heart rate and the gold standard was less than ±2 BPM.

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.

Temperature measurement.

For many decades the measurement of body core temperature has been ubiquitously established in medical and non-medical applications, e.g., in hospitals, occupational medicine, sports medicine, military and other settings. However, there are still numerous challenges, such as the precise definition of the body core temperature, establishing the clinical importance of the measured temperature and the lack of a reliable, non-invasive and fast measurement method for body core temperature. After an introduction to the topic, the medical aspects from a user point of view are presented, i.e., the needs for temperature measurements, as well as possible measurement sites and clinical specifications and needs are highlighted. Subsequently, technical methods are presented which are used for temperature measurement. The analysis of the technical methods is divided into two sections: the first deals with the standard methods, which are currently used and the second describes methods, which are currently under development. Although temperature measurement appears very easy and is very common in daily use, it has many constraints, which are considered later. The need for further research is deduced from the above-mentioned sections and is finally followed by the conclusions section.

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.

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.

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.