New precordial bipolar electrocardiographic leads for detecting left ventricular hypertrophy.

BACKGROUND: Novel small and wearable electrocardiogram (ECG) devices offer new means of recording cardiac activity in different applications. Our objective was to evaluate the performance of closely separated (6 cm) bipolar leads in differentiating subjects with left ventricular hypertrophy (LVH) from healthy subjects. METHODS: The material contained body surface ECG of 236 healthy and 116 LVH subjects. A total of 36 vertical, 30 horizontal, and 66 diagonal bipolar leads located on the anterior thorax were analyzed. The QRS amplitudes were calculated, and the leads' overall diagnostic performance was assessed by receiver operating characteristic (ROC) analysis. RESULTS: The best overall diagnostic performances were obtained from 2 areas: one near the precordial electrodes of standard leads V(1) to V(3) and the other on lower anterior thorax. Vertical and diagonal bipolar leads located at lower anterior thorax provided the highest ROC areas (≥0.79). These bipolar leads also provided similar sensitivities than the traditional Sokolow-Lyon method. CONCLUSION: The new short distance vertical and diagonal bipolar leads are efficient in discriminating subjects with LVH from healthy subjects based on QRS amplitude.

Value of leads V4R and CM5 in the detection of coronary artery disease during exercise electrocardiographic test.

The usefulness of the right precordial unipolar leads and the value of the bipolar lead CM5 in the detection of coronary artery disease (CAD) with exercise electrocardiographic (ECG) test are not well documented. The objective of this study was to evaluate the diagnostic performance of leads V4R and CM5. The study population comprised 579 patients referred for a bicycle exercise ECG test in the Finnish Cardiovascular Study. Patients were divided into three groups: angiographically proven CAD (CAD, n = 255), no CAD by angiography (NoCAD, n = 126), and low likelihood of CAD (LLC, n = 198). The maximum ST-segment depression at peak exercise was used as a parameter, and the diagnostic accuracy of different leads was assessed by receiver operating characteristic (ROC) analysis. Sensitivity and specificity values at a cut-off criterion of -0.10 mV ST-segment, 1-mm ST depression, were determined. According to the results, incorporating lead V4R with the standard leads decreased the ROC area from 0.71 to 0.69 (comparison CAD versus LLC) and from 0.55 to 0.53 (comparison CAD versus NoCAD) and had no effect on sensitivity or specificity. Adding lead CM5 to the standard leads did not affect the ROC area but increased the sensitivity and decreased the specificity. In conclusion, the use of right precordial lead V4R along with the standard 12-lead system does not improve the performance of the exercise ECG in diagnosing CAD. Adding lead CM5 to the standard leads increases the sensitivity but does not change the overall diagnostic performance.

Estimating the measuring sensitivity of unipolar and bipolar ECG with lead field method and FDM models.

New portable electrocardiogram (ECG) measurement systems are emerging into market. Some use nonstandard bipolar electrode montage and sometimes very small interelectrode distances to improve the usability of the system. Modeling could provide a straightforward method to test new electrode systems. The aim of this study was to assess whether modeling the electrodes' measuring sensitivity with lead field method can provide a simple tool for testing a number of new electrode locations. We evaluated whether the actual ECG signal strength can be estimated by lead fields with two realistic 3D finite difference method (FDM) thorax models. We compared the modeling results to clinical body surface potential map (BSPM) data from 236 normal patients and studied 117 unipolar and 42 bipolar leads. In the case of unipolar electrodes the modeled measuring sensitivities correlated well with the clinical data (r=0.86, N=117, p<0.05). In the case of bipolar electrodes the correlation was moderate (r=0.62 between Model 1 and clinical data, r=0.71 between Model 2 and clinical data, N=42 and p<0.05 for both). Based on this we can conclude that lead field analysis based on realistic thorax models provides a good initial prediction for designing new electrode montages and measurement systems.

Best electrode locations for a small bipolar ECG device: signal strength analysis of clinical data.

New miniaturized portable electrocardiogram (ECG) measuring devices may require small interelectrode distance. However, finding a suitable location for a tiny measurement device may prove tedious, as reducing interelectrode distance reduces signal strength. The objective of the study was to define the optimal location for a very closely located (5 cm) bipolar electrode pair. A total of 120 bipolar leads were analyzed from a body surface potential map (BSPM) data with 236 subjects with a normal ECG. The average and standard deviation (SD) of the QRS-complex and the P-wave amplitudes in each electrode location and for each subject were determined. The results showed that deviation in signal amplitude between different subjects is significant. However, judging from average values, the best orientation for a closely located bipolar electrode pair is diagonally on the chest. The best locations for QRS-complex and P-wave detection are around the chest electrodes of the standard precordial leads V2, V3, and V4, and above the chest electrodes of leads V1 and V2, respectively.

Measurement of noise and impedance of dry and wet textile electrodes, and textile electrodes with hydrogel.

Textile sensors, when embedded into clothing, can provide new ways of monitoring physiological signals, and improve the usability and comfort of such monitoring systems in the areas of medical, occupational health and sports. However, good electrical and mechanical contact between the electrode and the skin is very important, as it often determines the quality of the signal. This paper introduces a study where the properties of dry textile electrodes, textile electrodes moistened with water, and textile electrodes covered with hydrogel were studied with five different electrode sizes. The aim was to study how the electrode size and preparation of the electrode (dry electrode/wet electrode/electrode covered with hydrogel membrane) affect the measurement noise, and the skin-electrode impedance. The measurement noise and skin-electrode impedance were determined from surface biopotential measurements. These preliminary results indicate that noise level increases as the electrode size decreases. The noise level is high in dry textile electrodes, as expected. Yet, the noise level of wet textile electrodes is quite low and similar to that of textile electrodes covered with hydrogel. Hydrogel does not seem to improve noise properties, however it may have effects on movement artifacts. Thus, it is feasible to use textile embedded sensors in physiological monitoring applications when moistening or hydrogel is applied.

Wireless head cap for EOG and facial EMG measurements.

A head cap made of fabric for measuring EOG and facial EMG signals is presented. Reusable and easy to use electrodes, embroidered of silver coated thread, are integrated into the cap. A two-way wireless data transmission link operating at license free 2.4 GHz frequency band is used for transferring the 16-bit measurement data, sampled with 1 kHz frequency from six channels at maximum, to the receiver device connected to a PC. Tailored PC software is used for displaying the signals and controlling the measurement parameters. The measurement system is intended for recording facial expressions during human emotion studies but it can also be utilized in computer user interface control. The paper shows preliminary results from EOG and facial EMG measurements.