JMIR Publications

ABSTRACT

Background:

Accurate detection of myocardial ischemia and arrhythmias during free-living exercise could play a pivotal role in screening and monitoring for the prevention of exercise-related cardiovascular events in high risk populations. Although remote electrocardiogram (ECG) solutions are emerging rapidly, existing technology is neither designed nor validated for continuous use during vigorous exercise.

Objective:

In this proof-of-concept study we evaluated the usability, signal quality and accuracy for arrhythmia detection of a single-lead ECG patch platform featuring self-adhesive dry electrodes technology in individuals with chronic coronary syndrome (CCS). This sensor was evaluated during exercise and for prolonged continuous monitoring.

Methods:

Six consecutive CCS patients scheduled for an exercise stress test (EST) as part of routine cardiac follow-up were recruited. Traditional 12-lead ECG recording was combined with monitoring with the ECG patch. Following the EST, the subjects continuously wore the sensor for five days. Intraclass correlation coefficients (ICC) and Wilcoxon signed-rank tests were used to assess the utility to detect arrhythmias with the patch by comparing evaluations of two blinded assessors. Signal quality during EST and prolonged monitoring was evaluated by using a signal quality indicator (SQI). Additionally, connection time was calculated for prolonged ECG monitoring. The comfort and usability of the patch were evaluated by an online self-assessment questionnaire.

Results:

Six male patients with CCS (mean age 69.8 ± 6.2 years) completed the study protocol. The patch was worn for a mean of 118.3 hours (SD 5.6). The level of agreement between the patch and 12-lead ECG was excellent for detection of premature atrial contractions (PACs) and premature ventricular contractions (PVCs) during the whole test (ICC = 0.998, 1.000). No significant differences in the total number of PACs and PVCs were detected neither during the entire exercise test (p = 0.785 and 0.180, respectively) nor during exercise and recovery stages separately (p = 0.414, 0.655, 0.180 and 0.655). One episode of atrial fibrillation was detected by both methods. Total connection time during recording was between 88 and 100% in all subjects. There were no reports on skin irritation, erythema or pain while wearing the patch.

Conclusions:

This proof-of-concept study showed that this innovative ECG patch based on self-adhesive dry electrode technology can potentially be used for arrhythmia detection during vigorous exercise. The results suggests that the wearable patch is also usable for prolonged continuous ECG monitoring in free-living conditions and can therefore be of potential use in cardiac rehabilitation and tele monitoring for prevention of exercise-related cardiovascular events. Future efforts shall focus on optimizing signal quality over time and conducting a larger-scale validation study focusing on both arrhythmia and ischemia detection.