Precordial electrocardiographic recording and QT measurement from a novel wearable ring device

G Stuart Mendenhall; Matthew O Jones; Charles V Pollack; Greg P Eoyang; Steven H Silber; Alan Kennedy

doi:10.1016/j.cvdhj.2023.11.021

Precordial electrocardiographic recording and QT measurement from a novel wearable ring device

Cardiovasc Digit Health J. 2023 Dec 1;5(1):8-14. doi: 10.1016/j.cvdhj.2023.11.021. eCollection 2024 Feb.

Authors

G Stuart Mendenhall¹, Matthew O Jones², Charles V Pollack³, Greg P Eoyang², Steven H Silber⁴, Alan Kennedy⁵

Affiliations

¹ Scripps Memorial Hospital-La Jolla, La Jolla, California.
² Everbeat, Inc, Potomac, Maryland.
³ Department of Emergency Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.
⁴ Department of Emergency Medicine, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, New York.
⁵ PulseAI, Belfast, Northern Ireland.

Abstract

Background: The availability of portable and wearable electrocardiographic (ECG) devices has increased secondary to technological development. Single-lead ECG recordings have been shown to reliably detect and characterize cardiac rhythms such as atrial fibrillation. Acquisition of precordial electrodes for full 12-lead ECG reconstruction from bipolar recordings is complicated by the absence of a body ground/Wilson central terminal electrode. The extent of difference between standard precordial leads and those from a wearable bipolar ECG recorder has not been characterized.

Objective: The purpose of this study was to characterize the precordial ECG lead set from sequential bipolar recordings from an ECG ring wearable device.

Methods: In 70 patients who wore an ECG device on a right-hand finger, sequential precordial leads (CR1-CR6) were obtained along with chest electrodes (V1-V6). During acquisition of the modified precordial lead CR6, a full standardized 12-lead ECG capture was obtained. Signal quality was assessed using automated analysis software, and correlation values between the ring-derived ECG precordial leads and standard ECG leads were compared with regard to QRS duration, QT width, and RR interval.

Results: High concordance in the morphologies of precordial ECG leads obtained in a standard fashion and those recorded through an ECG ring was observed. Morphologic alignment improved with increasing laterality of the precordial lead with chest to right arm ring recording (CR5, CR6) compared with anterior chest leads to right arm (CR1, CR2). Segmental measurements of QRS duration and QT segment were well aligned and of high correlation.

Conclusion: Wearable ring-based ECG technology is capable of high-fidelity recordings of precordial leads for nonsimultaneous reconstruction of complete ECG sets. These recordings correlate highly with surface-obtained QRS and QT duration measurements and have significant implications for clinical applications. Uninterpretable tracings were primarily due to electrode noise from poor electrode contact.

Keywords: Antiarrhythmic monitoring; Arrhythmia; Electrocardiogram; Ischemia; QRS widening; QT prolongation; Wearable technology.