Diagnostic Advances
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2016; 8(10): 559-565
Published online Oct 26, 2016. doi: 10.4330/wjc.v8.i10.559
Remote electrocardiograph monitoring using a novel adhesive strip sensor: A pilot study
Charles J Bruce, Dorothy J Ladewig, Virend K Somers, Kevin E Bennet, Scott Burrichter, Christopher G Scott, Lyle J Olson, Paul A Friedman
Charles J Bruce, Division of Cardiovascular Disease, Mayo Clinic Jacksonville, FL 32224, United States
Virend K Somers, Lyle J Olson, Paul A Friedman, Division of Cardiovascular Disease, Mayo Clinic Rochester, MN 55901, United States
Dorothy J Ladewig, Mayo Clinic Ventures, Mayo Clinic, Rochester, MN 55905, United States
Kevin E Bennet, Division of Engineering, Mayo Clinic, Rochester, MN 55905, United States
Scott Burrichter, Division of Preventice, Mayo Clinic, Rochester, MN 55905, United States
Christopher G Scott, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Bruce CJ, Bennet KE, Burrichter S, Somers VK, Olson LJ and Friedman PA contributed equally to this work related to conception, design of study, drafting and revising; Scott CG contributed statistical analysis; Ladewig DJ contributed to design of study, data acquisition and review/drafting of manuscript.
Conflict-of-interest statement: Mayo Clinic and Drs. Bruce Friedman Somers, Mr. Kevin Bennet and Scott Burrichter have a financial interest in technology referenced in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul A Friedman, MD, Department of Cardiovascular Diseases, Mayo Clinic, 200 First ST SW, Rochester, MN 55902, United States. friedman.paul@mayo.edu
Telephone: +1-507-2552446 Fax: +1-507-2552550
Received: February 19, 2016
Peer-review started: February 22, 2016
First decision: March 25, 2016
Revised: May 25, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: October 26, 2016
Processing time: 250 Days and 12.6 Hours
Abstract

The increase in health care costs is not sustainable and has heightened the need for innovative low cost effective strategies for delivering patient care. Remote monitoring holds great promise for preventing or shortening duration of hospitalization even while improving quality of care. We therefore conducted a proof of concept study to examine the quality of electrocardiograph (ECG) recordings obtained remotely and to test its potential utility in detecting harmful rhythms such as atrial fibrillation. We tested a novel adhesive strip ECG monitor and assessed the ECG quality in ambulatory individuals. 2630 ECG strips were analyzed and classified as: Sinus, atrial fibrillation (AF), indeterminate, or other. Four readers independently rated ECG quality: 0: Noise; 1: QRS complexes seen, but P-wave indeterminate; 2: QRS complexes seen, P-waves seen but poor quality; and 3: Clean QRS complexes and P-waves. The combined average rating was: Noise 12%; R-R, no P-wave 10%; R-R, no PR interval 18%; and R-R with PR interval 60% (if Sinus). If minimum diagnostic quality was a score of 1, 88% of strips were diagnostic. There was moderate to high agreement regarding quality (weighted Kappa statistic values; 0.58 to 0.76) and high level of agreement regarding ECG diagnosis (ICC = 0.93). A highly variable RR interval (HRV ≥ 7) predicted AF (AUC = 0.87). The monitor acquires and transmits diagnostic high quality ECG data and permits characterization of AF.

Keywords: Remote, Electrocardiograph, Monitoring, Atrial fibrillation, Novel, Sensor

Core tip: The findings of this pilot study confirm that a remote monitoring system using a novel adhesive strip electrocardiograph (ECG) sensor can acquire and transmit diagnostic high quality ECG data over a period of 3 d when worn by elderly subjects leading active independent lives. Automated determination of heart rate variability permitted reliable characterization of ECG strips with atrial fibrillation. These data have implications for long term continuous monitoring for development of atrial fibrillation in independent elderly patients.