Background Electrocardiogram (ECG) monitoring in daily life is essential for effective management of cardiovascular disease, a leading cause of death. Wearable ECG measurement systems in the form of clothing have been proposed to replace Holter monitors used for clinical ECG monitoring; however, they have limitations in daily use because they compress the upper body and, in doing so, cause discomfort during wear. Objective The purpose of this study was to develop a wireless wearable ECG monitoring system that includes a textile ECG electrode that can be applied to the lining of pants and can be used in the same way that existing lower clothing is worn, without compression to the upper body. Methods A textile electrode with stretchable characteristics was fabricated by knitting a conductive yarn together with polyester-polyurethane fiber, which was then coated with silver compound; an ECG electrode was developed by placing it on an elastic band in a modified limb lead configuration. In addition, a system with analog-to-digital conversion, wireless communication, and a smartphone app was developed, allowing users to be able to check and store their own ECGs in real time. A signal processing algorithm was also developed to remove noise from the obtained signal and to calculate the heart rate. To evaluate the ECG and heart rate measurement performance of the developed module, a comparative evaluation with a commercial device was performed. ECGs were measured for 5 minutes each in standing, sitting, and lying positions; the mean absolute percentage errors of heart rates measured with both systems were then compared. Results The system was developed in the form of a belt buckle with a size of 53 × 45 × 12 mm (width × height × depth) and a weight of 23 g. In a qualitative evaluation, it was confirmed that the P-QRS-T waveform was clearly observed in ECGs obtained with the wearable system. From the results of the heart rate estimation, the developed system could track changes in heart rate as calculated by a commercial ECG measuring device; in addition, the mean absolute percentage errors of heart rates were 1.80%, 2.84%, and 2.48% in the standing, sitting, and lying positions, respectively. Conclusions The developed system was able to effectively measure ECG and calculate heart rate simply through being worn as existing clothing without upper body pressure. It is anticipated that general usability can be secured through further evaluation under more diverse conditions.
BACKGROUND Electrocardiogram (ECG) monitoring in daily life is essential for effective management of cardiovascular disease, a leading cause of death. Wearable ECG measurement systems in the form of clothing have been proposed to replace Holter monitors used for clinical ECG monitoring, however, they have limitations in daily use because they compress the upper body, and in doing so, cause discomfort during wearing. OBJECTIVE The purpose of this study was to develop a wireless wearable ECG monitoring system including a textile ECG electrode that can be applied to the lining of pants and can be used in the same way as existing clothing wearing styles without compression on the upper body. METHODS A textile electrode having stretchable characteristics was fabricated by knitting a conductive yarn with polyester-polyurethane fiber and then silver compound coated, and an ECG electrode was developed by placing it on an elastic band in a modified limb lead configuration. In addition, a system with analog-to-digital conversion and wireless communication, and a smart phone application were developed allowing users to be able to check and store their own ECG in real time. A signal processing algorithm was also developed to remove noise from the obtained signal and to calculate the heart rate. For evaluation of ECG and heart rate measurement performance of the developed module, a comparative evaluation with a commercial device was performed. ECG was measured for five minutes each, in standing, sitting, and lying positions, and the root-mean-square error (RMSE) of heart rates measured with both systems was compared. RESULTS The system was developed in the form of a belt buckle with a size of 53×45×12 mm (width × height × depth) and a weight of 23 g. In qualitative evaluation, it was confirmed that the representative waveform of the ECG was clearly observed. From the results of the heart rate estimation, the developed system could track changes in heart rate calculated by a commercial ECG measuring device, and the RMSE of heart rate was 2.5 bpm, 3.3 bpm, and 2.6 bpm in standing, sitting, and lying positions, respectively. CONCLUSIONS The developed system was able to effectively measure the ECG and calculate the heart rate through simply wearing as existing clothing without upper body pressure. It is expected that general usability can be secured through evaluation under more diverse conditions. CLINICALTRIAL 1040198-200609-HR-061-02
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