How Far Does the Situation of the Indifferent Electrode Influence the Electrocardiographic Unipolar Chest Leads?

Groedel, Franz M.

doi:10.1159/000164631

Cited by 8 publications

(2 citation statements)

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“…These leads are generated similarly to V1 through V6, but with RA used as a proxy for Wilson's negative pole. This approach was first investigated in the 1930s, and as it is considered diagnostically similar to the current precordial leads it has previously been recommended during the 1990s for use in emergency settings (36)(37)(38)(39)(40)(41). The second approach, recommended by Samol et al, is to use a similar technique but enclose the right wrist in the left hand, thereby combining LA and RA in the negative pole (20).…”

Section: Discussionmentioning

confidence: 99%

Einthoven and Precordial Lead Accuracy of Smartwatch-Acquired Electrocardiographs: A Review of the Literature

Wilkinson-Stokes

2020

Australasian Journal of Paramedicine

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IntroductionThis review aims to summarise the literature regarding the ability of commercial smartwatch products to produce an electrocardiograph of diagnostic quality for interpreting Einthoven and precordial leads. Methods PubMed, Embase, MEDLINE Complete, Web of Science, and Scopus were systematically searched. Articles were screened by a sole investigator against the inclusion criteria – first by title, then abstract, then full text. The reference lists of included articles were also screened. The inclusion criteria were: discussion of smartwatch-acquired tracing of Einthoven or precordial lead accuracy, and demonstrating sufficient rigor when undergoing critical appraisal using the Joanna Briggs Institute evaluation tools. A synopsis of results was provided in a summary of information table. ResultsTwelve articles were identified for inclusion, nine of which had physician (cardiology or emergency specialty) evaluation of tracings, one of which had statistical comparison of wave duration and amplitude, and two of which were expert commentary. Only evaluations of Apple Watch products were discovered during the literature search. All leads in all studies were considered suitable for interpretation, with no clinically significant differences. Four studies found that 100% of patients were able to accurately use a smartwatch as an electrocardiogram after a brief tutorial. ConclusionThe current early evidence, based largely on visual evaluations by cardiologists during the previous year, suggests that electrocardiograph abnormality recorded by this technology is sufficiently precise to be presumed accurate until proven otherwise.

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Section: Discussionmentioning

confidence: 99%

Einthoven and Precordial Lead Accuracy of Smartwatch-Acquired Electrocardiographs: A Review of the Literature

Wilkinson-Stokes

2020

Australasian Journal of Paramedicine

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“…First, this system type where the chest electrodes are referenced not to WCT, but instead to the right arm electrode, was originally favored not only by Einthoven himself [5], but also by others even after the introduction of WCT [6], [7]. Second, algebraically it is also possible to accomplish the same fundamental end point through a digital format wherein all other electrodes are referenced to the left arm electrode while a zero voltage is simultaneously imposed on the DAC left arm electrode input, or through a digital format wherein all other electrodes are referenced to the left leg electrode while a zero voltage is simultaneously imposed on the DAC left leg electrode input.…”

Section: Methodsmentioning

confidence: 99%

New System for Digital to Analog Transformation and Reconstruction of 12-Lead ECGs

et al. 2013

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IntroductionWe describe initial validation of a new system for digital to analog conversion (DAC) and reconstruction of 12-lead ECGs. The system utilizes an open and optimized software format with a commensurately optimized DAC hardware configuration to accurately reproduce, from digital files, the original analog electrocardiographic signals of previously instrumented patients. By doing so, the system also ultimately allows for transmission of data collected on one manufacturer's 12-lead ECG hardware/software into that of any other.Materials and MethodsTo initially validate the system, we compared original and post-DAC re-digitized 12-lead ECG data files (∼5-minutes long) in two types of validation studies in 10 patients. The first type quantitatively compared the total waveform voltage differences between the original and re-digitized data while the second type qualitatively compared the automated electrocardiographic diagnostic statements generated by the original versus re-digitized data.ResultsThe grand-averaged difference in root mean squared voltage between the original and re-digitized data was 20.8 µV per channel when re-digitization involved the same manufacturer's analog to digital converter (ADC) as the original digitization, and 28.4 µV per channel when it involved a different manufacturer's ADC. Automated diagnostic statements generated by the original versus reconstructed data did not differ when using the diagnostic algorithm from the same manufacturer on whose device the original data were collected, and differed only slightly for just 1 of 10 patients when using a third-party diagnostic algorithm throughout.ConclusionOriginal analog 12-lead ECG signals can be reconstructed from digital data files with accuracy sufficient for clinical use. Such reconstructions can readily enable automated second opinions for difficult-to-interpret 12-lead ECGs, either locally or remotely through the use of dedicated or cloud-based servers.

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A comparison of precordial electrocardiograms obtained with CR, CL, CF, and V leads

Dolgin

Grau

Katz

1949

American Heart Journal

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How Far Does the Situation of the Indifferent Electrode Influence the Electrocardiographic Unipolar Chest Leads?

Cited by 8 publications

References 0 publications

Einthoven and Precordial Lead Accuracy of Smartwatch-Acquired Electrocardiographs: A Review of the Literature

Einthoven and Precordial Lead Accuracy of Smartwatch-Acquired Electrocardiographs: A Review of the Literature

New System for Digital to Analog Transformation and Reconstruction of 12-Lead ECGs

A comparison of precordial electrocardiograms obtained with CR, CL, CF, and V leads

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