Korean Circ J.  2024 Mar;54(3):140-153. 10.4070/kcj.2023.0252.

Comparison of Novel Telemonitoring System Using the Single-lead Electrocardiogram Patch With Conventional Telemetry System

• Kwon S
• Choi EK
• Lee SR
• Oh S
• Song HS
• Lee YS
• Han SJ
• Lim HE

• KMID: 2554142
• DOI: http://doi.org/10.4070/kcj.2023.0252

Abstract

Background and Objectives
Although a single-lead electrocardiogram (ECG) patch may provide advantages for detecting arrhythmias in outpatient settings owing to user convenience, its comparative effectiveness for real-time telemonitoring in inpatient settings remains unclear. We aimed to compare a novel telemonitoring system using a single-lead ECG patch with a conventional telemonitoring system in an inpatient setting.
Methods
This was a single-center, prospective cohort study. Patients admitted to the cardiology unit for arrhythmia treatment who required a wireless ECG telemonitoring system were enrolled. A single-lead ECG patch and conventional telemetry were applied simultaneously in hospitalized patients for over 24 hours for real-time telemonitoring. The basic ECG parameters, arrhythmia episodes, and signal loss or noise were compared between the 2 systems.
Results
Eighty participants (mean age 62±10 years, 76.3% male) were enrolled. The three most common indications for ECG telemonitoring were atrial fibrillation (66.3%), sick sinus syndrome (12.5%), and atrioventricular block (10.0%). The intra-class correlation coefficients for detecting the number of total beats, atrial and ventricular premature complexes, maximal, average, and minimal heart rates, and pauses were all over 0.9 with p values for reliability <0.001. Compared to a conventional system, a novel system demonstrated significantly lower signal noise (median 0.3% [0.1–1.6%] vs. 2.4% [1.4–3.7%], p<0.001) and fewer episodes of signal loss (median 22 [2–53] vs. 64 [22–112] episodes, p=0.002).
Conclusions
The novel telemonitoring system using a single-lead ECG patch offers performance comparable to that of a conventional system while significantly reducing signal loss and noise.

Keyword

Electrocardiogram; Telemedicine; Wearable electronic devices

Figure

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  Figure 1 Schematic illustration of an inpatient setting for a novel telemonitoring system using a single-lead electrocardiogram patch.Patients in a cardiology unit wear a single-lead ECG patch. ECG data from the patch can be wirelessly transmitted to the central monitoring platform and real-time telemonitored at ward monitors, a dashboard in the nurse station, and a workstation. The gateways as ECG signal receivers are strategically installed to facilitate seamless reception of ECG data.ECG = electrocardiogram.

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  Figure 2 Schematic illustration of the dual connection configuration to prevent signal loss in ambulatory patient settings.The BLE protocol efficiently communicated the dual connection configuration between the ECG patch and the neighboring gateways. It allows the ECG patch to connect with 2 nearby gateways simultaneously. It prevents the risk of signal loss because the patient is within the effective range of another gateway, even if it is outside the effective range of one gateway.BLE = Bluetooth Low Energy; ECG = electrocardiogram.

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  Figure 3 Bland-Altman plots for ECG parameters.The limits of agreement and mean difference are represented. Most ECG parameters displayed good agreement between the two devices. The annotations (A-G) denote some outliers for each parameter. The analyses for the outliers are presented in the RESULT.AF = atrial fibrillation; APC = atrial premature complex; ECG = electrocardiogram; ICC = intraclass correlation; HR = heart rate; VPC = ventricular premature complex.

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  Figure 4 Various arrhythmic episodes recorded simultaneously by a novel telemonitoring system using a single-lead ECG patch and the conventional telemonitoring system.Arrhythmic episodes were identifiable in both systems simultaneously. The upper panel shows the conventional telemonitoring system with three channels, while the lower panel presents a novel telemonitoring system using a single-lead ECG patch.ECG = electrocardiogram.

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  Figure 5 Distributions of signal noise and signal loss between novel telemonitoring system using a single-lead ECG patch and the conventional telemonitoring system.A novel telemonitoring system using a single-lead ECG patch demonstrated a significant reduction in (A) proportions of noise data and (B) the total number of episodes of signal loss, compared to the conventional telemonitoring system. However, (C) the minimum or (D) maximum durations of signal loss were not significantly different between the two telemonitoring systems.ECG = electrocardiogram.

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