Modified precordial lead ECG SafOne on electrocardiography recordings

Electrocardiography (ECG or EKG) recording is one of the most important cardiac diagnostic tests because it is used to determine cardiac problems and is noninvasive, inexpensi1,2. This diagnostic tool works with an ECG signal recorded from many electrodes attached over the skin to detect and diagnose cardiac disease3,4. This method for electrocardiography recording was invented in the 1930s and established in clinical practice in the 1940s and is currently known as a 12-lead electrocardiogram (ECG)5. Since then, a wide range of ECG devices have been used in clinical practice: 12-lead ECG, multichannel ECG (MECG), Holter monitoring, implantable loop recorder (ILR), and others6,7,8. An excellent standard is the well-known 12-lead ECG, where wires are connected to electrodes placed on 10 locations on the body7.9. These 12-lead ECGs have recently become the topic of an important and interesting investigation around the globe since their introduction into clinical practice10.

The rapid development of technology has a significant impact on new technology, including in the health sector. A study conducted by Bond et al. (2016) developed the CardioQuick Patch (CQP) to assist operators in accurately positioning electrodes during 12-lead ECG acquisition11th. Similar to ECG SafOne, the CQP aims to improve the accuracy of electrode placement that can be applied in a time that is comparable to single-electrode application. CPQ and ECG SafOne use different designs, materials and procedures. The CQP uses adaptable horizontal placement and rigid vertical placement designs, which still need time to ensure electrode position when used, while ECG SafOne uses a single simple design. Thus, ECG SafOne is easy and practical in terms of finding the V1–V6 placement, and it is time efficient. CQP can be applied to both males and females of all torso sizes and stay on the patient for up to three days. On contrast, ECG SafOne can only be applied to males with two different sizes of device (medium and large) based on the Indonesian male standard size, and it is not designed for long-term use during the procedure.

Tsukada et al. (2019) and Li, Xiong and Li (2020) developed a measurement of ECG signals based on textile material called the wearable measurement of ECG6.12. Both studies aimed to investigate the usefulness of textile electrodes for ECG recording using fabric as the material. Electrode textile pads and lead wires were sewn to a textile that tolerated repeated washings and collected ECG signals during recording. The difference between these two tools is in the utility, where Tsukada’s smart garment is usable for continuous and repeated ECG monitoring, not during dynamic trunk movement, while Li’s smart clothing showed good recording performance in the conditions of sleeping and jogging6.12.

This diagnostic test (ECG) is important to record the electrical activities of the heart that can be recorded using electrodes attached to the six thoracic bones and four extremity landmarks. However, errors in the placement of precordial leads, misplacement, and interchange of precordial electrodes will cause invalid ECG recordings13. Misconnection or misplacement of the electrodes while performing a 12-lead electrocardiogram can lead to various electrocardiographic changes called artefacts. to collect accurate data, the ECG electrodes need to be correctly applied, in terms of both the electrode position and the adequacy of the conductor; otherwise, an inverted record or artefact will result13.

Definitions for precision in the electrocardiographic recording were addressed, and calibration methods were established to measure the timing and amplitude of electrical signals from the heart uniformly. Uniformity standardization for limb lead has been acknowledged; however, precordial lead placement is the most recognized source of variability5 and can result in several interpretation errors and artefacts. ECG artefacts are normal beats that result not only from the electrical activity of the heart but also from noise interference3. In the last two decades, several studies have investigated under what circumstances 12-lead ECG has been modified with a variety of aims10. However, there has been much debate about studies on how ECG morphology can change with different lead placements, particularly in healthy subjects.

When performing ECG under normal conditions, ECG electrodes can be attached properly, but this process sometimes takes time. The misplacement of the ECG electrodes can be avoided by reducing the misplacement of precordial electrodes11th. However, in responding to emergencies, the misplacement of precordial leads may occur. The condition will be exacerbated if a patient experiencing a heart attack is restless and unstable. As a result, ECG results can fail and affect ECG recordings and lead to incorrect interpretation and diagnosis.

These conditions can be anticipated by finding a practical way to determine the position of the placement of the precordial leads quickly and precisely so that they can be used in any condition. However, there is currently no specific device to determine practical electrodes to point to the position of the precordial lead used to perform ECG tests6,11,12. Therefore, an ECG precordial lead modification to answer this question is essential. The current study introduces a new tool designed to correct this problem and facilitate proper precordial lead placement. The authors of this study recently proposed a modified precordial lead ECG SafOne for recording electrocardiography. The present study investigated the modified precordial lead ECG SafOne on electrocardiography recordings. To ensure that this modified precordial lead ECG SafOne is appropriate to record ECG, the examination evaluated the different artefacts that emerged between the precordial lead ECG SafOne and the precordial lead ECG standard.

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