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Updated: Jun 22, 2025
Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function
Published on: December 11, 2019
Coronary Artery Occlusion Detection Using 3-Lead ECG System Suitable for Credit Card-Size Personal Device Integration
Alexei Shvilkin1, Dejan Vukajlović2, Boško P Bojović3,4
1Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Background:
Early coronary occlusion detection by portable personal device with limited number of electrocardiographic (ECG) leads might shorten symptom-to-balloon time in acute coronary syndromes.
Objectives:
The purpose of this study was to compare the accuracy of coronary occlusion detection using vectorcardgiographic analysis of a near-orthogonal 3-lead ECG configuration suitable for credit card-size personal device integration with automated and human 12 lead ECG interpretation.
Methods:
The 12-lead ECGs with 3 additional leads ("abc") using 2 arm and 2 left parasternal electrodes were recorded in 66 patients undergoing percutaneous coronary intervention prior to ("baseline", n = 66), immediately before ("preinflation", n = 66), and after 90-second balloon coronary occlusion ("inflation", n = 120). Performance of computer-measured ST-segment shift on vectorcardgiographic loops constructed from "abc" and 12 leads, standard 12-lead ECG, and consensus human interpretation in coronary occlusion detection were compared in "comparative" and "spot" modes (with/without reference to "baseline") using areas under ROC curves (AUC), reliability, and sensitivity/specificity analysis.
Results:
Comparative "abc"-derived ST-segment shift was similar to two 12-lead methods (vector/traditional) in detecting balloon coronary occlusion (AUC = 0.95, 0.96, and 0.97, respectively, P = NS). Spot "abc" and 12-lead measurements (AUC = 0.72, 0.77, 0.68, respectively, P = NS) demonstrated poorer performance (P < 0.01 vs comparative measurements). Reliability analysis demonstrated comparative automated measurements in "good" agreement with reference (preinflation/inflation), while comparative human interpretation was in "moderate" range. Spot automated and human reading showed "poor" agreement.
Conclusions:
Vectorcardiographic ST-segment analysis using baseline comparison of 3-lead ECG system suitable for credit card-size personal device integration is similar to established 12-lead ECG methods in detecting balloon coronary occlusion.
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