Validation of ECG Waveform and Arrhythmia Diagnosis Concordance Using ECG Monitoring Patch and Holter Monitoring

[How to conduct research] This study targeted adults aged 19 years or older. Written consent is obtained from those who are diagnosed with arrhythmia and need a Holter examination among outpatients or inpatients at the Cardiology Department of Kosin University Gospel Hospital. The medical staff attaches the Holter device to the subject and the patch-type electrocardiograph in the Holter examination room. Holter device and patch-type electrocardiograph are returned to the Holter examination room after measuring the electrocardiogram for 24 hours. ECG signals from patch-type electrocardiographs and commercial Holter device and arrhythmia detection information are compared and analyzed.

[Number of Subjects] The number of this study is 105. Written consent is obtained from those who are diagnosed with arrhythmia and need a Holter examination among outpatients or inpatients at the Cardiology Department.

[Data analysis plan] In this study, the personal identification information of the subjects will be coded non-identifying and the collected electrocardiogram data will be stored in the cloud with restricted access from outsiders. Coded, non-identified research data is stored and managed in the cloud in compliance with privacy standards and information security standards. ECG data transmitted through the mobile application is stored in the cloud. Confidentiality and security of data are guaranteed, and data collected from patch-type electrocardiograph is used only for research. The electrocardiogram data acquired in this study are obtained in TXT or MAT format and used for data analysis.

The efficacy evaluation items are as follows.

• Comparison of ECG signal concordance
• Comparison of the parameters below for a noise-free section of about 1 minute, not the entire section

• P-wave, QRS-complex, T-wave: Sensitivity, Positive Predictive Value, Amplitude difference, Correlation to the entire signal
• P, QRS, T (On/Off time): Time difference
• PR, QRS, QT (Duration/Interval): Time difference
• Comparison of arrhythmia diagnosis concordance rates between 24-hour patch-type electrocardiograph and commercial Holter device measurement data by arrhythmia categories (total of 19 including ventricular ectopic beat)

The evaluation method and interpretation method are as follows.

• In the case of categorical variables, the sensitivity and positive predictive value are evaluated, and in the case of continuous variables, the concordance between the measured values measured by the patch-type electrocardiograph and the Holter device is evaluated using the Bland-Altman plot.
• Amplitude difference of P-wave, QRS-complex and T-wave & Correlation to the entire signal

• Peaks of P-wave, QRS-complex (R-wave peaks) and peaks of T-wave are manually annotated in the holter device and patch-type ECG independently to assess amplitude difference and correlation to the entire ECG signal.
• Time difference of P, QRS, T (On/Off time) & PR, QRS, QT (Duration/Interval)

• Exact timing of fiducial markers such as onset of P-wave and QRS-complex, and offset of P-wave, QRS-complex, T-wave and clinically useful intervals and durations (PR-interval, RR interval, QT interval, P-wave duration, QRS-duration) are manually annotated in the holter device and patch-type ECG independently to quantify the accuracy of delineating these characteristic points in the patch sensor.
• Root Mean Square of Heart Rate

• Calculate and analyze the square root after averaging the squares of each heart rate value in the analysis section from the electrocardiogram obtained simultaneously from the Holter device and the patch-type electrocardiograph

Inclusion criteria

• Adults 19 years of age or older
• Patients who are diagnosed with arrhythmia and need regular Holter electrocardiography among outpatients or hospitalized patients at the Department of Cardiology, Kosin University Gospel Hospital
• Those who gave written consent to this clinical study
• Able to understand and carry out training and instructions

Exclusion criteria

• A person with a physical disability that cannot wear a patch-type electrocardiograph
• A person suffering from skin disease or functional disorder at the site where the patch-type electrocardiograph will be attached
• Subjects who cannot read the consent form (illiterate, foreigners, etc.)
• Patients judged to be unsuitable for participation in this clinical study by the judgment of investigators