The evolution of ECG
Electrocardiography is one of the most important, dependent, non-invasive and basic diagnostic procedures performed in causality, outpatient, intensive care, and surgical departments in order to find out the condition of the patient’s heart as well as its activity.
The output waveform of electrocardiography procedure representing biopotential voltage variation with reference to the time is termed as electrocardiogram and the machine or system used to acquire this waveform is known as an electrocardiograph. A single electrocardiogram waveform, recorded by connecting a minimum of two or three electrodes at different body parts, which exhibits a complete cycle of the heart’s contraction and relaxation process is called a lead.
Since the first recording of the electrocardiogram (ECG) by Willem Einthoven there has been an evolution in the procedure and technology of acquiring ECG, its analysis, interpretation, diagnosis, display of ECG waveforms, and their accurate measurements.
Today 12 lead ECG acquisition procedure is the standard technique for acquiring ECG waveforms, in which six leads are constituted by the combination of four limb electrodes: right arm (RA), left arm (LA), left leg (LL), and right leg (RL). And remaining six leads are fetched from the chest surface C1 to C6 (or V1 to V6). In all these electrode combinations RL electrode biopotential is referred to as neutral.
The data displaying complete 12 lead recorded waveforms along with measurements, interpretation, and diagnosis after an electrocardiography procedure is called ECG report.
The ECG machines are being manufactured by various companies in the world, and there are many varieties of reporting. Even though all standard ECG systems acquire all 12 leads data they have been categorized by their way of report displays. The standard ways of reporting ECG are as given below:
- Single Channel ECG system: This system gives a report of only one lead at that instance either on a display monitor or printed paper.
- Three Channel ECG system: This system provides reports of three leads at single instance mainly in manual mode printed form, in automatic printing mode remaining leads will be automatically added along with interpretation and diagnosis. All 12 leads will be available on a live display monitor.
- Six Channel ECG system: This system provides report six leads at a single instance mainly in manual mode printed form, in automatic report printing mode remaining leads will be automatically added along with interpretation and diagnosis. All 12 leads will be available on a live display monitor.
- Twelve Channel ECG system: This system reports all the twelve leads data in printed form, at that instance in manual reporting mode, whereas in automatic reporting mode, 12 leads along with interpretation and diagnosis. All 12 leads will be available on a live display monitor.
The challenges of ECG reporting
Even though there are many ECG machine brands providing ECG reports with interpretation and diagnosis there are a few challenges faced by the patients;
- Appropriate acquisition of the ECG
- Accurate interpretation of the waveforms
- Proper diagnosis of the heart condition
- Reliability of the report
Let us discuss the above challenges in brief;
1) Appropriate acquisition of the ECG: Sometimes due to human errors such as wrong placement of electrodes on the patient’s body, movement artifacts occurring due to body vibration, and inaccurate signal noise cancellation system, the recorded ECG waveforms will be displayed in the system may not lead to proper reporting of the electrocardiography.
2) Accurate interpretation of the waveforms: Most of the ECG machines in the market are programmed to analyze the ECG waveform and mention specific conditions as interpretation, whereas in reality there are more than 250 arrhythmia conditions to be diagnosed carefully by cardiologists. So inaccurate interpretation of the ECG waveforms may lead to incorrect ECG diagnosis.
3) Proper diagnosis of the heart condition: Even there are ECG systems that implement very accurate ECG analysis algorithms and provide accurate interpretation, they are prone to report diagnosis improperly because certain conditions of the subjected heart need to be analyzed by the doctors with reference to patients health history, gender, age, and habits.
4) Reliability of the report: The ECG reports generated automatically by ECG machines are not completely reliable because of the absence of a properly trained doctor’s analysis. So the automated ECG report generation leads the patient only to unreliable diagnostic information which needs to be avoided in any given situation. Only a trained doctor can hand over the proper reliable ECG report to the patient.
Available technology with a solution
Today the internet is easily accessible by most hospitals, clinics, diagnostic centers, and doctors. One of the technological advantages of the internet is cloud computing. In cloud computing, most of the data used will be stored in highly secured servers and can be accessed by the user at any time through the internet. When this cloud computing technology is used to transfer ECG data to a doctor who is trained and approved ECG interpreter, the ECG reports are highly reliable because;
- Proper verification of ECG waveform acquisition
- Accurate analysis of the ECG waveforms leading to the appropriate interpretation
- Reliable diagnosis constructed based on patients health history, current situation, and habits
So the ECG reporting challenges discussed previously can be overcome with the help of currently available technology.
Is this ‘need of the hour’ technology available?
Present-day we have a product in the market which can provide us with the solution required.
InstaECG is Tricog’s flagship product that has made the aim of saving lives a reality. It is a cloud-connected device that makes the interpretation and analysis of an ECG report quick and easy. With the InstaECG, patients can receive the Cardiologist Certified ECG reports within 10 minutes.
This made in India, Tricog product is a 12 channel ECG machine that can be used by interfacing to a smartphone through a USB cable. The machine comes with 10 electrode cables with 4 clamp electrodes for arms/limbs and 6 bulb electrodes for the chest.
The smartphone should be connected to the internet in order to get an instant ECG report.
This system uses a smartphone connection for its electrical power needs, so it does not require any battery or a power adapter.