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Cited by 174ECG Monitoring and AnalysisNon-Invasive Vital Sign MonitoringCardiac pacing and defibrillation studies

Portable out-of-hospital electrocardiography: A review of current technologies

Open access
Bansal, Agam, Joshi, Rajnish·2018·Journal of Arrhythmia
DOI 10.1002/joa3.12035PMC PMC5891427
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Abstract

Background: Availability of portable and home‐based electrocardiography ( ECG ) is an important medical innovation, which has a potential to transform medical care. We performed this review to understand the current state of out‐of‐hospital portable ECG technologies with respect to their scope, ease of use, data transmission capabilities, and diagnostic accuracy. Methods: We conducted PubMed and Internet searches for “handheld” or “wearable” or “patch” electrocardiography devices to enlist available technologies. We also searched PubMed with names of individual devices to obtain additional citations. We classified available devices as a “single limb lead ECG recording devices” and chest‐lead “ ECG recording devices.” If a device used more than three electrodes, it was defined as a conventional electrocardiography or Holter machine and was excluded from this review. Results: We identified a total of 15 devices. Overall, only six of these devices (five single lead and one chest lead) featured in published medical literature as identified from PubMed search. A total of 13 citations were available for the single limb lead ECG recording devices and 6 citations for the chest‐lead ECG recording devices. Conclusions: Despite the increase in number of such devices, published biomedical literature regarding their diagnostic accuracy, reproducibility, or utility is scant.

AI snapshot

Written from the paper’s full text.

TL;DR

This review catalogs portable out-of-hospital ECG technologies, identifying 15 commercially available devices divided into single-limb-lead and chest-lead/multiple-lead categories. It finds that only 6 of 15 devices have published medical literature, and that evidence on diagnostic accuracy, reproducibility, and utility remains scant.

Key findings

  • The review identified 15 devices: 12 single-limb-lead ECG recording devices and 3 chest-lead ECG recording devices; only 6 devices (5 single-lead and 1 chest-lead) appeared in published medical literature via PubMed.
  • Published citations were limited: 13 citations for single-limb-lead devices and 6 citations for chest-lead devices.
  • Diagnostic accuracy varied widely. For Alivecor Kardia, atrial fibrillation sensitivity/specificity was 98%/97% in one study and 98.5%/91.4% in another, but sensitivity fell to 71.4% in a large study with low AF prevalence (2.7%). For Omron HeartScan, AF sensitivity ranged from 30% to 100% across studies, with specificities of 76.2% to 97%.
  • For ZioPatch, longer wear increased diagnostic yield: compared with the first 48 hours, the overall diagnostic yield was greater when the entire wear duration was included for any arrhythmia and any symptomatic arrhythmia (P < .0001); it also detected more arrhythmia events than Holter over total wear time (P < .001).

Methods

  • Narrative review using PubMed and Internet searches for “handheld,” “wearable,” or “patch” electrocardiography devices, plus PubMed searches by individual device names.
  • Included only commercially available devices; classified them as single-limb-lead ECG recording devices if they used fingers/thumb of both hands, and as chest-lead ECG recording devices if they captured two or more leads via chest-wall sensors.
  • Excluded devices using more than three electrodes, which were defined as conventional ECG or Holter machines, and excluded devices that only analyzed pulse regularity without evaluating electrocardiograph.

Limitations

  • The paper states that published biomedical literature on these devices’ diagnostic accuracy, reproducibility, or utility is scant, and suggests reasons including early development phase, regulatory environments not mandating robust pre-launch studies, devices being developed in the engineering domain, and disconnect with biomedical research.
  • Evident from the text: the review relied partly on manufacturer and Internet information, did not report a systematic search protocol or formal quality appraisal, and did not perform meta-analysis.
  • Evident from the text: included studies were heterogeneous in populations, devices, outcomes, and definitions of arrhythmia, limiting direct comparison across devices.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/joa3.12035

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 19 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The review identified a total of 15 portable out-of-hospital ECG devices.

    “We identified a total of 15 devices.”
    • Also stated in: § RESULTS · plain
      “We identified a total of 15 devices, 12 of these were single limb lead ECG recording devices and remaining 3 were chest‐lead ECG recording devices.”
    • Also stated in: § DISCUSSION · plain
      “Of a total of 15 devices identified in our review, only 6 have been evaluated and published in biomedical literature.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Only six of the identified devices (five single lead and one chest lead) featured in published medical literature as identified from PubMed search.

    “Overall, only six of these devices (five single lead and one chest lead) featured in published medical literature as identified from PubMed search.”
    • Also stated in: § RESULTS · plain
      “Overall, only six of these devices (five single lead and one chest lead) featured in published medical literature as identified from PubMed search (Table 1).”
    • Also stated in: § DISCUSSION · plain
      “Of a total of 15 devices identified in our review, only 6 have been evaluated and published in biomedical literature.”
    Quote in the paperSubstantial claim
  • Interpretationown data

    Published biomedical literature regarding the diagnostic accuracy, reproducibility, or utility of portable out-of-hospital ECG devices is scant.

    “Despite the increase in number of such devices, published biomedical literature regarding their diagnostic accuracy, reproducibility, or utility is scant.”
    • Also stated in: § CONCLUSION · plain
      “Despite an explosion of such devices, published biomedical literature about their diagnostic accuracy, reproducibility, or utility is scant.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Despite a limited number of publications, sufficient literature exists to prove the concept and utility of portable out-of-hospital ECG devices.

    “Despite a limited number of publications, sufficient literature exists to prove the concept and utility of such devices.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    There is potential for multiple chest-lead wearable devices to supplant exercise-electrocardiography in stable angina situations.

    “There could be a potential to supplant exercise‐electrocardiography in these situations.”
    Quote in the paperSubstantial claim
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 3

  • May combine two claims.

    Findingown data

    A total of 13 citations were available for the single limb lead ECG recording devices and 6 citations for the chest-lead ECG recording devices.

    “A total of 13 citations were available for the single limb lead ECG recording devices and 6 citations for the chest‐lead ECG recording devices.”
    • Also stated in: § RESULTS · plain
      “A total of 13 citations were available for the single limb lead ECG recording devices and 6 citations for the chest‐lead ECG recording devices.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 15 identified devices, 12 were single limb lead ECG recording devices and 3 were chest-lead ECG recording devices.

    “We identified a total of 15 devices, 12 of these were single limb lead ECG recording devices and remaining 3 were chest‐lead ECG recording devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Multiple-lead devices use chest patch/electrodes and may have utility to detect both abnormal rhythms and localization of ischemic abnormalities.

    “Multiple‐lead devices use chest patch/electrodes and may have a utility to detect both abnormal rhythms and localization of ischemic abnormalities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Single-lead devices may be with or without a display of ECG and have a capability to detect abnormal rhythms.

    “Single‐lead devices maybe with or without a display of ECG and have a capability to detect abnormal rhythms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Available portable out-of-hospital ECG devices are heterogeneous and can be broadly classified as single limb lead and multiple-lead devices.

    “There is a heterogeneity in terms of available devices, and broadly these can be classified as single limb lead and multiple‐lead devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Multiple chest-lead wearable devices will have unparalleled utility in diagnosis of stable angina when individuals have chest pain or equivalent symptoms on exertion.

    “Multiple chest‐lead wearable devices however will have an unparalleled utility in diagnosis of stable angina, when individuals have chest pain or equivalent symptoms on exertion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Bolourchi et al., mean times to first detected and first symptom-triggered arrhythmias were 2.7 ± 3.0 and 3.3 ± 3.3 days, respectively.

    “The results in a large study among the pediatric age group 28 showed that the mean times to first detected and first symptom‐triggered arrhythmias were 2.7 ± 3.0 and 3.3 ± 3.3 days, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Bolourchi M, Batra AS. Diagnostic yield of patch ambulatory electrocardiogram monitoring in children (from a National Registry). Am J Cardiol. 2015; 115: 630– 4. 25591894

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Marazzi et al., Omron HeartScan had 100% sensitivity, 92% specificity, and 95% accuracy for detection of atrial fibrillation.

    “However, a study by Marazzi G et al15 demonstrated 100% sensitivity, 92% specificity, and 95% accuracy in detection of atrial fibrillation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Marazzi G, Iellamo F, Volterrani M, et al. Erratum to: comparison of microlife BP A200 plus and omron M6 blood pressure monitors to detect atrial fibrillation in hypertensive patients. Adv Ther. 2014; 31: 1317– 1317. 22198902

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Lau et al., Alivecor Kardia had 98% sensitivity and 97% specificity for detection of atrial fibrillation.

    “In a study by Lau and colleagues,9 the sensitivity of the device for detection of atrial fibrillation was 98% and specificity of 97%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Lau J, Lowres N, Neubeck L, et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int J Cardiol. 2013; 165: 193– 4. 23465249 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Utility of a single-lead ECG is highly questionable in the setting of chest pain, with a potential for false-negative test results.

    “Utility of a single‐lead ECG is highly questionable in this setting with a potential for false‐negative test results.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A single ECG has limited sensitivity for chest pain.
    • Rests on an assumption: Serial ECGs with a cardiac biomarker study are required to make an accurate diagnosis of chest pain.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Potential reasons for scant literature include early phase of development, regulatory environment not mandating robust studies prior to launch, devices being developed in engineering domain, and disconnect with biomedical research.

    “The potential reasons for scant literature include early phase of development of such devices, regulatory environment not mandating robust studies prior to launch of such devices, devices being developed in engineering domain, and disconnect with biomedical research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Turakhia et al., compared with first 48 hours of monitoring, overall diagnostic yield was greater when data from the entire ZioPatch wear duration were included for any arrhythmia (P < .0001) and for any symptomatic arrhythmia (P < .0001).

    “In a large study by Turakhia MP et al23 it was found that compared with first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire ZioPatch wear duration were included for any arrhythmia (P < .0001) and for any symptomatic arrhythmia (P < .0001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Turakhia MP, Hoang DD, Zimetbaum P, et al. Diagnostic utility of a novel leadless arrhythmia monitoring device. Am J Cardiol. 2013; 112: 520– 4. 23672988 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Usadel et al., Zenicor yielded 92% sensitivity in diagnosing supraventricular tachycardia and 77% sensitivity and 92% specificity in identifying abnormal ECGs.

    “In a study among children by Usadel et al21 Zenicor yielded 92% sensitivity in diagnosing supraventricular tachycardia plus 77% sensitivity and 92% specificity in identifying abnormal ECGs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Usadel L, Haverkämper G, Herrmann S, et al. Arrhythmia detection in pediatric patients: ECG quality and diagnostic yield of a patient‐triggered einthoven lead‐I event recorder (Zenicor EKG‐2™). Pediatr Cardiol. 2015; 37: 491– 6. 26573815

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Multiple-lead wearable devices are likely better than single-lead devices for chest pain, but interpretation of the presence or absence of ischemia remains uncertain compared to a 12-lead ECG.

    “Multiple‐lead wearable devices are likely to be better than a single‐lead device in this regard, but interpretation of the presence or absence of ischemia will still be uncertain as compared to a 12‐lead ECG.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A single ECG has limited sensitivity for chest pain.

  • May combine two claims.

    Premisecitation

    In Barrett et al., adhesive patch monitor detected more arrhythmia events compared with Holter monitor over total wear time (P < .001), although Holter detected more events during initial 24-h monitoring (P = .013).

    “In another study by Barrett PM et al24 it was shown that adhesive patch monitor detected more arrhythmia events compared with the Holter monitor over the total wear time (P < .001), although the Holter monitor detected more events during the initial 24‐h monitoring period (P = .013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Barrett PM, Komatireddy R, Haaser S, et al. Comparison of 24‐hour holter monitoring with 14‐day novel adhesive patch electrocardiographic monitoring. Am J Med. 2014; 127: e11– 7. PMC3882198 24384108 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Wearable multiple-lead devices are better suitable as ambulatory cardiac rhythm analysis devices and could be the future of Holter monitoring systems.

    “Wearable devices are better suitable as ambulatory cardiac rhythm analysis devices and could be the future of Holter monitoring systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Tung et al., about 15% of first paroxysmal atrial fibrillation occurred after 48 hours, which would not be detected by conventional Holter monitor but can be detected by ZioPatch.

    “A study by Christine E Tung et al27 showed that about 15% of first paroxysmal atrial fibrillation occurred after 48 hours, which will not be detected by conventional Holter monitor but can be detected by ZioPatch.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Tung C, Su D, Turakhia M, Lansberg M. Diagnostic yield of extended cardiac patch monitoring in patients with stroke or TIA. Front Neurol. 2015; 5: 266. 25628595 PMC4290477 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Usadel et al., Zenicor ECG measured heart rate, QRS duration, and PR interval accurately but P-wave detection was not statistically significant.

    “Zenicor ECG measured heart rate, QRS duration, and PR interval accurately but P‐wave detection was not statistically significant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Usadel L, Haverkämper G, Herrmann S, et al. Arrhythmia detection in pediatric patients: ECG quality and diagnostic yield of a patient‐triggered einthoven lead‐I event recorder (Zenicor EKG‐2™). Pediatr Cardiol. 2015; 37: 491– 6. 26573815

      Not checked in the free run.

18 of 18

  • The paper relies on this without support.

    Many handheld ECG devices give only limited information compared to conventional 12-lead ECGs.

    “Many handheld ECG devices give only limited information as compared to conventional 12‐lead ECGs.”

  • The paper relies on this without support.

    ECG information invariably needs to be interpreted along with clinical inputs.

    “As information obtained by ECG invariably needs to be interpreted along with clinical inputs, it is debated if out‐of‐hospital use will really be beneficial.”

  • The paper relies on this without support.

    A single ECG has limited sensitivity for chest pain.

    “While ECG is a mainstay in diagnostic algorithm of chest pain, a single ECG has limited sensitivity.”

  • The paper relies on this without support.

    Serial ECGs with a cardiac biomarker study are required to make an accurate diagnosis of chest pain.

    “Often serial ECGs with a cardiac biomarker study is required to make an accurate diagnosis.”

  • The paper relies on this without support.

    The prevalence of episodic rhythm disturbances is low.

    “While prevalence of these episodic rhythm disturbances is low, early treatment has a high immediate impact in preventing mortality and morbidity.”

  • The paper relies on this without support.

    The number of available portable out-of-hospital ECG devices is increasing.

    “The number of available devices that can record and analyze electric signals emitting from the cardiac conduction system is on the rise.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Schreiber study's overall arrhythmia yield is described as an AF yield

    Major

    The text attributes the 63.2% diagnostic yield specifically to atrial fibrillation. Table 1 describes the yield as detection of significant arrhythmias, a category that also includes ventricular and supraventricular tachycardia, pauses, and heart block.

  • Lau study's atrial fibrillation prevalence differs

    Minor

    Table 1 reports 35.8% for the Lau study, while the text reports 35.7% for the same study.

2 of 2

Cites

Flagged first, then by citations

1 of the 33 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Mason J, 2000, Cecil textbook of medicine XXI edn, 230
  2. 10.1160/th14-03-0231 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Bansal, A., & Joshi, R.
Affiliations
All India Institute of Medical Sciences Bhopal (IN)
Corresponding author
Joshi, Rajnish
ORCID
Venue
Journal of Arrhythmia
Publisher
Wiley
Published
2018-02-23
Volume
34
Issue
2
Pages
129-138
ISSN
  • 1880-4276 (ISSN-L)
  • 1883-2148
DOI
10.1002/joa3.12035
PMC
PMC5891427
OpenAlex
W2790931684
Semantic Scholar
366b637a490017541db552808415fad5e610145f
Cited by
174
References
33
Citations by year
2026: 9 · 2025: 16 · 2024: 19 · 2023: 32 · 2022: 23 · 2021: 31 · 2020: 21 · 2019: 21 · 2018: 2
FWCI
3.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Arrhythmia (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
wearable ECG, Holter monitoring, diagnostic accuracy, data transmission

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