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Research of novel biosignal modalities with application to remote patient monitoring is a subject of state-of-the-art developments. This study is focused on sonified ECG modality, which can be transmitted as an acoustic wave and received by GSM (Global System for Mobile Communications) microphones. Thus, the wireless connection between the patient module and the cloud server can be provided over an audio channel, such as a standard telephone call or audio message. Patients, especially the elderly or visually impaired, can benefit from ECG sonification because the wireless interface is readily available, facilitating the communication and transmission of secure ECG data from the patient monitoring device to the remote server. The aim of this study is to develop an AI-driven algorithm for 12-lead ECG sonification to support diagnostic reliability in the signal processing chain of the audio ECG stream. Our methods present the design of two algorithms: (1) a transformer (ECG-to-Audio) based on the frequency modulation (FM) of eight independent ECG leads in the very low frequency band (300-2700 Hz); and (2) a transformer (Audio-to-ECG) based on a four-layer 1D convolutional neural network (CNN) to decode the audio ECG stream (10 s @ 11 kHz) to the original eight-lead ECG (10 s @ 250 Hz). The CNN model is trained in unsupervised regression mode, searching for the minimum error between the transformed and original ECG signals. The results are reported using the PTB-XL 12-lead ECG database (21,837 recordings), split 50:50 for training and test. The quality of FM-modulated ECG audio is monitored by short-time Fourier transform, and examples are illustrated in this paper and supplementary audio files. The errors of the reconstructed ECG are estimated by a popular ECG diagnostic toolbox. They are substantially low in all ECG leads: amplitude error (quartile range RMSE = 3-7 µV, PRD = 2-5.2%), QRS detector (Se, PPV > 99.7%), P-QRS-T fiducial points' time deviation (<2 ms). Low errors generalized across diverse patients and arrhythmias are a testament to the efficacy of the developments. They support 12-lead ECG sonification as a wireless interface to provide reliable data for diagnostic measurements by automated tools or medical experts.

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BACKGROUND: The World Health Organization declared the outbreak of SARS-CoV-2 a pandemic on February 11, 2020. This organism causes COVID-19 disease and the rapid rise in cases and geographic spread strained healthcare systems. Clinical research trials were hindered by infection control measures discouraging physical contact and diversion of resources to meet emergent requirements. The need for effective treatment and prevention of COVID-19 prompted an untested investigational response. Trial groups adapted approaches using remote enrolment and consenting, newly developed diagnostic tests, delivery of study medications and devices to participants' homes, and remote monitoring to ensure investigator/enrollee safety while preserving ethical integrity, confidentiality, and data accuracy. METHODS: Clinical researchers at our community health system in the USA undertook an outpatient randomized open-label study of hydroxychloroquine (HCQ) prophylaxis versus observation of SARS-CoV-2 infection in household COVID-19 contacts. Designed in March 2020, challenges included COVID-19 infection in the research group, HCQ shortage, and lack of well-established home SARS-CoV-2 tests and remote ECG monitoring protocols in populations naive to these procedures. The study was written, funded, and received ethical committee approval in 4 months and was completed by September 2020 during a period of fluctuating infection rates and conflicting political opinions on HCQ use; results have been published. Singular methodology included the use of a new RNA PCR saliva SARS-CoV-2 home diagnostic test and a remote smartphone-based 6-lead ECG recording system. RESULTS: Of 483 households contacted regarding trial participation, 209 (43.3%) did not respond to telephone calls/e-mails and 90 (18.6%) declined; others were not eligible by inclusion or exclusion criteria. Ultimately, 54 individuals were enrolled and 42 completed the study. Numbers were too small to determine the efficacy of HCQ prophylaxis. No serious treatment-related adverse events were encountered. CONCLUSIONS: Flexibility in design, a multidisciplinary research team, prompt cooperation among research, funding, ethics review groups, and finding innovative study approaches enabled this work. Concerns were balancing study recruitment against unduly influencing individuals anxious for protection from the pandemic and exclusion of groups based on lack of Internet access and technology. An issue to address going forward is establishing research cooperation across community health systems before emergencies develop. TRIAL REGISTRATION: ClinicalTrials.gov NCT04652648 . Registered on December 3, 2020.

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Background: Demand is growing for remote electrocardiogram (ECG) monitoring systems in the COVID-19 era in Japan. This study describes initial experiences with a small wireless ECG monitoring device and the utility of delivery via the postal service for outpatient care in Japan. Methods and Results: Long-term ECG monitoring following postal delivery of the small ECG device was evaluated in 25 patients. The patients had no difficulties with either the postal delivery or self-fitting and wearing the devices. A median of 57 h monitoring per patient was performed. Arrhythmic events were detected in 8 patients. Most patients were satisfied with both the ECG devices and postal delivery. Conclusions: Postal delivery of ECG devices could be used in clinical practice to achieve less or no in-person contact during the COVID-19 era.

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Arrhythmias are very common in the healthy populations as well as patients with cardiovascular diseases. Among them, atrial fibrillation (AF) and malignant ventricular arrhythmias are usually associated with some clinical events. Early diagnosis of arrhythmias, particularly AF and ventricular arrhythmias, is very important for the treatment and prognosis of patients. Holter is a gold standard commonly recommended for noninvasive detection of paroxysmal arrhythmia. However, it has some shortcomings such as fixed detection timings, delayed report and inability of remote real-time detection. To deal with such problems, we designed and applied a new wearable 72-hour triple-lead H3-electrocardiogram (ECG) device with a remote cloud-based ECG platform and an expert-supporting system. In this study, 31 patients were recruited and 24-hour synchronous ECG data by H3-ECG and Holter were recorded. In the H3-ECG group, ECG signals were transmitted using remote real-time modes, and confirmed reports were made by doctors in the remote expert-supporting system, while the traditional modes and detection systems were used in the Holter group. The results showed no significant differences between the two groups in 24-hour total heart rate (HR), averaged HR, maximum HR, minimum HR, premature atrial complexes (PACs) and premature ventricular complexes (PVCs) ( P>0.05). The sensitivity and specificity of capture and remote automatic cardiac events detection of PACs, PVCs, and AF by H3-ECG were 93% and 99%, 98% and 99%, 94% and 98%, respectively. Therefore, the long-term limb triple-lead H3-ECG device can be utilized for domiciliary ECG self-monitoring and remote management of patients with common arrhythmia under medical supervision.

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Objective To build a server to receive ECG data from the smart phone through remote network transmission,which has the functions of data storage,painting ECG waveform at real time,browsing historical waveform,preliminary ECG self-diagnosis and etc.Methods The development was executed with C# language in Visual Studio 2013,which used the socket for network transmission,GDI for waveform painting,Dataset/Datareader for data access as well as thread for multithreaded programming etc.Five-point smoothing filter was applied to ECG signal preliminary processing,and classical difference threshold algorithm was used to implement waveform analysis of ECG data.The main QRS waves were detected,and ECG features such as R-R interval were analyzed to form ECG self-diagnosis report.Results The server received and showed the ECG data transmitted by smart phone successfully,and then generated ECG waveform and self-diagnosis report.Conclusion This server has a great performance on receiving the data from portable facilities.In addition,it also performs well and stably in accessing and showing ECG data.

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Objective This study was aimed to evaluate the remote real-time transmission 12-lead electrocardiogram system on door-to-balloon time in patients with ST-segment elevation myocardial infarction.Methods We retrospectively analyzed the consecutive patients with STEM I who had accepted primary percutaneous coronary intervention (PCI) in the chest pain center of our hospital from February 2012 to July 2012.The study group consisted of patients with pre-hospital ECG,while the control group included patients without pre-hospital ECG,Their door-to-balloon time and door-to-catheter room time,mortality w ere compared.Results Totally 60 consecutive patients who had received primary PC I for STEMI were evaluated.Among them,35 patients were hospitalized with pre-hospital ECG while the other 25 patients without ECG.The Pre-hospital ECG was associated with a significautly shorter median door-to-balloon time (38 min vs.94min;P ＜0.01),The proportion of patients received balloon dilation within the guidelinerecommended 90 min timeframes Was significantly higher in pre-hospital ECG group than in non pre-hospital ECG group (94.6％ vs.60％;P =0.001).No difference was observed in mortality between the two groups (5.7％vs.4％;P ＞ 0.05),Significant difference was seen in the median hospital time in study group (5 compared with control group (7day) (5 day vs.7 day;P ＜ 0.01).Conclusions The remote real-time transmission 12-lead electrocardiogram system is associated with a significantly shorter door-to-balloon time in STEMI patients.The remote real-time transmission 12-lead electrocardiogram system is recommended in patients suspected STEMI.

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Objective To evaluate the pre-hospital diagnostic reliability of real-time tele-transmission of 12-lead electrocardiogram of patients with ST-segment elevated acute myocardial infarction (STEMI).Methods The 12-lead electrocardiogram was simultaneously recorded with real-time tele-transmission system and a conventional electrocardiograph in 40 STEMI cases.The width and amplitude of each wave,the deviated amplitude of ST-segment in the same leads were compared by t-test and rank-sum test.Results There were no statistical differences in the width and amplitude of P wave,QRS wave and t wave as well as the deviated altitude of ST-segment between the two separate electrocardiographs (P ＞0.05).There was a significant positive correlation between the two ECG devices in respect of ST-segment elevated altitude (r =0.912,P =0.000).The differential ability of ST-segment elevation between two separate ECG devices kept highly consistent (Kappa value:0.976).Conclusions Real-time tele-transmission of 12-lead electrocardiogram is reliable for the pre-hospital diagnosis of STEMI.