Expanding a single-lead mobile electrocardiographic device to multiple-lead recordings improves diagnostic accuracy and confidence

Background: Mobile electrocardiographic (mECG) devices that record ECG lead I have been used to detect atrial fibrillation. Other arrhythmias may not be readily diagnosed with one lead. Obtaining multi-lead tracings from an mECG (MLmECG) to simulate a 12-lead ECG may lead to more accurate diagnoses. Methods: We developed a method to generate multi-lead ECGs using a mECG device by attaching it with alligator clips connected to an insulated copper wire to adhesive electrodes on the patient's limbs and torso according to standard lead configurations. Different rhythm and conduction abnormalities from a sample of inpatients were collected. Arrhythmias were recorded in three ways (single lead, MLmECG, and standard 12-lead) and grouped by category. Recordings were sent to cardiology fellows in the form of a multiple choice survey. Participants were asked for their diagnosis and confidence in their decision. Results: Survey response rate was 100%. Single-lead, MLmECG, and 12-lead yielded 48.2%, 81.6%, and 88.6% of agreement with the correct diagnosis, respectively (single-lead vs. MLmECG or 12-lead; p < 0.01). Overall mean confidence scores were 3.34, 4.35, and 4.53 out of 5, for single-lead, MLmECG, and 12-lead ECG, respectively (single-lead vs. MLmECG or 12-lead; p < 0.01, MLmECG vs. 12-lead; p = 0.09). Conclusion: The diagnostic accuracy of MLmECGs were similar to that of a standard 12-lead ECG. Fellows' confi-dence in their diagnosis were similar between MLmECG or 12-lead ECG, and higher with both modalities com-pared to a single-lead tracing. The ability to recreate, as fully as possible, a standard 12-lead ECG is a reasonable goal for mobile technology. (c) 2021 Elsevier Inc. All rights reserved.