Abstract 13578: 12-Lead Electrocardiograms Can Be Reconstructed Using the 3 Electrodes of a Subcutaneous Implantable Cardioverter Defibrillator

Abstract

Background: Data from reduced lead ECG configurations can be transformed to reconstruct a 12-lead ECG. The sensing electrodes of a subcutaneous ICD (S-ICD) could provide a suitable basis for such a system. Reconstruction of a 12-lead ECG from conventional S-ICD vectors has not previously been demonstrated. Hypothesis: A 12-lead ECG signal can be accurately derived from S-ICD electrode vectors. Methods: Participants with ICDs (N=61) underwent 3 minute ECGs with electrodes in the standard S-ICD and 12-lead positions. Participants were randomised to either a training (N=31) or validation (N=30) group. Two participants and one further lead were subsequently excluded from the validation group due to technical faults. The transformation was a linear combination of the 2 independent S-ICD vectors to each of the 8 independent leads of the 12-lead ECG, with coefficients selected that minimized the root mean square error (RMSE) between recorded and derived ECGs when applied to the training group. The transformation was then applied to the validation group and agreement between the recorded and derived lead pairs was measured by Pearson correlation coefficient (r) and normalised RMSE (NRMSE). Results: In total, 335 lead pairs were compared (figure1). Distribution of r and NRMSE were skewed. Mean r = 0.731 (SE 0.021), Median r = 0.903 (SE 0.015). NRMSE Mean = 0.227 (SE 0.011) Median = 0.167 (SE 0.008). 252/335 (75.2%) of all pairs had an r > 0.7 (indicating very strong positive correlation). Figure 1: Example 12-lead ECG, recorded (blue line) and derived (red line). Participant randomly selected from top 20% by mean Pearson correlation coefficient. Conclusions: We have demonstrated reconstruction of a 12-lead ECG from S-ICD vectors. The agreement between derived and measured signals was generally excellent and comparable with other widely accepted reduced lead systems. If perfected, the ability to generate 12-lead data from an S-ICD could help clinicians to localise and treat arrhythmias.