Wireless ECG: Literature review
Azra Anjum and Mythri
Biomedical Signal processing and Instrumentation
BMSCE Bangalore
azra.lbi20@bmsce.ac.in,mythri.lbi20@bmsc.ac.in
Abstract— The main aim of this look over is to give an outline of
current developments within the domain of wireless heart
monitoring. Recently, there has been attention on wireless
technology to watch heart activities of heart disease patients. This
technology gives patients more satisfaction, more flexibility, and
ease of use. Wireless technology, electrodes, signal analyzing and
data acquisition systems, also has some heart monitors with built-in
GPS(global positioning systems) which are included in the
development of many parts of the monitoring system. This attribute
gives the physician and patient’s family the ability to identify the
patient's location when a heart attack happens. The technology of
smartphones has motivated engineers to develop smartphones to
work as a heart monitor, since the technology is integrated with
smart phones such as web accessibility, wireless communication,
big screen size, high-speed processors, and other features. They do
so because many people have smartphones, and they use their
phone all day. Thus, smartphones have facilitated the
manufacturing of heart monitoring systems at reduced cost.
Introduction- Indians have been affected by high rates of
diabetes, metabolic syndrome, hypertension, and smoking.
These are major risk factors for cardiac disease. When heart
disease strikes Indians, it tends to do so at an earlier age
(almost 33% earlier) than other demographics, often without
prior warning. About 655,000 Americans die from heart
condition each year—that’s 1 in every 4 deaths. The annual
number of deaths from CVD in India is projected to rise from
2.26 million in the year 1990 to 4.77 million in the year 2020.
Coronary heart disease prevalence rates in India have been
estimated over the past several decades and have ranged from
1.6% to 7.4% in rural populations and from 1% to 13.2% in
urban populations. Since there are less health care facilities in
the rural areas, this led researchers to evolve remote heart
monitoring solutions. Only 9% of physicians in America add
rural areas, and 20% of USA citizens sleep in these areas.
Some people living in rural areas travel long distances for
health care, because their areas do not have health care
centres, or they only have health care centres with basic
facilities. Patients with chronic heart disease need continuous
monitoring of their heart, with correct and accurate diagnosis,
many lives can be saved. These patients go to work on daily
bases and cannot afford to miss their jobs, it is impossible for
them to spend their entire lives in the hospital. It is very
expensive to spend so much money at the hospital which is
irrational and impossible. These monitoring systems heart
monitoring and diagnosing generally depends on the electrical
activities of the centre that are generated by the centre nodes
(sinoatrial node (SA node) and heart muscle (AV node))
located inside it. The electrical activities of the centre are
measured by using electrocardiograph (ECG), an instrument
used for detecting and recording the electrical activities of the
centre muscle by measuring the electrical potentials on the
body’s surface and generating a record of the electrical
currents related to cardiac muscle activity to diagnosis heart
abnormalities. People prefer wireless heart monitors (WHM)
as it has closed the gaps of old designs and improved the
performance. These enhancements have given the WHM only
performance with good results and have facilitated remote
monitoring of the patient by the doctor.
GENERAL DESIGN OF THE Wireless ECG:
Wireless ECG heart monitoring involves: analog circuit, ADC
(analog to digital converter), pre-processor, wireless
transceivers, processing unit that is personal computer (PC) or
smartphone, electrodes and a display. In some WHMs the PC
or smartphone connected to the Internet provides remote
monitoring.
a. The Electrodes
An electrode is a solid electrical conductor that carries electric
current into patient’s body in order to collect the ECG signal.
The ECG electrodes have many configurations and types.
a.1. Electrodes Configuration
Depending upon the analog circuit design, the configuration
of WHM electrodes is done. There are two types of electrodes
configurations: two electrodes and three electrodes. The two
electrodes are attached to the patient’s chest and the three
electrodes are attached to the left arm, right arm, and to the
left leg. This configuration provides low noise measurement.
a.2. Electrodes Types
The most widely used WHM is the Ag/AgCl disposable
electrode that's used once. If Ag/AgCl electrode is used for
long term then the skin may get damaged. To avoid damage,
one must use dry electrodes. Use of dry electrode gives dry
contact with skin and low noise. The contacting part of this
electrode may be a micro needle array with a length of 10-15
μm. Utilization of Ag/AgCl electrode and dry electrode under
water is not applicable. Therefore, new sorts of electrodes are
developed for under water monitoring. It’s composed of a mix
of lampblack powder (CB) and polydimethylsiloxane
(PDMS). For long-term monitoring with patient movements,
the electrodes will lose the adhesion property that results in
increasing resistance conduction between the electrode and
the patient’s skin. Therefore, the simplest solution for this
problem is flexible electrodes supported conductive rubber
that provides more flexibility and conductivity. To avoid the
problems that accompany contact of electrodes on skin, a
replacement non-contact electrode has been developed. These
electrodes don't make contact with the skin. Instead, it's
attached over a patient’s clothes. The working rule of those
electrodes is that it works as a capacitor. The skin works
because the primary plate of the capacitor, and thus the
electrode works as a second plate. The electrical current
generated by the guts muscle will be transferred to the skin
and affect the measured capacitance. The simplest use of this
electrode is in an automotive application for monitoring the
driver’s heart by attaching the electrodes to the seat. There is
another sort of electrode that doesn't depend upon the
electrical signals of the guts. This sort depends on the
movement of the guts. It detects it by sending a narrow beam
of microwaves to the guts and receives the echo of the
microwave and depends on Doppler to detect the movement
of the heart. This is to monitor abnormalities of the guts like
akinesia and fibrillation.
b). Analog Conditioning Circuit
From the electrode hearts signals are gathered and these
signals are limited from 0.1mv to 5mv. The acquired signals
need to be amplified over and over (maybe a hundred times)
using an analog circuit. The analog circuit comprises an
instrumentation amplifier and filter. The instrumentation
amplifier used with the wireless heart monitor must have
certain characteristics, sort of a high common mode rejection
ratio (CMRR), low power consumption, a coffee offset
current, low input bias, and a quick rate. The amplified heart
signals shave noise from other physical body muscles and
from power lines. These noisy signals need to be filtered by
employing a coffee pass filter, notch filter 50-60 Hz, and
band-pass filter. These filters are often passive or active
filters. Usually, the WHMs work with rechargeable batteries.
To increase the time of battery discharge of a WHM, the
circuit must be designed in such a way that it consumes low
power. The commonly low power of WHM circuit design
depends on low power consuming integrated circuits (IC) and
on-chip filters. This CMOS ICs design has low power
consumption. The ECG analog circuit design may have plenty
of some time and energy in selecting ICs and elegance
calculations. This point and energy are often avoided by using
ECG ICs. ICs include an instrumentation amplifier, a MUX
(channel selector), a filter, ADC, serial communication, and
other components.
c). ADC and Pre-Processing
The acquired filtered and amplified ECG signal has to be
converted into its digital form so that further processing and
transmission by wireless transceiver can be done. Often the
ADC could also be embedded within the microcontrollers,
FPGA, or during a Bluetooth module. The ECG signals that
are converted into digital form are going to be pre-processed
employing a microcontroller or by using FPGA. The pre-
processing includes an easy digital filter or heart beat rate
detection. In some WHMs if the connection fails between
wireless transceivers, then the microcontroller stores the ECG
data to the memory to stop data loss. The microcontroller may
be a pre-processing unit that controls the wireless module and
sends the ECG signal to the wireless module by serial
communication or other methods.
d. The Wireless Communication
The ECG signal that’s converted to digital form is going to be
transmitted by wireless module to the opposite part so as to
display it. The essential wireless transmitting method is
infrared (IR) due to its low cost. Within the IR transmitting
method orientation, the transmitter must get on the other side
of the receiver a brief distance away. The acceptable solution
for the problem of IR is frequency (RF) transceivers with a 2.4
GHz frequency where these sorts of transceivers are low
power consumption. An RFID is another RF module that has
an equivalent property. A peer-peer network should be created
using the previous module. One must use another RF
communication like ZigBee to make a many-to-one or one-to-
many network. It’s the protocol for normal IEEE 802.15.4,
and it's low-cost with an easy protocol. The ZigBee standard
is employed in three areas: industrial, science, and medical,
called (ISM) bands. ZigBee works with three frequencies: 915
MHz and 868 MHz for North America and Europe,
respectively, and 2.4 GHz for the remaining planet; the other
RF communication is Wi-Fi. Wi-Fi technology features a
standard IEEE 802.11 protocol. This protocol controls a wide
local area network (WLAN) to attach many WHMs together,
where this network features a wide distance. The ZigBee
protocol can communicate with PCs that include a ZigBee
module or with another circuit that has an equivalent module.
It also can’t communicate with smartphones and other devices
with no ZigBee modules. Bluetooth communication technique
may be a low power technology with a one-to-many or many-
to-one Pico-net. Bluetooth communication has no interference
with other RF because Bluetooth works with a frequency
hopping technique that's controlled by a special protocol. This
technology makes Bluetooth more suitable for medical
applications. Bluetooth works with 2.4 GHz frequency, which
is in the ISM band. Bluetooth features a range of 100 meters
and may communicate with an outsized number of devices
like mobile phones; PCs, PDAs and other Bluetooth enabled
devices.
e. Processing Unit
The ECG signal that's wirelessly transmitted to the receiver
that is connected to a processing unit is going to be processed
and displayed. The essential processing unit that's normally
utilized in WHM design is the microcontroller because it's
cheap, has low power consumption, and is a small size. The
microcontroller is slow in processing as compared with PCs.
Therefore, most WHMs are designed with PCs as a main
processing unit. Advantage of using PCs as a processing unit
are high processing, good performance, internet connection
capability (for remote telemedicine), the ability to
communicate with any communication technology by adding
peripheral, and a simple processing method by using some
programs like MATLAB or LABVIEW . Despite all the
advantages of using PCs, they even have disadvantages, like
high cost, heaviness (they don’t work as a transportable
monitor), and high-power consumption. Therefore, PDAs are
suitable as processing and display tools with WHMs because
they're small size, have low power consumption, have the
power to speak with some wireless communications, and are
portable ECG. Figure 4 shows a PDA as a wireless ECG. In
fact, PDAs have less processing ability than PCs, so smart
phones are a better processor and display unit for WHMs than
PDAs because smart phones have higher processing
capabilities. Plus, smart phones have become an important
part of our lives, and that they have the power to access
online. Due to this feature, implementing telemedicine using
WHMs is much easier.
f. ECG Signal Analyzing
The ECG signal that's received within the processing unit
must be filtered to get rid of the noise that's generated by the
patient’s body muscles. one among digital filtration
techniques is adaptive filters. After filtration, the signal is
going to be processed to detect heart abnormalities. The
essential method that wants to detect heart abnormalities is
calculating the guts beat rate. This method is achieved by
counting R-peaks within the period heart because it can’t
detect abnormalities in some cases such as in fibrillation.
Therefore, detecting fibrillation could be done by calculating
the amount of the R-R interval. In some cases, it must detect
the QRS wave where if a number of QRS waves have missed
the counting of the heart beat rate method it might be difficult
to detect it using this incomplete ECG signal.
g. Remote ECG Monitoring
Patients having cardiovascular illnesses and need continuous
monitoring for their heart signals, can opt for remote heart
monitoring (telemedicine). Communication techniques such as
the internet have made telemedicine possible also because of
the development of new technologies like the smartphone that
have internet facility via 3G network. The information that is
transmitted by the internet is going to be displayed,
monitored, and stored within the cloud storage system. The
most common heart telemedicine systems are supported PCs
and internet networks. during this sort of remote monitoring,
the patient must be near the PC, and therefore the PC, in most
designs, must be the main processing and display unit. In
order to give patients more freedom, the new telemedicine
systems must be designed with good range communication
like PDAs and smartphones. Smartphones are very popular
these days, and it comes with high possibilities for processing
and most of the communications techniques i.e. (Bluetooth,
Wi-Fi and internet access), also as global positioning systems
(GPS). GPS is extremely useful for determining the situation
of the patient in an emergency, so it's suitable for
telemedicine. PDAs and smartphones have a lower processing
ability than PCs, which makes them unable to process the
ECG signal in high levels. Figure 5 shows the overall
structure of PDAs and mobile phones telemedicine networks.
Result analysis: This paper aims on the importance of WHM
system designing , the different techniques which uses it in
telemedicine, and it's advantages and disadvantages which
were faced while designing it. WHMs gives patients a wide
prospective for heart monitoring. With the help of
telemedicine, people who require continuous heart monitoring
and need full time physician monitoring, this technique has
made life survival easier for them. The ability to monitor heart
using WHMs is very easy and convenient for cardiovascular
patients. Using different technologies like smartphones,
PDAs, make the design of telemedicine much easier.
Although WHMs are used in monitoring most heart activities,
it cannot detect many abnormalities. Hence this technique is
not very reliable.
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