{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T14:17:38Z","timestamp":1785161858293,"version":"3.55.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Consumer-grade electrocardiogram (ECG) devices enable accessible rhythm monitoring. Recently developed six-lead handheld ECGs promise improved signal quality and diagnostic performance; however, comparative validation remains limited. Using 12-lead ECGs as reference, we compared diagnostic performance and quantitative agreement of a 6-lead and single-lead consumer ECGs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this prospective single-centre study, 194 arrhythmia-clinic patients (498 paired recordings) underwent simultaneous 10-s 12-lead and 30-s 6-lead ECG acquisition, followed by sequential 30-s single-lead recording. Two blinded electrophysiologists interpreted ECGs. Diagnostic performance for predefined rhythm categories (sinus rhythm, atrial\/ventricular premature complex, atrial fibrillation\/flutter\/tachycardia, atrioventricular block, others) was assessed by sensitivity, specificity, and accuracy. Waveform agreement was evaluated using Bland\u2013Altman analysis and intraclass correlation coefficients (ICC) accounting for repeated measures. Sensitivity was higher for the 6-lead ECG for ectopic beats, atrial flutter, and first-degree atrioventricular block, with comparable specificity across categories. Overall diagnostic accuracy was 98.6% (95% confidence interval, 97.4\u201399.6) for the 6-lead and 96.9% (94.7\u201398.7) for the single-lead ECG. Agreement with the 12-lead ECG was higher for the 6-lead device for PR interval (ICC 0.89; 0.85\u20130.92) and QRS amplitude (0.96; 0.94\u20130.97) than for the single-lead device (0.57; 0.48\u20130.63 and 0.04; \u22120.13\u20130.21, respectively). Bland\u2013Altman analysis demonstrated generally narrower limits of agreement for the 6-lead ECG. Findings were consistent in patient-level sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 6-lead handheld ECG demonstrated a higher point estimate for diagnostic accuracy and closer agreement with the 12-lead ECG than the single-lead smartwatch ECG, supporting its use for arrhythmia assessment and interval measurement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztag086","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:46:29Z","timestamp":1781091989000},"source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of 6-lead and single-lead consumer-grade electrocardiograms: diagnostic accuracy, numerical agreement, and inter-rater reliability"],"prefix":"10.1093","volume":"7","author":[{"given":"Myoung Jung","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8351-6894","authenticated-orcid":false,"given":"Sujeong","family":"Eom","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Jung","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoung-Min","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Keun","family":"On","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3538-3975","authenticated-orcid":false,"given":"Sunghoon","family":"Joo","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4569-6326","authenticated-orcid":false,"given":"Mineok","family":"Chang","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1897-2336","authenticated-orcid":false,"given":"Yeongyeon","family":"Na","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8907-7008","authenticated-orcid":false,"given":"Minje","family":"Park","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4271-9239","authenticated-orcid":false,"given":"Jeonghwa","family":"Lim","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4800-0822","authenticated-orcid":false,"given":"Taehyung","family":"Yu","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5920-1585","authenticated-orcid":false,"given":"Hyun Jin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Biosignal R&D Team, VUNO Inc. , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5323-3428","authenticated-orcid":false,"given":"Ju Youn","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"2026072709480184000_ztag086-B1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1001\/jamacardio.2018.0136","article-title":"Passive detection of atrial fibrillation using a commercially available smartwatch","volume":"3","author":"Tison","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2026072709480184000_ztag086-B2","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1016\/j.jacc.2018.03.003","article-title":"Smartwatch algorithm for automated detection of atrial fibrillation","volume":"71","author":"Bumgarner","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026072709480184000_ztag086-B3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.jacep.2022.09.011","article-title":"Clinical validation of 5 direct-to-consumer wearable smart devices to detect atrial fibrillation: BASEL wearable study","volume":"9","author":"Mannhart","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2026072709480184000_ztag086-B4","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1016\/j.jacc.2023.03.428","article-title":"Utility of a handheld, single-lead ECG device for diagnosis of cardiac arrhythmias","volume":"81","author":"Turnbull","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026072709480184000_ztag086-B5","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.jacc.2020.01.046","article-title":"Wearable devices for ambulatory cardiac monitoring: JACC state-of-the-art review","volume":"75","author":"Sana","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026072709480184000_ztag086-B6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/s41591-018-0268-3","article-title":"Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network","volume":"25","author":"Hannun","year":"2019","journal-title":"Nat Med"},{"key":"2026072709480184000_ztag086-B7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jelectrocard.2021.02.011","article-title":"Usefulness, pitfalls and interpretation of handheld single-lead electrocardiograms","volume":"66","author":"Witvliet","year":"2021","journal-title":"J Electrocardiol"},{"key":"2026072709480184000_ztag086-B8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ahj.2022.06.010","article-title":"Six-lead device superior to single-lead smartwatch ECG in atrial fibrillation detection","volume":"253","author":"Scholten","year":"2022","journal-title":"Am Heart J"},{"key":"2026072709480184000_ztag086-B9","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1093\/ehjdh\/ztab083","article-title":"Clinical validation and evaluation of a novel six-lead handheld electrocardiogram recorder compared to the 12-lead electrocardiogram in unselected cardiology patients (EVALECG cardio)","volume":"2","author":"Azram","year":"2021","journal-title":"Eur Heart J Digit Health"},{"key":"2026072709480184000_ztag086-B10","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1161\/CIRCULATIONAHA.120.050231","article-title":"Artificial intelligence-enabled assessment of the heart rate corrected QT interval using a Mobile electrocardiogram device","volume":"143","author":"Giudicessi","year":"2021","journal-title":"Circulation"},{"key":"2026072709480184000_ztag086-B11","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1161\/CIRCULATIONAHA.106.180200","article-title":"Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology","volume":"115","author":"Kligfield","year":"2007","journal-title":"Circulation"},{"key":"2026072709480184000_ztag086-B12","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511802843","volume-title":"Bootstrap Methods and Their Application","author":"Davison","year":"1997"},{"key":"2026072709480184000_ztag086-B13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/001316446002000104","article-title":"A coefficient of agreement for nominal scales","volume":"20","author":"Cohen","year":"1960","journal-title":"Educ Psychol Meas"},{"key":"2026072709480184000_ztag086-B14","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/10543400701329422","article-title":"Agreement between methods of measurement with multiple observations per individual","volume":"17","author":"Bland","year":"2007","journal-title":"J Biopharm Stat"},{"key":"2026072709480184000_ztag086-B15","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1037\/0033-2909.86.2.420","article-title":"Intraclass correlations: uses in assessing rater reliability","volume":"86","author":"Shrout","year":"1979","journal-title":"Psychol Bull"},{"key":"2026072709480184000_ztag086-B16","doi-asserted-by":"crossref","first-page":"euac053-583","DOI":"10.1093\/europace\/euac053.583","article-title":"Head-to-head comparison of single-lead and six-lead electrocardiography of a wrist-worn device for atrial fibrillation detection","volume":"24","author":"Bacevicius","year":"2022","journal-title":"EP Europace"},{"key":"2026072709480184000_ztag086-B17","doi-asserted-by":"crossref","first-page":"1160242","DOI":"10.3389\/fcvm.2023.1160242","article-title":"Six-lead electrocardiography compared to single-lead electrocardiography and photoplethysmography of a wrist-worn device for atrial fibrillation detection controlled by premature atrial or ventricular contractions: six is smarter than one","volume":"10","author":"Bacevicius","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2026072709480184000_ztag086-B18","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.jacep.2023.03.004","article-title":"Technical characterization of single-lead ECG signals from 4 different smartwatches and its potential clinical implications","volume":"9","author":"Knecht","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2026072709480184000_ztag086-B19","first-page":"29","article-title":"Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting","volume":"19","author":"Desteghe","year":"2017","journal-title":"Europace"},{"key":"2026072709480184000_ztag086-B20","doi-asserted-by":"crossref","first-page":"e12872","DOI":"10.1111\/anec.12872","article-title":"Comparison of electrocardiograms (ECG) waveforms and centralized ECG measurements between a simple 6-lead mobile ECG device and a standard 12-lead ECG","volume":"26","author":"Kleiman","year":"2021","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"2026072709480184000_ztag086-B21","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.hroo.2021.06.005","article-title":"Portable single-lead electrocardiogram device is accurate for QTc evaluation in hospitalized patients","volume":"2","author":"Marin","year":"2021","journal-title":"Heart Rhythm O2"},{"key":"2026072709480184000_ztag086-B22","doi-asserted-by":"crossref","first-page":"e055072","DOI":"10.1136\/bmjopen-2021-055072","article-title":"Manual QT interval measurement with a smartphone-operated single-lead ECG versus 12-lead ECG: a within-patient diagnostic validation study in primary care","volume":"11","author":"Beers","year":"2021","journal-title":"BMJ Open"},{"key":"2026072709480184000_ztag086-B23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jelectrocard.2022.11.010","article-title":"Review of current ECG consumer electronics (pros and cons)","volume":"77","author":"Hilbel","year":"2023","journal-title":"J Electrocardiol"},{"key":"2026072709480184000_ztag086-B24","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ajem.2024.01.046","article-title":"Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: a comparison with 12-lead ECG in emergency department","volume":"79","author":"Pasli","year":"2024","journal-title":"Am J Emerg Med"},{"key":"2026072709480184000_ztag086-B25","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jelectrocard.2019.06.008","article-title":"Correlation of P-wave properties with the size of left atrial low voltage areas in patients with atrial fibrillation","volume":"56","author":"Schreiber","year":"2019","journal-title":"J Electrocardiol"}],"container-title":["European Heart Journal - Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjdh\/advance-article-pdf\/doi\/10.1093\/ehjdh\/ztag086\/68509817\/ztag086.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/7\/6\/ztag086\/68509817\/ztag086.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/7\/6\/ztag086\/68509817\/ztag086.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:48:09Z","timestamp":1785160089000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjdh\/article\/doi\/10.1093\/ehjdh\/ztag086\/8705676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,23]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjdh\/ztag086","relation":{},"ISSN":["2634-3916"],"issn-type":[{"value":"2634-3916","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,6,11]]},"article-number":"ztag086"}}