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We evaluated the signal equivalence of a handheld 6\u2011lead ECG (HATIV\n                      <jats:sup>\u00ae<\/jats:sup>\n                      P30) versus the standard 12\u2011lead in an arrhythmia cohort, considering posture and synchrony.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective single-center study, simultaneous 10-s 12-lead ECGs and time-aligned 10-s segments from 30-s 6-lead recordings were obtained from arrhythmia patients in both supine and sitting positions. A blinded electrophysiologist performed rhythm classification and ECG measurements. Diagnostic accuracy and numerical agreement of key parameters (PR interval, QRS duration, QT\/QTc intervals, and amplitudes) were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 229 paired recordings were analyzed after excluding 6 pairs. The overall diagnostic accuracy of the 6\u2011lead versus 12\u2011lead was 99.1% in the supine position (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009113) and 99.1% in the sitting position (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009116); one atrial flutter was misclassified as atrial fibrillation in each position. Bland\u2013Altman analyses showed small mean differences (12\u2011lead minus 6\u2011lead): PR\u2009+\u200912.1\/\u2009+\u20097.4\u00a0ms (supine\/sitting), QRS\u2009\u2212\u20096.4\/\u2009\u2212\u20096.0\u00a0ms, QT\u2009\u2212\u200910.3\/\u2009\u2212\u20095.3\u00a0ms, QTc\u2009\u2212\u200911.5\/\u2009\u2212\u20096.4\u00a0ms; heart\u2011rate difference \u22480.03\u00a0bpm. The absolute differences were\u2009&lt;\u200920\u00a0ms in approximately\u2009~\u200970% for PR and\u2009~\u200955\u201362% for QT\/QTc. In an exploratory asynchronous pairing (supine 12\u2011lead vs sitting 6\u2011lead;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009103), accuracy decreased to 97.1% and parameter differences widened, consistent with postural\/temporal effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with arrhythmia, the handheld 6\u2011lead showed near\u2011perfect rhythm agreement and small numerical differences versus the 12\u2011lead under synchronized acquisition in both positions. Asynchronous or posture-mismatched comparisons reduce the agreement, and acquisition conditions should be considered. The 6\u2011lead may be a practical alternative when the 12\u2011lead is unavailable in patients with arrhythmia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-05971-x","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T08:49:04Z","timestamp":1780908544000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Position-wise comparison of handheld\u202f6-lead ECG versus the standard\u202f12-lead ECG in patients with arrhythmia: comparative study"],"prefix":"10.1186","volume":"26","author":[{"given":"Young Jun","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujeong","family":"Eom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Jun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeongyeon","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeonghwa","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minje","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Jin","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mineok","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunghoon","family":"Joo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Soo","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"16","key":"5971_CR1","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1136\/heartjnl-2020-316611","volume":"106","author":"KC Wong","year":"2020","unstructured":"Wong KC, Klimis H, Lowres N, von Huben A, Marschner S, Chow CK. 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This study was approved by the Institutional Review Board of Wonju Severance Christian Hospital (approval number: CR222011). Written informed consent was obtained from all participants.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent, which included consent for the publication of de-identified study results, was obtained from all participants in accordance with the protocol approved by the Institutional Review Board of Wonju Severance Christian Hospital (approval number: CR222011). All ECG images shown in this manuscript are fully de-identified.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SE, YN, JL, MP, HJA, MC and SJ are employees of VUNO Inc.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"689"}}