{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T05:45:56Z","timestamp":1775367956463,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2018,11,5]],"date-time":"2018-11-05T00:00:00Z","timestamp":1541376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>In recent years, a number of proposals for electrocardiogram (ECG) monitoring based on mobile systems have been delivered. We propose here an STM32F-microcontroller-based ECG mobile system providing both long-term (several weeks) Holter monitoring and 12-lead ECG recording, according to the clinical standard requirements for these kinds of recordings, which in addition can yield further digital compression at stages close to the acquisition. The system can be especially useful in rural areas of developing countries, where the lack of specialized medical personnel justifies the introduction of telecardiology services, and the limitations of coverage and bandwidth of cellular networks require the use of efficient signal compression systems. The prototype was implemented using a small architecture, with a 16-bits-per-sample resolution. We also used a low-noise instrumentation amplifier TI ADS1198, which has a multiplexer and an analog-to-digital converter (16 bits and 8 channels) connected to the STM32F processor, the architecture of which incorporates a digital signal processing unit and a floating-point unit. On the one hand, the system portability allows the user to take the prototype in her\/his pocket and to perform an ECG examination, either in 12-lead controlled conditions or in Holter monitoring, according to the required clinical scenario. An app in the smartphone is responsible for giving the users a friendly interface to set up the system. On the other hand, electronic health recording of the patients are registered in a web application, which in turn allows them to connect to the Internet from their cellphones, and the ECG signals are then sent though a web server for subsequent and ubiquitous analysis by doctors at any convenient terminal device. In order to determine the quality of the received signals, system testing was performed in the three following scenarios: (1) The prototype was connected to the patient and the signals were subsequently stored; (2) the prototype was connected to the patient and the data were subsequently transferred to the cellphone; (3) the prototype was connected to the patient, and the data were transferred to the cellphone and to the web via the Internet. An additional benchmarking test with expert clinicians showed the clinical quality provided by the system. The proposed ECG system is the first step and paves the way toward mobile cardiac monitors in terms of compatibility with the electrocardiographic practice, including the long-term monitoring, the usability with 12 leads, and the possibility of incorporating signal compression at the early stages of the ECG acquisition.<\/jats:p>","DOI":"10.3390\/s18113773","type":"journal-article","created":{"date-parts":[[2018,11,5]],"date-time":"2018-11-05T10:43:45Z","timestamp":1541414625000},"page":"3773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A Flexible 12-Lead\/Holter Device with Compression Capabilities for Low-Bandwidth Mobile-ECG Telemedicine Applications"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2632-7573","authenticated-orcid":false,"given":"Flavio","family":"Pineda-L\u00f3pez","sequence":"first","affiliation":[{"name":"Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Madrid, Spain"},{"name":"Departamento de El\u00e9ctrica y Electr\u00f3nica, Universidad de las Fuerzas Armadas ESPE, Av. General Rumi\u00f1ahui s\/n, Sangolqu\u00ed 171-5-231B, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0041-1443","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Mart\u00ednez-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-8912","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Rojo-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Madrid, Spain"},{"name":"Center for Computational Simulation, Universidad Polit\u00e9cnica de Madrid, Boadilla, 28223 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1928-865X","authenticated-orcid":false,"given":"Arcadi","family":"Garc\u00eda-Alberola","sequence":"additional","affiliation":[{"name":"Cardiology Service, Arrhythmia Unit, Hospital General Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6593-1517","authenticated-orcid":false,"given":"Manuel","family":"Blanco-Velasco","sequence":"additional","affiliation":[{"name":"Signal Theory and Communications Department, Alcal\u00e1 University, 33600 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,11,5]]},"reference":[{"key":"ref_1","unstructured":"Cromwell, L., Weibell, F., and Pfeiffer, A. (1980). Biomedical Instrumentation and Measurements, Prentice Hall."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1109\/TITB.2004.842411","article-title":"Analysis of information and communication needs in rural primary health care in developing countries","volume":"9","author":"Martinez","year":"2005","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1109\/TITB.2004.837869","article-title":"A novel mobile transtelephonic system with synthesized 12-lead ECG","volume":"8","author":"Hadzievski","year":"2004","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chan, C.-C., Chou, W.-C., Chen, C.-W., Ho, Y.-L., Lin, Y.-H., and Ma, H.-P. (2012, January 17\u201320). Energy efficient diagnostic grade mobile ECG monitoring. Proceedings of the 2012 IEEE 10th International New Circuits and Systems Conference, Montreal, QC, Canada.","DOI":"10.1109\/NEWCAS.2012.6328979"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gradl, S., and Kugler, P. (September, January 28). Real-time ECG monitoring and arrhythmia detection using Android\u2122-based mobile devices. Proceedings of the 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Piscataway, NJ, USA.","DOI":"10.1109\/EMBC.2012.6346460"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chen, C., Bian, K., Huang, A., Duan, X., Gao, H., Jiao, B., Xie, L., and Wang, S. (2013, January 9\u201313). WE-CARE: A wearable efficient telecardiology system using mobile 7-lead ECG devices. Proceedings of the 2013 IEEE International Conference on Communications, Budapest, Hungary.","DOI":"10.1109\/ICC.2013.6655252"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bobra, N., Wang, Z., Zhang, W., and Luo, A. (2013, January 10\u201313). A high-quality, low-energy, small-size system-on-chip (soc) solution enabling ECG mobile applications. Proceedings of the 2013 39th Annual Conference of the IEEE Industrial Electronics Society, Vienna, Austria.","DOI":"10.1109\/IECON.2013.6700542"},{"key":"ref_8","unstructured":"Chai, J. (2013, January 15\u201317). The design of mobile ECG monitoring system. Proceedings of the 2013 IEEE 4th International Conference on Electronics Information and Emergency Communication, Piscataway, NJ, USA."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"De Lucena, S., Sampaio, D., Mall, B., Meyer, M., Burkart, M.A., and Keller, F.V. (2015, January 11\u201314). ECG monitoring using Android\u2122 mobile phone and Bluetooth. Proceedings of the 2015 IEEE International Instrumentation and Measurement Technology Conference, Pisa, Italy.","DOI":"10.1109\/I2MTC.2015.7151585"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"De la cruz, B., Cuellar, R., Rojas, E., Molina, V., and Robles, H. (2015, January 23\u201328). Transmission of ECG signals with Android\u2122 mobile system via Bluetooth. Proceedings of the 2015 Pan American Health Care Exchanges, Vi\u00f1a del Mar, Santiago, Chile.","DOI":"10.1109\/PAHCE.2015.7173316"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"25607","DOI":"10.3390\/s151025607","article-title":"Assessment of mental, emotional and physical stress through analysis of physiological signals using smartphones","volume":"15","author":"Ferreira","year":"2015","journal-title":"Sensors"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1109\/TITB.2004.837869","article-title":"A novel mobile transtelephonic system with synthesized 12-lead ECG","volume":"8","author":"Chan","year":"2004","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"29297","DOI":"10.3390\/s151129297","article-title":"Concept design for a 1-lead wearable\/implantable ECG front-end: Power management","volume":"15","author":"Libin","year":"2015","journal-title":"Sensors"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pavani, M., and Kumar, K. (2017, January 3\u20135). Design of low cost portable 12 lead wireless ECG device using TI ADS 1198. Proceedings of the 2017 8th IEEE Annual Information Technology, Electronics and Mobile Communication Conference, Vancouver, BC, Canada.","DOI":"10.1109\/IEMCON.2017.8117182"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sahoo, P., Thakkar, H.K., Lin, W.Y., Chang, P.C., and Lee, M.Y. (2018). On the design of an efficient cardiac health monitoring system through combined analysis of ECG and SCG signals. Sensors, 18.","DOI":"10.3390\/s18020379"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vel\u00e1squez-Villada, C., and Donoso, Y. (2016). Delay\/disruption tolerant network-based message forwarding for a river pollution monitoring wireless sensor network application. Sensors, 16.","DOI":"10.3390\/s16040436"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1109\/MCOM.2016.7509376","article-title":"The TUCAN3G project: Wireless technology for isolated rural communities in developing countries on 3G small cell deployments","volume":"54","author":"Vidal","year":"2016","journal-title":"IEEE Commun. Mag."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kwon, S., Lee, D., Kim, J., Lee, Y., Kang, S., Seo, S., and Park, K. (2016). A smartphone-integrated opportunistic electrocardiogram monitoring system. Sensors, 16.","DOI":"10.3390\/s16030361"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11465","DOI":"10.3390\/s150511465","article-title":"A wearable context-aware ECG monitoring system integrated with built-in kinematic sensors of the smartphone","volume":"15","author":"Miao","year":"2015","journal-title":"Sensors"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Deb, S., Islam, S., RobaiatMou, J., and Islam, M. (2017, January 16\u201318). Design and implementation of low cost ECG monitoring system for the patient using smart device. Proceedings of the 2017 International Conference on Electrical, Computer and Communication Engineering, Cox\u2019s Bazar, Bangladesh.","DOI":"10.1109\/ECACE.2017.7913007"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Walker, B., Khandoker, A., and Black, J. (2009, January 7\u201310). Low cost ECG monitor for developing countries. Proceedings of the 2009 International Conference on Intelligent Sensors, Sensor Networks and Information Processing, Melbourne, VIC, Australia.","DOI":"10.1109\/ISSNIP.2009.5416759"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s12938-018-0487-3","article-title":"Mobile GPU-based implementation of automatic analysis method for long-term ECG","volume":"17","author":"Fan","year":"2018","journal-title":"Biomed. Eng. Online"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12938-017-0371-6","article-title":"Multi-purpose ECG telemetry system","volume":"16","author":"Marouf","year":"2017","journal-title":"Biomed. Eng. Online"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Shu, M., Wei, N., Xu, J., and Yang, M. (2017, January 22\u201324). An intelligent ECG interactive processing system based on Android\u2122 and cloud computing platform. Proceedings of the 2017 IEEE\/CIC International Conference on Communications, Qingdao, China.","DOI":"10.1109\/ICCChinaW.2017.8355263"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1049\/el:20046382","article-title":"ECG compression with retrieved quality guaranteed","volume":"40","author":"Barner","year":"2004","journal-title":"Electron. Lett."},{"key":"ref_26","unstructured":"(2018, November 03). Monitoreo ECG en Linea. Available online: http:\/\/www.ecgholterurjc.com."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hernando-Ramiro, C., Blanco-Velasco, M., Cruz-Rold\u00e1n, F., and Pedroviejo-Benito, F. (September, January 30). Efficient thresholding-based ECG compressors for high quality applications using cosine modulated filter banks. Proceedings of the 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Boston, MA, USA.","DOI":"10.1109\/IEMBS.2011.6091789"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/j.sigpro.2007.12.006","article-title":"Embedded filter bank-based algorithm for ECG compression","volume":"88","year":"2008","journal-title":"Signal Process."},{"key":"ref_29","unstructured":"Fensli, R. (2018, October 20). Evaluation of International Standards for ECG-Recording and Storage for Use in Tele-Medical Services. Available online: https:\/\/brage.bibsys.no\/xmlui\/handle\/11250\/137680."},{"key":"ref_30","unstructured":"(2018, November 03). Diagnostic Electrocardiographic Devices. Available online: http:\/\/www.ele.uri.edu\/courses\/bme484\/AAMI_EC11_parts.pdf."},{"key":"ref_31","unstructured":"(2018, November 03). ANSI\/AAMI\/IEC 60601-2-47:2012\/(R)2016. Available online: https:\/\/my.aami.org\/aamiresources\/previewfiles\/601247_1701_preview.pdf."},{"key":"ref_32","unstructured":"ICT Facts & Figures (2018, August 30). The World in 2015. Available online: http:\/\/www.itu.int\/en\/ITU-D\/Statistics\/Documents\/facts\/ICTFactsFigures2015.pdf."},{"key":"ref_33","unstructured":"(2018, August 30). ICT Facts and Figures 2016. Available online: https:\/\/www.itu.int\/en\/ITU-D\/Statistics\/Documents\/facts\/ICTFactsFigures2016.pdf."},{"key":"ref_34","unstructured":"Naciones Unidas (2018, October 20). Objetivos De Desarrollo Del Milenio. Informe De 2015. Available online: http:\/\/www.un.org\/es\/millenniumgoals\/pdf\/2015\/mdg-report-2015_spanish.pdf."},{"key":"ref_35","unstructured":"(2018, August 15). ITU, ICT Development Index 2017. Available online: http:\/\/www.itu.int\/net4\/ITU-D\/idi\/2015\/index.html."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/18\/11\/3773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:27:59Z","timestamp":1760196479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/18\/11\/3773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,5]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["s18113773"],"URL":"https:\/\/doi.org\/10.3390\/s18113773","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,5]]}}}