{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T12:29:09Z","timestamp":1772713749107,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,24]],"date-time":"2022-09-24T00:00:00Z","timestamp":1663977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union (EU): H2020-MSCA-RISE Programme","award":["#645759"],"award-info":[{"award-number":["#645759"]}]},{"name":"Ulster Garden Villages Ltd.","award":["#645759"],"award-info":[{"award-number":["#645759"]}]},{"name":"McGrath Trust","award":["#645759"],"award-info":[{"award-number":["#645759"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Sudden cardiac death (SCD) risk can be reduced by early detection of short-lived and transient cardiac arrhythmias using long-term electrocardiographic (ECG) monitoring. Early detection of ventricular arrhythmias can reduce the risk of SCD by allowing appropriate interventions. Long-term continuous ECG monitoring, using a non-invasive armband-based wearable device is an appealing solution for detecting early heart rhythm abnormalities. However, there is a paucity of understanding on the number and best bipolar ECG electrode pairs axial orientation around the left mid-upper arm circumference (MUAC) for such devices. This study addresses the question on the best axial orientation of ECG bipolar electrode pairs around the left MUAC in non-invasive armband-based wearable devices, for the early detection of heart rhythm abnormalities. A total of 18 subjects with almost same BMI values in the WASTCArD arm-ECG database were selected to assess arm-ECG bipolar leads quality using proposed metrics of relative (normalized) signal strength measurement, arm-ECG detection performance of the main ECG waveform event component (QRS) and heart-rate variability (HRV) in six derived bipolar arm ECG-lead sensor pairs around the armband circumference, having regularly spaced axis angles (at 30\u00b0 steps) orientation. The analysis revealed that the angular range from \u221230\u00b0 to +30\u00b0of arm-lead sensors pair axis orientation around the arm, including the 0\u00b0 axis (which is co-planar to chest plane), provided the best orientation on the arm for reasonably good QRS detection; presenting the highest sensitivity (Se) median value of 93.3%, precision PPV median value at 99.6%; HRV RMS correlation (p) of 0.97 and coefficient of determination (R2) of 0.95 with HRV gold standard values measured in the standard Lead-I ECG.<\/jats:p>","DOI":"10.3390\/s22197240","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T03:34:17Z","timestamp":1664163257000},"page":"7240","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Armband Sensors Location Assessment for Left Arm-ECG Bipolar Leads Waveform Components Discovery Tendencies around the MUAC Line"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6696-5911","authenticated-orcid":false,"given":"Omar","family":"Escalona","sequence":"first","affiliation":[{"name":"School of Engineering, Ulster University, Newtownabbey BT37 0QB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sephorah","family":"Mukhtar","sequence":"additional","affiliation":[{"name":"School of Engineering, Ulster University, Newtownabbey BT37 0QB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"McEneaney","sequence":"additional","affiliation":[{"name":"Craigavon Area Hospital, Portadown BT63 5QQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dewar","family":"Finlay","sequence":"additional","affiliation":[{"name":"School of Engineering, Ulster University, Newtownabbey BT37 0QB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart Disease and Stroke Statistics\u20142020 Update: A Report from the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics\u20142019. Update: A report from the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.15420\/aer.2017.40.3","article-title":"Drivers of Atrial Fibrillation: Theoretical Considerations and Practical Concerns","volume":"7","author":"Mann","year":"2018","journal-title":"Arrhythmia Electrophysiol. Rev."},{"key":"ref_4","first-page":"193","article-title":"Dysfunction of the autonomic nervous system in atrial fibrillation","volume":"7","author":"Xi","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e13174","DOI":"10.1111\/eci.13174","article-title":"Heart rate variability in atrial fibrillation: The balance between sympathetic and parasympathetic nervous system","volume":"49","author":"Khan","year":"2019","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14563","DOI":"10.1109\/JSEN.2022.3174779","article-title":"Contactless Monitoring of Heart Rate Variability During Respiratory Maneuvers","volume":"22","author":"Shoushan","year":"2022","journal-title":"IEEE Sens. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"012026","DOI":"10.1088\/1742-6596\/450\/1\/012026","article-title":"Arm and wrist surface potential mapping for wearable ECG rhythm recording devices: A pilot clinical study","volume":"450","author":"Lynn","year":"2013","journal-title":"J. Phys. Conf. Ser."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3464","DOI":"10.1109\/TBME.2020.2987759","article-title":"Wearable Armband Device for Daily Life Electrocardiogram Monitoring","volume":"67","author":"Lazaro","year":"2020","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lee, D., Kwon, H., Lee, H., Seo, C., and Park, K. (2020). Optimal Lead Position in Patch-Type Monitoring Sensors for Reconstructing 12-Lead ECG Signals with Universal Transformation Coefficient. Sensors, 20.","DOI":"10.3390\/s20040963"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"109243","DOI":"10.1016\/j.measurement.2021.109243","article-title":"Wireless ECG and cardiac monitoring systems: State of the art, available commercial devices and useful electronic components","volume":"177","author":"Cosoli","year":"2021","journal-title":"Meas. J. Int. Meas. Confed."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bae, T.W., Kwon, K.K., and Kim, K.H. (2020). Vital Block and Vital Sign Server for ECG and Vital Sign Monitoring in a Portable u-Vital System. Sensors, 20.","DOI":"10.3390\/s20041089"},{"key":"ref_12","first-page":"1","article-title":"Wrist and Arm Body Surface Cardiac Electrogram Mapping Techniques Study for Long-Term Rhythm Monitoring","volume":"44","author":"Escalona","year":"2017","journal-title":"Comput. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1109\/JSEN.2014.2370945","article-title":"Wearable Sensors for Human Activity Monitoring: A Review","volume":"15","author":"Mukhopadhyay","year":"2015","journal-title":"IEEE Sens. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Villegas, A., McEneaney, D., and Escalona, O. (2018). Arm-ECG Wireless Sensor System for Wearable Long-Term Surveillance of Heart Arrhythmias. Electronics, 8.","DOI":"10.3390\/electronics8111300"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.bspc.2019.01.020","article-title":"Standard ECG lead I prospective estimation study from far-field bipolar leads on the left upper arm: A neural network approach","volume":"51","author":"Vizcaya","year":"2019","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Escalona, O.J., Villegas, A., Mukhtar, S., Perpi\u00f1an, G., and McEneaney, D.J. (2020, January 13\u201316). Wireless Arm Wearable Sensor Band for Long-Term Heart Rhythms Surveillance Using a Bipolar Arm-ECG Lead. Proceedings of the 2020 Computing in Cardiology, Rimini, Italy.","DOI":"10.22489\/CinC.2020.470"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Escalona, O.J., Lynn, W.D., Perpi\u00f1an, G., McFrederick, L., and McEneaney, D.J. (2017). Data-Driven ECG Denoising Techniques for Characterising Bipolar Lead Sets along the Left Arm in Wearable Long-Term Heart Rhythm Monitoring. Electronics, 6.","DOI":"10.3390\/electronics6040084"},{"key":"ref_18","first-page":"1","article-title":"Arm-ECG Bipolar Leads Signal Recovery Methods for Wearable Long-term Heart Rate and Rhythm Monitoring","volume":"44","author":"Lynn","year":"2017","journal-title":"Comput. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1109\/TBME.1985.325532","article-title":"A Real-Time QRS Detection Algorithm","volume":"32","author":"Pan","year":"1985","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Brito, N.B., Llanos, J.P.S., Ferrer, M.F., Garc\u00eda, J.G.O., Brito, I.D., Castro, F.P.-G., Castellanos, N.C., Rodr\u00edguez, C.X.A., and Abizanda, E.P. (2016). Relationship between Mid-Upper Arm Circumference and Body Mass Index in Inpatients. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0160480"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jchf.2015.11.010","article-title":"Complementary Role of Arm Circumference to Body Mass Index in Risk Stratification in Heart Failure","volume":"4","author":"Kamiya","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_22","unstructured":"(2022, August 20). MathWorks\u2014Makers of MATLAB and Simulink, Mathworks.com. Available online: https:\/\/www.mathworks.com\/."},{"key":"ref_23","first-page":"177","article-title":"Frequency bandwidth limitations in the signa--averaged ECG by the maximum coherence matching technique","volume":"13","author":"Escalona","year":"1991","journal-title":"Automedica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S137","DOI":"10.1007\/BF02446662","article-title":"A fast and reliable QRS alignment technique for high-frequency analysis of the signal-averaged ECG","volume":"3","author":"Escalona","year":"1993","journal-title":"Med Biol. Eng. Comput."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4365","DOI":"10.5958\/0974-360X.2017.00802.2","article-title":"Pan Tompkins Algorithm based ECG Signal Classification","volume":"10","author":"Ali","year":"2017","journal-title":"Res. J. Pharm. Technol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"012022","DOI":"10.1088\/1742-6596\/1532\/1\/012022","article-title":"Analysis of Pan-Tompkins Algorithm Performance with Noisy ECG Signals","volume":"1532","author":"Fariha","year":"2020","journal-title":"J. Phys. Conf. Ser."},{"key":"ref_27","first-page":"1","article-title":"Wearable Technology: Signal Recovery of Electrocardiogram from Short Spaced Leads in the Far-Field Using Discrete Wavelet Transform Based Techniques","volume":"46","author":"McCallan","year":"2019","journal-title":"Comput. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nasir, I.M., Khan, M.A., Yasmin, M., Shah, J.H., Gabryel, M., Scherer, R., and Dama\u0161evi\u010dius, R. (2020). Pearson Correlation-Based Feature Selection for Document Classification Using Balanced Training. Sensors, 20.","DOI":"10.3390\/s20236793"},{"key":"ref_29","unstructured":"(2022, July 14). Detect and Remove Outliers in Data\u2014MATLAB Rmoutliers\u2014MathWorks United Kingdom. Available online: https:\/\/uk.mathworks.com\/help\/matlab\/ref\/rmoutliers.html."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2140\/pjm.1963.13.459","article-title":"The inverse of the error function","volume":"13","author":"Carlitz","year":"1963","journal-title":"Pac. J. Math."},{"key":"ref_31","unstructured":"(2022, July 14). Inverse complementary error function\u2014MATLAB erfcinv\u2014MathWorks United Kingdom. Available online: https:\/\/uk.mathworks.com\/help\/matlab\/ref\/erfcinv.html."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"R155","DOI":"10.1088\/0967-3334\/26\/5\/R01","article-title":"Wavelet transforms and the ECG: A review","volume":"26","author":"Addison","year":"2005","journal-title":"Physiol. Meas."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/19\/7240\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:38:39Z","timestamp":1760143119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/19\/7240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,24]]},"references-count":32,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["s22197240"],"URL":"https:\/\/doi.org\/10.3390\/s22197240","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,24]]}}}