Synthesizing the 12-Lead Electrocardiograms by the Single-Lead ECG System-Reconstruction of Temporal Asynchronous Bipolar ECG Recordings

Introduction: Synthesizing 12-lead ECG from the portable system with limited leads can provide additional information of morphological changes of ECG related to cardiac diseases. To extend the usage of the systems with limited leads, we proposed an innovative 12 lead reconstruction algorithm based on multiple ECGs recorded asynchronously from different sites by single-lead event recorder. Methods: Conventional 12-lead ECGs of 11 subjects (5 controls, 5 AMI, and 1 COPD) were recorded and diagnosed by experienced cardiologists. Fifteen-second bipolar ECG recordings from 10 different places on chest and abdomen by referencing to electrode on right hand were acquired (Fig 1). Respiratory related QRS amplitude variations and baseline drifting were removed and the template of QRS wave of each ECG recording was derived by averaging the PQRST wave aligned with R peaks. Finally, the synthesis of 12-lead ECG was transformed from linear combination of different bipolar signals with optimal weighting coefficient. To validate the algorithm, the reconstructed 12-lead ECGs of the subjects were reviewed by 2 cardiologists and 1 emergency physician. Results: Diagnoses of all subjects were correctly made by those physicians with 100% agreement. There were no significantly differences in QRS duration (95.2 vs 94.9 ms), QT interval (383.6 vs 384.3 ms), and ST elevation (1.36 vs 1.42 mm) between conventional and reconstructed 12-lead ECGs (Fig 2) . Conclusions: The 12-lead ECG can be accurately reconstructed by the algorithm based on the single-lead event recorder with dry electrodes and our method provides a new possibility for telemedicine in screening or early diagnosis of severe cardiac events.