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Smart Wearables for Cardiac Monitoring
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Smart Wearables for Cardiac Monitoring

A special issue of Sensors (ISSN 1424-8220). This special issue belongs to the section "Wearables".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 35087

Special Issue Editors

Prof. Dr. Andreas Bollmann

E-Mail Website
Guest Editor
Leipzig Heart Institute, Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Germany
Interests: cardiac electrophysiology; catheter ablation; cardiac monitoring; digital health; artificial intelligence; big data
Dr. Alireza Sepehri Shamloo

E-Mail Website
Guest Editor
Leipzig Heart Institute, Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, 04289 Leipzig, Germany
Interests: cardiac electrophysiology; wearables; artificial intelligence; cardiac monitoring; digital health; big data analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the digital era, wearable healthcare technologies are coming into focus in the field of cardiology and are being widely adopted by patients and consumers worldwide. Wearables include wristwatches, smartphones, patches, electronic skins, headbands, fitness trackers, eye-glasses, necklaces, clothing, and rings that are applied to screening, diagnosing, and monitoring treatments and outcomes. More and more wearables and related technologies focusing on remote and long-term cardiac monitoring are being developed. However, in order to introduce these new technologies to the daily clinical setting, the limitations and challenges posed by them and the way to overcome potential errors need to be understood.

The present Special Issue aims to highlight some of the latest developments in the field of health tracking wearables, focusing on advances in cardiac monitoring. With this letter, we welcome the submission of cutting-edge original research papers and case reports, viewpoints as well as state-of-the-art reviews and meta-analyses on the topic of wearables for cardiac monitoring.

We look forward to your contributions in this exciting, rapidly evolving field.

Prof. Dr. Andreas Bollmann
Dr. Alireza Sepehri Shamloo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Sensors is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Wearables
  • Smartphones
  • Smartwatches
  • Sensor devices and technologies
  • Electrocardiogram Photoplethysmography (PPG)
  • Accelerometers
  • Artificial Intelligence
  • Innovative applications
  • Cardiac monitoring
  • Telemedicine

Published Papers (6 papers)

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Research

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19 pages, 1496 KiB  
Article
Real-Time Quality Index to Control Data Loss in Real-Life Cardiac Monitoring Applications
by Gaël Vila, Christelle Godin, Sylvie Charbonnier and Aurélie Campagne
Sensors 2021, 21(16), 5357; https://0-doi-org.brum.beds.ac.uk/10.3390/s21165357 - 09 Aug 2021
Cited by 2 | Viewed by 2217
Abstract
Wearable cardiac sensors pave the way for advanced cardiac monitoring applications based on heart rate variability (HRV). In real-life settings, heart rate (HR) measurements are subject to motion artifacts that may lead to frequent data loss (missing samples in the HR signal), especially [...] Read more.
Wearable cardiac sensors pave the way for advanced cardiac monitoring applications based on heart rate variability (HRV). In real-life settings, heart rate (HR) measurements are subject to motion artifacts that may lead to frequent data loss (missing samples in the HR signal), especially for commercial devices based on photoplethysmography (PPG). The current study had two main goals: (i) to provide a white-box quality index that estimates the amount of missing samples in any piece of HR signal; and (ii) to quantify the impact of data loss on feature extraction in a PPG-based HR signal. This was done by comparing real-life recordings from commercial sensors featuring both PPG (Empatica E4) and ECG (Zephyr BioHarness 3). After an outlier rejection process, our quality index was used to isolate portions of ECG-based HR signals that could be used as benchmark, to validate the output of Empatica E4 at the signal level and at the feature level. Our results showed high accuracy in estimating the mean HR (median error: 3.2%), poor accuracy for short-term HRV features (e.g., median error: 64% for high-frequency power), and mild accuracy for longer-term HRV features (e.g., median error: 25% for low-frequency power). These levels of errors could be reduced by using our quality index to identify time windows with few or no data loss (median errors: 0.0%, 27%, and 6.4% respectively, when no sample was missing). This quality index should be useful in future work to extract reliable cardiac features in real-life measurements, or to conduct a field validation study on wearable cardiac sensors. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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19 pages, 1712 KiB  
Article
Regulatory, Legal, and Market Aspects of Smart Wearables for Cardiac Monitoring
by Jan Benedikt Brönneke, Jennifer Müller, Konstantinos Mouratis, Julia Hagen and Ariel Dora Stern
Sensors 2021, 21(14), 4937; https://0-doi-org.brum.beds.ac.uk/10.3390/s21144937 - 20 Jul 2021
Cited by 17 | Viewed by 7737
Abstract
In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access [...] Read more.
In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access are often evolving slowly, sometimes creating market barriers. This article gives a brief overview of the existing clinical studies regarding the use of smart wearables in cardiac monitoring and provides insight into the main regulatory and legal aspects that need to be considered when such products are intended to be used in a health care setting. Based on this brief overview, the article elaborates on the specific requirements in the main areas of authorization/certification and reimbursement/compensation, as well as data protection and data security. Three case studies are presented as examples of specific market access procedures: the USA, Germany, and Belgium. This article concludes that, despite the differences in specific requirements, market access pathways in most countries are characterized by a number of similarities, which should be considered early on in product development. The article also elaborates on how regulatory and legal requirements are currently being adapted for digitally driven wearables and proposes an ongoing evolution of these requirements to facilitate market access for beneficial medical technology in the future. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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13 pages, 5709 KiB  
Article
Kinocardiography Derived from Ballistocardiography and Seismocardiography Shows High Repeatability in Healthy Subjects
by Amin Hossein, Jérémy Rabineau, Damien Gorlier, Jose Ignacio Juarez Del Rio, Philippe van de Borne, Pierre-François Migeotte and Antoine Nonclercq
Sensors 2021, 21(3), 815; https://0-doi-org.brum.beds.ac.uk/10.3390/s21030815 - 26 Jan 2021
Cited by 15 | Viewed by 2558
Abstract
Recent years have witnessed an upsurge in the usage of ballistocardiography (BCG) and seismocardiography (SCG) to record myocardial function both in normal and pathological populations. Kinocardiography (KCG) combines these techniques by measuring 12 degrees-of-freedom of body motion produced by [...] Read more.
Recent years have witnessed an upsurge in the usage of ballistocardiography (BCG) and seismocardiography (SCG) to record myocardial function both in normal and pathological populations. Kinocardiography (KCG) combines these techniques by measuring 12 degrees-of-freedom of body motion produced by myocardial contraction and blood flow through the cardiac chambers and major vessels. The integral of kinetic energy (iK) obtained from the linear and rotational SCG/BCG signals, and automatically computed over the cardiac cycle, is used as a marker of cardiac mechanical function. The present work systematically evaluated the test–retest (TRT) reliability of KCG iK derived from BCG/SCG signals in the short term (<15 min) and long term (3–6 h) on 60 healthy volunteers. Additionally, we investigated the difference of repeatability with different body positions. First, we found high short-term TRT reliability for KCG metrics derived from SCG and BCG recordings. Exceptions to this finding were limited to metrics computed in left lateral decubitus position where the TRT reliability was moderate-to-high. Second, we found low-to-moderate long-term TRT reliability for KCG metrics as expected and confirmed by blood pressure measurements. In summary, KCG parameters derived from BCG/SCG signals show high repeatability and should be further investigated to confirm their use for cardiac condition longitudinal monitoring. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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25 pages, 7416 KiB  
Article
Premature Atrial and Ventricular Contraction Detection Using Photoplethysmographic Data from a Smartwatch
by Dong Han, Syed Khairul Bashar, Fahimeh Mohagheghian, Eric Ding, Cody Whitcomb, David D. McManus and Ki H. Chon
Sensors 2020, 20(19), 5683; https://0-doi-org.brum.beds.ac.uk/10.3390/s20195683 - 05 Oct 2020
Cited by 27 | Viewed by 4913
Abstract
We developed an algorithm to detect premature atrial contraction (PAC) and premature ventricular contraction (PVC) using photoplethysmographic (PPG) data acquired from a smartwatch. Our PAC/PVC detection algorithm is composed of a sequence of algorithms that are combined to discriminate various arrhythmias. A novel [...] Read more.
We developed an algorithm to detect premature atrial contraction (PAC) and premature ventricular contraction (PVC) using photoplethysmographic (PPG) data acquired from a smartwatch. Our PAC/PVC detection algorithm is composed of a sequence of algorithms that are combined to discriminate various arrhythmias. A novel vector resemblance method is used to enhance the PAC/PVC detection results of the Poincaré plot method. The new PAC/PVC detection algorithm with our automated motion and noise artifact detection approach yielded a sensitivity of 86% for atrial fibrillation (AF) subjects while the overall sensitivity was 67% when normal sinus rhythm (NSR) subjects were also included. The specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for the combined data consisting of both NSR and AF subjects were 97%, 81%, 94% and 92%, respectively, for PAC/PVC detection combined with our automated motion and noise artifact detection approach. Moreover, when AF detection was compared with and without PAC/PVC, the sensitivity and specificity increased from 94.55% to 98.18% and from 95.75% to 97.90%, respectively. For additional independent testing data, we used two datasets: a smartwatch PPG dataset that was collected in our ongoing clinical study, and a pulse oximetry PPG dataset from the Medical Information Mart for Intensive Care III database. The PAC/PVC classification results of the independent testing on these two other datasets are all above 92% for sensitivity, specificity, PPV, NPV, and accuracy. The proposed combined approach to detect PAC and PVC can ultimately lead to better accuracy in AF detection. This is one of the first studies involving detection of PAC and PVC using PPG recordings from a smartwatch. The proposed method can potentially be of clinical importance as this enhanced capability can lead to fewer false positive detections of AF, especially for those NSR subjects with frequent episodes of PAC/PVC. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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Review

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25 pages, 2801 KiB  
Review
Smart Wearables for Cardiac Monitoring—Real-World Use beyond Atrial Fibrillation
by David Duncker, Wern Yew Ding, Susan Etheridge, Peter A. Noseworthy, Christian Veltmann, Xiaoxi Yao, T. Jared Bunch and Dhiraj Gupta
Sensors 2021, 21(7), 2539; https://0-doi-org.brum.beds.ac.uk/10.3390/s21072539 - 05 Apr 2021
Cited by 58 | Viewed by 13393
Abstract
The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of [...] Read more.
The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of nonatrial fibrillation arrhythmias represents a broad field of wearable technologies in cardiology using Holter, event recorder, electrocardiogram (ECG) patches, wristbands and textiles. Implementation in other patient cohorts, such as ST-elevation myocardial infarction (STEMI), heart failure or sleep apnea, is feasible and expanding. In addition to appropriate accuracy, clinical studies must address the validation of clinical pathways including the appropriate device and clinical decisions resulting from the surrogate assessed. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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Other

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6 pages, 216 KiB  
Viewpoint
Smart Wearables for Cardiac Autonomic Monitoring in Isolated, Confined and Extreme Environments: A Perspective from Field Research in Antarctica
by Michele M. Moraes, Thiago T. Mendes and Rosa M. E. Arantes
Sensors 2021, 21(4), 1303; https://0-doi-org.brum.beds.ac.uk/10.3390/s21041303 - 11 Feb 2021
Cited by 7 | Viewed by 2796
Abstract
Antarctica is a space-analog ICE (isolated, cold, and extreme) environment. Cardiovascular and heart autonomic adjustments are key-adaptive physiological responses to Antarctica, both in summer camps and in research stations winter-over. Research fieldwork in ICE environments imposes limitations such as energy restriction, the need [...] Read more.
Antarctica is a space-analog ICE (isolated, cold, and extreme) environment. Cardiovascular and heart autonomic adjustments are key-adaptive physiological responses to Antarctica, both in summer camps and in research stations winter-over. Research fieldwork in ICE environments imposes limitations such as energy restriction, the need for portable and easy-to-handle resources, and resistance of materials to cold and snow/water. Herein, we present the methods we use for cardiac monitoring in the Antarctic field, the limitations of the equipment currently available, and the specific demands for smart wearables to physiological and health tracking in ICE environments, including the increased remote monitoring demand due to COVID-19 restrictions. Full article
(This article belongs to the Special Issue Smart Wearables for Cardiac Monitoring)
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