A real-time quality monitoring system for optimal recording of 12-lead resting ECG

Minimizing the impact of artifacts prior to the start of the ECG recording is an approach for providing a diagnostically reliable data. A solution to this problem is a continuous feedback of the ECG quality and prompt start of the recording at potentially the best quality. The real-time lead quality monitoring library (LQMLib) is introduced to trigger the recording of 10 s resting 12-lead ECG at the optimal snapshot moment (the earliest in time, the best in quality). The triggering condition considers the Snapshot quality (signal-to-noise ratio of the most noisy 4 s segment within 10 s) exceeding an adaptive quality threshold (AQT). The optimal AQT (descending from 85% down to 60% over 1 min) is validated on two independent clinical datasets from an emergency department, including 267/385 standard 12-lead ECGs. The test-validation LQMLib performance is: (84.7-87.2)% of ECGs would be triggered at their maximal Snapshot quality; (31.2-33.1)% at the optimal snapshot time (±2.5 s); (25.7-29.3)% would be started earlier, typical for high quality ECGs with progressively increasing supra-threshold Snapshot quality; (37.2-43.1)% would be recorded with a delay >2.5 s, typical for low quality ECGs with sub-threshold maximal Snapshot quality that is not validated as potentially the best quality until AQT criterion declines later within 1 min.