Unveiling the superiority of 6-lead consumer-grade ECG: a comparative study on arrhythmia detection and numerical accuracy

Multiple consumer driven devices to detect cardiac rhythm are available these days. However, most devices are single lead. This study aimed to compare the diagnostic accuracy and performance of electrocardiogram (ECG) readings from consumer-grade devices, the single-lead(1L) and the 6-lead(6L), against a standard 12-lead(12L) ECG system.

A total of 187 patients participated in the study. 6L and 12L ECGs were recorded simultaneously, while the 1L measurements were slightly delayed. Diagnostic agreement and the accuracy of numerical values were analyzed across the devices using sensitivity and the Bland-Altman method. Two criteria were applied: ECG criterion (all pairs from one visit) and patient identification criterion (most recent ECG pair per patient) (figure1).

6L ECG had a diagnostic agreement sensitivity of 97.79% with 12-lead ECG for arrhythmia diagnosis, while the 1L ECG had 93.37%. Outlier rates, reflecting numerical accuracy for PR/QRS/QT intervals, were lower for 6L ECG: PR interval outliers were 1.10% (6L) vs. 3.35% (1L); QRS complex outliers were 4.42% (6L) vs. 5.03% (1L); and QT interval outliers were 4.97% (6L) vs. 5.03% (1L) (figure 2).

Both the 6L and 1L ECGs demonstrated acceptable diagnostic accuracy compared to the 12-lead ECG system. However, the 6L ECG device outperformed the 1L ECG in terms of better diagnostic concordance and lower outlier rates. The results suggest that consumer-grade ECG devices could serve as reliable alternatives for preliminary cardiac assessments, particularly in remote settings, with the 6L ECG system showing a more favorable performance.