A Zero-Interaction, Cloud-Free Remote ECG Monitoring and Arrhythmia Screening System Using Handheld Leads and Email Transmission

To address the challenges of complex operation, high server deployment costs, and insufficient automated identification capabilities in community-based centralized electrocardiogram (ECG) screening, a novel arrhythmia screening system based on handheld ECG leads and email transmission is proposed. The system is operated in a zero-interaction mode: ECG acquisition is initiated automatically upon skin contact with the electrodes, and upon completion, the ECG signal is automatically analyzed and the email transmission function is triggered—no user intervention being required. First, noise in the ECG signal is effectively suppressed by cascading a zero-phase high-pass filter with a sliding window and a zero-crossing-rate (ZCR) guided adaptive wavelet thresholding technique. Subsequently, RR interval sequences are extracted from the denoised signals and fed into a lightweight bidirectional long short-term memory (BiLSTM) network for automatic arrhythmia detection. In the final step, a 30 s standard ECG, screening status, and acquired image are automatically delivered to clinicians via standard IMAP/SMTP email protocols—eliminating the need for dedicated mobile applications or cloud platforms. Experimental results demonstrated that the relative signal-to-noise ratio (SNRECG) was improved by 2.36 dB. On the independent test set, a sensitivity of 97.98%, a specificity of 98.21%, and an AUC of 0.994 were achieved. Furthermore, an end-to-end email transmission latency of less than 7.68 s was recorded. These findings confirm the potential of the proposed system as a low-cost, easily deployable, and elderly-friendly remote ECG solution for primary healthcare settings. Finally, in a pilot screening involving 10 volunteers, one case of arrhythmia was successfully identified, which validated the feasibility of the system.