Clinical Correlation and Postoperative Findings of Thigh-Based Electrocardiography in Aortic Stenosis

Previous studies on healthy controls suggest the added value of thigh-based Electrocardiography (ECG), which collects data using sensors embedded in a toilet seat for unobtrusive signal acquisition. However, further evidence regarding its clinical feasibility is needed; with this work, we investigated three complementary aspects: signal quality, morphological correlation with standard ECG leads, and the system’s potential for heart rate variability (HRV) analysis in patients undergoing aortic valve replacement. This work was divided into two main phases. In the first, 32 healthy volunteers underwent simultaneous ECG recordings using both a standard 12-lead ECG system and the thigh-based system. Signal Quality Index (SQI) analysis revealed that 56.25% of the experimental signals were classified as excellent, and over 62.5% of recordings showed a strong correlation with Lead I of the clinical ECG. These findings extend the state of the art by further characterising the quality and relevance of the captured signals. In the second phase, two patients with severe aortic stenosis were monitored before and after surgical valve replacement. HRV metrics derived from the thigh-based ECG captured distinct autonomic responses: one patient showed significant postoperative improvement in global and parasympathetic modulation (increased SDNN, RMSSD, and Sample Entropy), while the other exhibited reduced variability and complexity, potentially indicating impaired autonomic recovery. These results highlight the feasibility of thigh-based ECG data acquisition for passive, longitudinal cardiac health monitoring in everyday environments and its applicability for pre- and postoperative autonomic assessment.