Validation of a handheld electrocardiogram 6 lead recorder to obtain chest lead equivalents: An Africa Heart Rhythm Association study

Background: Handheld electrocardiograms (ECGs) can be used easily in remote centers at low cost and are therefore attractive options for rural, low-income settings. A modification to the Kardia 6L ECG has been developed to record chest leads V2 and V4 by placing the device electrodes in standard V2 and V4 position. Objective: The study sought to validate this novel technique against the 12-lead ECG in a multicenter cohort from Africa and the United Kingdom to determine whether recordings are adequate for clinical use. Methods: Adults >18 years of age who required an ECG as part of routine care were invited to participate. A 12-lead ECG was obtained followed by a 6-lead ECG using the Kardia 6L, then V2 and V4 chest lead equivalents were recorded. The primary endpoint was agreement between QT interval measurement in V2 and V4 on 12-lead ECG and Kardia 6L. Secondary endpoints assessed included rate, rhythm, PR interval, QRS duration, QRS amplitude, and ST-segment abnormalities. Results: for multiple ECG parameters was >0.5, indicating satisfactory agreement. Conclusion: Modified chest lead recordings using the Kardia 6L handheld ECG recorder compared well with gold standard 12-lead ECG recordings and provide a basis for future simulated 12-lead ECG recordings using the Kardia 6L. This could improve accessibility of high-quality ECG recording and interpretation in rural, low-income settings.