Design of An ECG System : Review

K Krishna Bai, S C Prasanna Kumar, B S Sathyanarayana & B G Sudhrashan

R v College Engineering , Bangalore
Email:krishnabaik@gmail.com

Abstract - From the beginning of medical sciences and technology, ECG has been a valuable diagnostic tool in assessing cardiac
condition. The electrocardiograph system design, performance, size , ease of use, recording time, cost etc has undergone a gr eat
transition along the timeline. Compact low power embedded hardware technology and advanced signal processing platforms has led
a way to design a more efficient ECG systems. ECG systems, once which was used for patients who are at risk, are now used as a
life style product. The design of a portable low cost user friendly ECG monitor system that can be affordable and manageable by
common man is a great research area.

I. INTRODUCTION
With the recent dramatic advancements in micro
Initial healthcare systems were just intended for electronics, micro mechanical, information and
hospital applications. The healthcare systems is communication technology, and efficient physiological
changing due to raising healthcare costs, busier measurement bioinstrumentation with smaller size,
lifestyles, increasing aging population, strengthening better performance, low power consumption has been
healthcare consciousness and growing economy. This developed. The application of computer to traditional
calls for radical changes in how care will be provided, electrocardiographs began a new era. Continuing
targeting preventive care, effective provision of miniaturization of electronic equipment and increasing
continuous treatment, personalized and connected power of portable computers has made possible to
health.[1] integrate various types of signal acquisition units(data
loggers) and sophisticated analysis software into
Cardiac healthcare is the fastest growing market as notebook type computer. The concept of hardware and
cardiovascular disease is the leading cause of death in software co-design methodology solves the challenges
the world. Among the various medical or healthcare of size and power constraints. This also supports online
information , ECG is best way to measure and diagnose and offline signal processing options. Proper balance of
abnormal conditions of the heart .It is a painless, power and performance by profiling power consumption
inexpensive and measuring quantity and thus ECG has of different hardware subsystems as well as software
become one of the most preferable vital in the area of functions an optimum system can be designed.
healthcare.
Due to development of information and
The ECG machine has a rich history that has lead to communication technology (ICT), the feasibility of
its prominent future in medical equipment and health telecare has improved. Initially it was done
supplies. In 1856, and Mueller discovered the electrical utilizing traditional Public Switched Telephone Network
activity of the heart. Alexander Muirhead attached wires (PSTN). Various other networks that were used are
to a feverish patient's wrist to obtain a record of the Cable Television (CATV) network, Wireless LAN,
patient's heartbeat while studying for his DSc (in Integrated Services Digital Network (ISDN). The latest
electricity) in 1872 using a Lippmann capillary available channels are GSM, GPRS, EDGE, 3G, and
electrometer fixed to a projector. The trace from the INMARSAT etc. By choosing proper compression
heartbeat was projected onto a photographic plate which techniques, channel bandwidth & encoding systems, an
was itself fixed to a toy train. In 1903, Holland efficient telecare system could be developed for event
physiologist W. Einthoven developed the string recorders and for giving emergency alerts/alarms. With
galvanometer, and recorded the first practical the advent of cellular phone, mobile telemedicine
electrocardiogram on an optically sensitive plate systems are becoming more important all the time,
through an optical amplifier.

International Conference on Computer Science and Informatics (ICCSI) – Hyderabad - 9th March, 2012
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 Design of an ECG System: Review

especially in the care of patients that are isolated or using 5 or 6 lead wires. Philips Medical system
travelling, far from reference hospital care. developed the EASI lead system using 5 cable systems
to estimate a 12 lead ECG. General Electric Medical
ECG feature extraction plays a significant role in developed the interpolated 12 lead system using a 6
diagnosing most cardiac diseases. The fundamental cable system.
features(amplitudes and intervals) could be used for
subsequent automatic analysis. Automatic ECG analysis
is one of the hot topics in the research work of
biomedical engineering. Advantage of automatic ECG
analysis is the gradual development of a commonly
accepted set of diagnostic criteria and lower price of
clinical assessment. Over the past two decades various
types of ECG analysis algorithms are developed and
improved. Various mathematical platforms are available
for performing complex and tedious calculations like
Matlab, Code Composer Studio, and Labview etc.
Proper processing of different parameters as well as
knowledge of the clinical features of certain risk groups
can be used in decision making of a disease.
With the design of low voltage operations and
rechargeable batteries and communication protocols and
modules like Bluetooth, zigbee etc, the applications of
ECG was extended to other medical equipments. Some Fig. 1 : 12 lead ECG Electrode placement
of the most common are Telemetry devices, Holter
monitors, Consumer products, Automatic External Cardiac monitors were developed with ability to
Defibrillators (AED), Diagnostic ECG, Patient view multiple leads simultaneously which offered a
monitors. Current applications of ECG include stress more comprehensive electrical picture of the hearts.
monitoring and to study the effect of exercise. With the development of more conductive electrodes
and gels the sensitivity of ECG acquisition significantly
The main areas of concern in the design of an ECG improved.
system are analog front end unit, microcontroller and
processing unit and the display and analysis unit. The Conventional electrodes required skin preparation
features and architectures of these vary depending on in advance and required sticky pads, pastes or gels to
applications and some of them are discussed in the make electrical contact to the skin. The disadvantage of
following sections. using gels was it caused skin irritation and these
electrodes could not be used for mobile applications or
II. ECG SENSORS / ELECTRODES patients in motion. These problems made a way to
design electrodes that required no gels and suitable for
The first unit ECG electrodes make the interface portable applications.
between the patients heart’s electrical activity and the
For long term applications, the limb leads cause
further electric circuitry. The ECG lead system may be
discomfort to the patients. Along the time line, the
12 lead, 6 lead ,5 lead or 3 lead one. Depending on the
systems had to improve upon the size, weight ,
clinical application and real time complexity of the
performance and ease of use factors with the
placement of electrodes any of these lead systems is
development of low power digital signal processors,
employed.
system on chip etc. Geng Yang et al from Royal
For portable application usually 3 lead system is Institute of Technology proposed an intelligent electrode
employed which uses the principle of Einthoven’s which was composed of ASIC chip and a micro Spike
triangle for placement of electrodes and analysis. By array. These micro pikes were 100micrometer long
using vector algebra and suitable mathematical fabricated with MEMS technology. By penetrating the
operations the 12 lead ECG information can be outer layer of skin more accurate bio potential could be
extracted from 3 lead ECG. performed. The ASIC chip performed the requires
signal conditioning operations. [2]
In between these two systems, 5 or 6 lead system
also existed. In an effort to reap the advantages of 12
lead views while keeping the monitoring system
practical ,reduced lead set technologies were developed

International Conference on Computer Science and Informatics (ICCSI) – Hyderabad - 9th March, 2012
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 Design of an ECG System: Review

amplifier INA118 , ADI (Analog Devices Inc) AD8544

is used as the second level amplifier and with
HPF(>0.5Hz), LPF(<110Hz) and 50Hz notch
filtering.[5].
Sungkil Hwang et al in Tuffs University designed
an asynchronous ECG acquisition system with a low
noise front end amplifier, with a tuneable bandwidth, an
asynchronous ADC and a DSP. The advantage of this
Fig. 2 : Intelligent ECG electrode with in built signal design is the signal dependent sampling rate which
conditioning unit [2]
makes it attractive for compact ECG systems.
Next type of electrodes had a capability of
transmitting ECG with emergence of Wireless Body
Area Network (WBAN) technology.[3]These types are
suitable for home care or personalized applications.
These are designed to recognize changes in person’s
health and context and it communicates with ambient to
assist changes in regard to living conditions and also
activate devices.
Initially monitoring systems were used only at risk
times, now they are used in daily living environment. To
solutions to this was wearable ECG monitors. These Fig. 4 : ECG Analog Front End [5]
include onchip processing options too. Latest types of
Texas Instrument has designed a complete analog
electrodes include chest belt type, wrist watch type and
front end for ECG named ADS1298. It is eight-
shirt type. These devices are non invasive and
channel, 24-bit first in a family of fully integrated
monitoring happens throughout time. Life Shirt (Vivo
analog front ends (AFEs) for patient monitoring,
Metrics) is an example of commercial product.[4]
portable and high-end electrocardiogram. The
advantages of this include Reduce components and
board size by 95%, 1mW/channel reduces solution
power by 95% and Single-chip solution increases
system reliability and patient mobility.[6]
CARDIC (p/n AUM441CX) is a low power
integrated circuit which is a multi Sensor front end
acquisition system with onboard ADC (12bit @
83KS/sec) and serial interface communication protocol
[7].This IC has channels for ECG recording and
measurement of vitals like Blood Pressure and
temperature.
Fig. 3 : Wearable ECG Electrodes Types[4]
A product by National Instruments named low cost
III. ANALOG FRONT END UNIT E-series PCI-6034E is data acquisition board which is
included with NI-DAQ software. This software
The front end of an ECG must be able to deal with integrates the full functionality of DAQ hardware to
extremely weak signals ranging from 0.5 mV to 5.0 mV, LABVIEW for further display and processing.[8].
combined with a dc component of up to 300 mV—
resulting from the electrode-skin contact—plus a The system on chip concept applied to front end
design improves performances in terms of cost, area,
common-mode component of up to 1.5 V, resulting
speed and power consumption compared to discrete or
from the potential between the electrodes and ground.
partly integrated solutions. An SOC for ECG acquisition
The main components include ECG sensor,
Instrumentation amplifier, Drive Right Leg, Filter and processing is discussed in [9] which include features
circuitry, & Gain amplifier. like time sharing of amplifiers within ADC in order to
lower the power consumptions and to save area, Built In
Fan Aihua et al in china proposed an ECG signal Self Test (BIST) and auto calibration capabilities to
detection front end. The signal first level amplifier used enhance reliability.
high accuracy ,low power consumption instrumentation

International Conference on Computer Science and Informatics (ICCSI) – Hyderabad - 9th March, 2012
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 Design of an ECG System: Review

This unit serves a basic unit of the system as it Fig. 5 : Block Diagram Of ECG Biochip[11]
provides the signal in appropriate form and electrical
Thus choosing a right microcontroller is very
characteristics required for further processing.
important as it provides the right combination of
programming, cost and power consumption need to
IV. MICROCONTROLLER AND PROCESSING
realize a portable medical device.
UNIT
The adoption of microcontrollers and processors V. DISPLAY AND ANALYSIS METHODS
further enhanced the performance of the ECG systems.
Originally, ECG systems were intended to just
Microcontrollers is considered as heart of any
display the heart electrical activity. This was initially
embedded medical device such as portable devices like
done on a optical plate or CRO. Later the ECG system
heart rate monitor ,wearable devices like continuous
printed the waveform a graphical paper. In current era,
health monitors and implantable devices such as
the acquired ECG can be displayed on PC, LCD module
pacemakers.. Some controllers best chosen for this
like OCM12864- or on a PDA or mobile.. The latest
medical applications are are discussed below.
devices include the capability to do large amounts of
Atmel ARM7 processor which is a versatile 32bit autonomous signal analysis to reduce the burden on the
processor designed for mobile devices and other low person using it.
power electronics. This processor architecture is capable
In each case suitable software is written for display
of up to 130 MIPS on a typical 0.13 µm process. The
of waveforms. The display on PDA and LCD need to
ARM7TDMI processor core implements ARM
address lot of real time issues and programming
Architecture v4T. The processor supports both 32-bit
considerations. Thus here some methods and platforms
and 16-bit instructions via the ARM and Thumb
for PC display and processing are discussed.
instruction sets.
The acquired ECG can be transferred to PC either
Next popular competitor are class of dsPIC
through wireless option(Bluetooth) or wired means(
microcontrollers which can acquire and process medical
serial port or USB).The communication through the
signals. The main benefits include low cost, low power
serial port can be accomplished by using the
consumption, high speed of computation and data
communication control in Visual Basic 6.0.It provides
storing capabilities.
an interface to a standard set of communication
The most apt MSP430 16-bit microcontroller commands..
platform of ultra-low power RISC mixed-signal
Texas Instruments DSP(TIMS320C67X) based
microprocessors from TI provides the ultimate solution
starter kit(DSK) with a two electrode ECG preamplifier.
for a wide range of low power and medical portable
This kit is provided with an integrated development
applications such as pulse oximeter, blood glucose
environment (IDE) called Code Composer
meter and digital thermometer.
Studio(CCS).This CCS is a high level language which
The latest technology is the development of ECG has built in FFT, wavelet and other functions for signal
biochip of variable ECG applications. The advantages of processing. The kit has a built in 16bit CODEC to
Biochips are improved capability to perform real time acquire the ECG signal. The kit can process 5000
analysis of input data, more accurate diagnosis of samples and can display 2048 samples a time[6].
cardiac diseases and prompter reaction to abnormal
heart alterations.

Fig. 6 :DSP starter kit based ECG analysis setup[6]

International Conference on Computer Science and Informatics (ICCSI) – Hyderabad - 9th March, 2012
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 Design of an ECG System: Review

Fig. 9 : Example of Labview GUI for ECG Display [8]

Fig.7 :Denoised ECG using CCS software[7]
Thus we see wide choices of implementation
Another platform for effective acquisition and
methods and processing platforms are available. The
processing of ECG is Matlab. It is universally accepted
best can choosen.
data processing platform. Its connectivity with many
advanced programming languages(C,Java,VB) and
VI. PRODUCTS SURVEY
available of a wide range of signal processing tool boxes
makes it popular use in ECG system too. Automatic Many companies like Freescale, Microchip, Texas
ECG analysis using different techniques provides the Instruments ,Maxim , Analog Devices ,GE healthcare
patient the cardiac information or assist the cardiologist and many more have proposed solutions for
in detecting abnormalities.[12] components of an ECG system. They include ICs for
amplifiers, Filters, battery management, protection
circuitry, microcontrollers, LCDs, audio alerts etc.
Some companies have designed their own ECG
monitor as discussed below.
Nurosynaptic has developed an ECG machine with
USB interface. It is 12 channel system with
simultaneous acquisition. It provides a world class
diagnostic ECG and has optional upgrade to include
fetal ECG.Its small size makes it to be carried anywhere
easily.
Other ECG monitors include Handheld ECG
monitor by Med choice, HCG-801 portable ECG
monitor by OMRON,Biolog 3000i ECG monitor
/recorder by Daray Healthcare products, Handheld
Fig. 8 : Matlab GUI with ECG signal plots and ReadMyHeart by Japanese manufacturer of medical
processed ECG feature [12] equipments,MAC 800 resting ECG analysis system by
The advent of Virtual Instrumentation has GE Healthcare.
revolutionised the way the circuits are designed and the The costs of these heart monitors are not less than
processing methods. Labview is one such platform $200.Thus they are not affordable by a common man of
which uses PC to perform measurements, calculations a developing country like India. Thus there is great need
and analysis for testing. The advantages include its to adopt cost effective components and design
flexibility and automation feature. It is a graphical techniques to reach common man needs.
programming technique. It has number of built in tools
which makes it so powerful. The toolboxes which could The world’s smallest wearable cardiac monitor
be used for our application include Digital Filter Design, called the silicon locket is developed by IIT professor in
Advance Signal Processing, Spectral measurements etc. collaboration with TCS. It is a real time cardiac monitor
Another added feature is that it can also include visual which can perform classification of heart beat and
and audio alerts for better conveying the information. severity of cardiac condition. It can act as Bedside
Monitor, Holster Monitor and a portable ECG monitor.
It can contact the monitoring centre when cardiac
disorder is detected.

International Conference on Computer Science and Informatics (ICCSI) – Hyderabad - 9th March, 2012
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 Design of an ECG System: Review

VII. CONCLUSIONS [7] Noureddine Belgacem, Fethi Bereksi-

Reguig‖Bluetooth portable device for ECG and
The opportunity and expectation of developing
patient motion monitoring‖ Biomedical
countries in terms of healthcare are to be studied. The
engineering laboratory, abou bekr belkaid
importance of ECG in cardiac assessment necessitates
university, Bp 230 Tlemcen, 13000, Algeria,issue
the study of advances in medical technology that could
4, pp 19-23, Nov 2010
be utilized for prevention and early diagnosis. By using
low cost components and user friendly techniques, in [8] R Gupta ,J N Bera,M Mitra,‖ Development of an
contrast with conventional treatments , the product embedded system and matlab based GUI for
would reach a common and an untrained man. By online acquisition and analysis of ECG
integrating advances in various spheres like signal‖,Measurement 43(2010),pp 1119-
communications, Information Technology, 1126,2010 Science Direct.
Microelectronics, Fabrication Technology , Power
[9] N. Van Helleputte a,, J.M. Tomasik b, W. Galjan
management , an effective system could be designed
b, A. Mora-Sanchez b,et al,‖ A flexible system-
meeting all the demands of developing countries and the
on-chip (SoC) for biomedical signal acquisition
aging population.
and
processing‖,linkinghub.elsevier.com/retrieve/pii/
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