Textile Concentric Ring Electrodes for ECG Recording Based on Screen-Printing Technology

Advances in Printed Electronic Textiles

Electronic textiles (e-textiles) have emerged as a revolutionary solution for personalized healthcare, enabling the continuous collection and communication of diverse physiological parameters when seamlessly integrated with the human body. Among various methods employed to create wearable e-textiles, printing offers unparalleled flexibility and comfort, seamlessly integrating wearables into garments. This has spurred growing research interest in printed e-textiles, due to their vast design versatility, material options, fabrication techniques, and wide-ranging applications. Here, a comprehensive overview of the crucial considerations in fabricating printed e-textiles is provided, encompassing the selection of conductive materials and substrates, as well as the essential pre- and post-treatments involved. Furthermore, the diverse printing techniques and the specific requirements are discussed, highlighting the advantages and limitations of each method. Additionally, the multitude of wearable applications made possible by printed e-textiles is explored, such as their integration as various sensors, supercapacitors, and heated garments. Finally, a forward-looking perspective is provided, discussing future prospects and emerging trends in the realm of printed wearable e-textiles. As advancements in materials science, printing technologies, and design innovation continue to unfold, the transformative potential of printed e-textiles in healthcare and beyond is poised to revolutionize the way wearable technology interacts and benefits.

Characterizing the Impedance Properties of Dry E-Textile Electrodes Based on Contact Force and Perspiration

Biopotential electrodes play an integral role within smart wearables and clothing in capturing vital signals like electrocardiogram (ECG), electromyogram (EMG), and electroencephalogram (EEG). This study focuses on dry e-textile electrodes (E1-E6) and a laser-cut knit electrode (E7), to assess their impedance characteristics under varying contact forces and moisture conditions. Synthetic perspiration was applied using a moisture management tester and impedance was measured before and after exposure, followed by a 24 h controlled drying period. Concurrently, the signal-to-noise ratio (SNR) of the dry electrode was evaluated during ECG data collection on a healthy participant. Our findings revealed that, prior to moisture exposure, the impedance of electrodes E7, E5, and E2 was below 200 ohm, dropping to below 120 ohm post-exposure. Embroidered electrodes E6 and E4 exhibited an over 25% decrease in mean impedance after moisture exposure, indicating the impact of stitch design and moisture on impedance. Following the controlled drying, certain electrodes (E1, E2, E3, and E4) experienced an over 30% increase in mean impedance. Overall, knit electrode E7, and embroidered electrodes E2 and E6, demonstrated superior performance in terms of impedance, moisture retention, and ECG signal quality, revealing promising avenues for future biopotential electrode designs.

Soft Electronics for Health Monitoring Assisted by Machine Learning

Due to the development of the novel materials, the past two decades have witnessed the rapid advances of soft electronics. The soft electronics have huge potential in the physical sign monitoring and health care. One of the important advantages of soft electronics is forming good interface with skin, which can increase the user scale and improve the signal quality. Therefore, it is easy to build the specific dataset, which is important to improve the performance of machine learning algorithm. At the same time, with the assistance of machine learning algorithm, the soft electronics have become more and more intelligent to realize real-time analysis and diagnosis. The soft electronics and machining learning algorithms complement each other very well. It is indubitable that the soft electronics will bring us to a healthier and more intelligent world in the near future. Therefore, in this review, we will give a careful introduction about the new soft material, physiological signal detected by soft devices, and the soft devices assisted by machine learning algorithm. Some soft materials will be discussed such as two-dimensional material, carbon nanotube, nanowire, nanomesh, and hydrogel. Then, soft sensors will be discussed according to the physiological signal types (pulse, respiration, human motion, intraocular pressure, phonation, etc.). After that, the soft electronics assisted by various algorithms will be reviewed, including some classical algorithms and powerful neural network algorithms. Especially, the soft device assisted by neural network will be introduced carefully. Finally, the outlook, challenge, and conclusion of soft system powered by machine learning algorithm will be discussed.

Fully Screen-Printed PI/PEG Blends Enabled Patternable Electrodes for Scalable Manufacturing of Skin-Conformal, Stretchable, Wearable Electronics

Recent advances in soft materials and nano-microfabrication have enabled the development of flexible wearable electronics. At the same time, printing technologies have been demonstrated to be efficient and compatible with polymeric materials for manufacturing wearable electronics. However, wearable device manufacturing still counts on a costly, complex, multistep, and error-prone cleanroom process. Here, we present fully screen-printable, skin-conformal electrodes for low-cost and scalable manufacturing of wearable electronics. The screen printing of the polyimide (PI) layer enables facile, low-cost, scalable, high-throughput manufacturing. PI mixed with poly(ethylene glycol) exhibits a shear-thinning behavior, significantly improving the printability of PI. The premixed Ag/AgCl ink is then used for conductive layer printing. The serpentine pattern of the screen-printed electrode accommodates natural deformation under stretching (30%) and bending conditions (180°), which are verified by computational and experimental studies. Real-time wireless electrocardiogram monitoring is also successfully demonstrated using the printed electrodes with a flexible printed circuit. The algorithm developed in this study can calculate accurate heart rates, respiratory rates, and heart rate variability metrics for arrhythmia detection.

Identification of atrial fibrillation drivers by means of concentric ring electrodes

BACKGROUND AND OBJECTIVE

The prevalence of atrial fibrillation (AF) has tripled in the last 50 years due to population aging. High-frequency (DFdriver) activated atrial regions lead the activation of the rest of the atria, disrupting the propagation wavefront. Fourier based spectral analysis of body surface potential maps have been proposed for DFdriver identification, although these approaches present serious drawbacks due to their limited spectral resolution for short AF epochs and the blurring effect of the volume conductor. Laplacian signals (BC-ECG) from bipolar concentric ring electrodes (CRE) have been shown to outperform the spatial resolution achieved with conventional unipolar recordings. Our aimed was to determine the best DFdriver estimator in endocardial electrograms and to assess the BC-ECG capacity of CRE to quantify AF activity non-invasively.

METHODS

31 AF episodes were simulated using realistic tridimensional models of the atria electrical activity and torso. Periodogram and autoregressive (AR) spectral estimators were computed and the percentile (P90^th, P95^th and P98^th) to impose on the dominant frequencies (DFs) across whole atria to define the best DFdriver estimator evaluated. The identification of DFdriver on DFs from BC-ECG and unipolar surface signals with conventional disc electrodes was compared.

RESULTS

The best DFdriver estimator was P95^th and AR order 100. BC-ECG signals allowed better detection of AF activity than unipolar signals, with a significantly greater percentage of electrode locations in which DFdriver was identified (p-value 0.0095).

CONCLUSIONS

The use of BC-ECG signals for body surface Laplacian potential mapping with CRE could be helpful for better AF diagnosis, prognosis and ablation procedures than those with conventional disk electrodes.

Smart Electronic Textiles for Wearable Sensing and Display

Increasing demand of using everyday clothing in wearable sensing and display has synergistically advanced the field of electronic textiles, or e-textiles. A variety of types of e-textiles have been formed into stretchy fabrics in a manner that can maintain their intrinsic properties of stretchability, breathability, and wearability to fit comfortably across different sizes and shapes of the human body. These unique features have been leveraged to ensure accuracy in capturing physical, chemical, and electrophysiological signals from the skin under ambulatory conditions, while also displaying the sensing data or other immediate information in daily life. Here, we review the emerging trends and recent advances in e-textiles in wearable sensing and display, with a focus on their materials, constructions, and implementations. We also describe perspectives on the remaining challenges of e-textiles to guide future research directions toward wider adoption in practice.

Exploring textile-based electrode materials for electromyography smart garments

Introduction

In recent years, electromyography (EMG) has been increasingly studied for wearable applications. Conventional gel electrodes for electrophysiological recordings have limited use in everyday applications such as prosthetic control or muscular therapy at home. This study investigates the efficacy and feasibility of dry-contact electrode materials employed in smart textiles for EMG recordings.

Methods

Dry-contact electrode materials were selected and implemented on textile substrates. Using these electrodes, EMG was recorded from the forearm of able-bodied subjects. 25% and 50% isometric maximum voluntary contractions were captured. A comparative investigation was performed against gel electrodes, assessing the effect of material properties on signal fidelity and strength compared.

Results

When isolating for electrode surface area and pressure, 31 of the 40 materials demonstrated strong positive correlations in their mean PSD with gel electrodes (r > 95, p < 0.001). The inclusion of ionic liquids in the material composition, and using raised or flat electrodes, did not demonstrate a significant effect in signal quality.

Conclusions

For EMG dry-contact electrodes, comparing the performance against gel electrodes for the application with the selected material is important. Other factors recommended to be studied are electrodes’ durability and long-term stability.

Textile-Based Sensors for Biosignal Detection and Monitoring

Biosignals often have to be detected in sports or for medical reasons. Typical biosignals are pulse and ECG (electrocardiogram), breathing, blood pressure, skin temperature, oxygen saturation, bioimpedance, etc. Typically, scientists attempt to measure these biosignals noninvasively, i.e., with electrodes or other sensors, detecting electric signals, measuring optical or chemical information. While short-time measurements or monitoring of patients in a hospital can be performed by systems based on common rigid electrodes, usually containing a large amount of wiring, long-term measurements on mobile patients or athletes necessitate other equipment. Here, textile-based sensors and textile-integrated data connections are preferred to avoid skin irritations and other unnecessary limitations of the monitored person. In this review, we give an overview of recent progress in textile-based electrodes for electrical measurements and new developments in textile-based chemical and other sensors for detection and monitoring of biosignals.

Signal Quality Assessment of a Novel ECG Electrode for Motion Artifact Reduction

BACKGROUND

The presence of noise is problematic in the analysis and interpretation of the ECG, especially in ambulatory monitoring. Restricting the analysis to high-quality signal segments only comes with the risk of excluding significant arrhythmia episodes. Therefore, the development of novel electrode technology, robust to noise, continues to be warranted.

METHODS

The signal quality of a novel wet ECG electrode (Piotrode) is assessed and compared to a commercially available, commonly used electrode (Ambu). The assessment involves indices of QRS detection and atrial fibrillation detection performance, as well as signal quality indices (ensemble standard deviation and time-frequency repeatability), computed from ECGs recorded simultaneously from 20 healthy subjects performing everyday activities.

RESULTS

The QRS detection performance using the Piotrode was considerably better than when using the Ambu, especially for running but also for lighter activities. The two signal quality indices demonstrated similar trends: the gap in quality became increasingly larger as the subjects became increasingly more active.

CONCLUSIONS

The novel wet ECG electrode produces signals with less motion artifacts, thereby offering the potential to reduce the review burden, and accordingly the cost, associated with ambulatory monitoring.

Evaluation of dry textile electrodes for long-term electrocardiographic monitoring

Background

Continuous long-term electrocardiography monitoring has been increasingly recognized for early diagnosis and management of different types of cardiovascular diseases. To find an alternative to Ag/AgCl gel electrodes that are improper for this application scenario, many efforts have been undertaken to develop novel flexible dry textile electrodes integrated into the everyday garments. With significant progresses made to address the potential issues (e.g., low signal-to-noise ratio, high skin–electrode impedance, motion artifact, and low durability), the lack of standard evaluation procedure hinders the further development of dry electrodes (mainly the design and optimization).

Results

A standard testing procedure and framework for skin–electrode impedance measurement is demonstrated for the development of novel dry textile electrodes. Different representative electrode materials have been screen-printed on textile substrates. To verify the performance of dry textile electrodes, impedance measurements are conducted on an agar skin model using a universal setup with consistent frequency and pressure. In addition, they are demonstrated for ECG signals acquisition, in comparison to those obtained using conventional gel electrodes.

Conclusions

Dry textile electrodes demonstrated similar impedance when in raised or flat structures. The tested pressure variations had an insignificant impact on electrode impedance. Looking at the effect of impedance on ECG signals, a noticeable effect on ECG signal performance metrics was not observed. Therefore, it is suggested that impedance alone is possibly not the primary indicator of signal quality. As well, the developed methods can also serve as useful guidelines for future textile dry-electrode design and testing for practical ECG monitoring applications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12938-021-00905-4.

Nanomaterials-patterned flexible electrodes for wearable health monitoring: a review

ABSTRACT

Electrodes fabricated on a flexible substrate are a revolutionary development in wearable health monitoring due to their lightweight, breathability, comfort, and flexibility to conform to the curvilinear body shape. Different metallic thin-film and plastic-based substrates lack comfort for long-term monitoring applications. However, the insulating nature of different polymer, fiber, and textile substrates requires the deposition of conductive materials to render interactive functionality to substrates. Besides, the high porosity and flexibility of fiber and textile substrates pose a great challenge for the homogenous deposition of active materials. Printing is an excellent process to produce a flexible conductive textile electrode for wearable health monitoring applications due to its low cost and scalability. This article critically reviews the current state of the art of different textile architectures as a substrate for the deposition of conductive nanomaterials. Furthermore, recent progress in various printing processes of nanomaterials, challenges of printing nanomaterials on textiles, and their health monitoring applications are described systematically.

Evaluation of Swallowing Related Muscle Activity by Means of Concentric Ring Electrodes

Surface electromyography (sEMG) can be helpful for evaluating swallowing related muscle activity. Conventional recordings with disc electrodes suffer from significant crosstalk from adjacent muscles and electrode-to-muscle fiber orientation problems, while concentric ring electrodes (CREs) offer enhanced spatial selectivity and axial isotropy. The aim of this work was to evaluate CRE performance in sEMG recordings of the swallowing muscles. Bipolar recordings were taken from 21 healthy young volunteers when swallowing saliva, water and yogurt, first with a conventional disc and then with a CRE. The signals were characterized by the root-mean-square amplitude, signal-to-noise ratio, myopulse, zero-crossings, median frequency, bandwidth and bilateral muscle cross-correlations. The results showed that CREs have advantages in the sEMG analysis of swallowing muscles, including enhanced spatial selectivity and the associated reduction in crosstalk, the ability to pick up a wider range of EMG frequency components and easier electrode placement thanks to its radial symmetry. However, technical changes are recommended in the future to ensure that the lower CRE signal amplitude does not significantly affect its quality. CREs show great potential for improving the clinical monitoring and evaluation of swallowing muscle activity. Future work on pathological subjects will assess the possible advantages of CREs in dysphagia monitoring and diagnosis.

Evaluation of Bipolar, Tripolar, and Quadripolar Laplacian Estimates of Electrocardiogram via Concentric Ring Electrodes

Surface Laplacian estimates via concentric ring electrodes (CREs) have proven to enhance spatial resolution compared to conventional disc electrodes, which is of great importance for P-wave analysis. In this study, Laplacian estimates for traditional bipolar configuration (BC), two tripolar configurations with linearly decreasing and increasing inter-ring distances (TC_LDIRD and TC_LIIRD, respectively), and quadripolar configuration (QC) were obtained from cardiac recordings with pentapolar CREs placed at CMV1 and CMV2 positions. Normalized P-wave amplitude (NAP) was computed to assess the contrast to study atrial activity. Signals were of good quality (20-30 dB). Atrial activity was more emphasized at CMV1 (NAP ≃ 0.19-0.24) compared to CMV2 (NAP ≃ 0.08-0.10). Enhanced spatial resolution of TC_LIIRD and QC resulted in higher NAP values than BC and TC_LDIRD. Comparison with simultaneous standard 12-lead ECG proved that Laplacian estimates at CMV1 outperformed all the limb and chest standard leads in the contrast to study P-waves. Clinical recordings with CRE at this position could allow more detailed observation of atrial activity and facilitate the diagnosis of associated pathologies. Furthermore, such recordings would not require additional electrodes on limbs and could be performed wirelessly, so it should also be suitable for ambulatory monitoring, for example, using cardiac Holter monitors.

Ambulatory Evaluation of ECG Signals Obtained Using Washable Textile-Based Electrodes Made with Chemically Modified PEDOT:PSS

A development of washable PEDOT:PSS (poly(3,4-ethylenedioxythiophene) polystyrene sulfonate) polyamide textile-based electrodes is an interesting alternative to the traditional Ag/AgCl disposable electrodes, usually used in clinical practice, helping to improve medical assessment and treatment before apparition or progress of patients’ cardiovascular symptoms. This study was conducted in order to determine whether physical properties of PEDOT:PSS had a significant impact on the coated electrode’s electrocardiogram (ECG) signal quality, particularly after 50 washing cycles in a domestic laundry machine. Tests performed, included the comparison of two PEDOT:PSS solutions, in term of viscosity with emphasis on wetting tests, including surface tension and contact angle measurements. In addition, polyamide textile fabrics were used as substrate to make thirty electrodes and to characterize the amount of PEDOT:PSS absorbed as a function of time. The results showed that surface tension of PEDOT:PSS had a significant impact on the wetting of polyamide textile fabric and consequently on the absorbed amount. In fact, lower values of surface tension of the solution lead to low values contact angles between PEDOT:PSS and textile fabric (good wettability). Before washing, no significant difference has been observed among signal-to-noise ratios measured (SNR) for coated electrodes by the two PEDOT:PSS solutions. However, after 50 washing cycles, SNR decreased strongly for electrodes coated by the solution that had low viscosity, since it contained less solid contents. That was confirmed by scanning electron microscopy images (SEM) and also by analyzing the color change of electrodes based on the calculation of CIELAB color space coordinates. Moreover, spectral power density of recorded ECG signals has been computed and presented. All cardiac waves were still visible in the ECG signals after 50 washing cycles. Furthermore, an experienced cardiologist considered that all the ECG signals acquired were acceptable. Accordingly, our newly developed polyamide textile-based electrodes seem to be suitable for long-term monitoring. The study also provided new insights into the better choice of PEDOT:PSS formulation as a function of a specific process in order to manufacture cheaper electrodes faster.

[Research progress on fabric electrode technologies for electrocardiogram signal acquisition]

In recent years, wearable devices grew up gradually and developed increasingly. Aiming at the problems of skin sensibility and the change of electrode impedance of Ag/AgCl electrode in the process of long-term electrocardiogram (ECG) signal monitoring and acquisition, this paper discussed in detail a new sensor technology-fabric electrode, which is used for ECG signal acquisition. First, the concept and advantages of fabric electrode were introduced, and then the common substrate materials and conductive materials for fabric electrode were discussed and evaluated. Next, we analyzed the advantages and disadvantages from the aspect of textile structure, putting forward the evaluation system of fabric electrode. Finally, the deficiencies of fabric electrode were analyzed, and the development prospects and directions were prospected.