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

Eco-Friendly Conductive Hydrogels: Towards Green Wearable Electronics

The rapid advancement of wearable electronics has catalyzed the development of flexible, lightweight, and highly conductive materials. Among these, conductive hydrogels have emerged as promising candidates due to their tissue-like properties, which can minimize the mechanical mismatch between flexible devices and biological tissues and excellent electrical conductivity, stretchability and biocompatibility. However, the environmental impact of synthetic components and production processes in conventional conductive hydrogels poses significant challenges to their sustainable application. This review explores recent advances in eco-friendly conductive hydrogels used in healthcare, focusing on their design, fabrication, and applications in green wearable electronics. Emphasis is placed on the use of natural polymers, bio-based crosslinkers, and green synthesis methods to improve sustainability while maintaining high performance. We discuss the incorporation of conductive polymers and carbon-based nanomaterials into environmentally benign matrices. Additionally, the article highlights strategies for improving the biodegradability, recyclability, and energy efficiency of these materials. By addressing current limitations and future opportunities, this review aims to provide a comprehensive understanding of environmentally friendly conductive hydrogels as a basis for the next generation of sustainable wearable technologies.

Comfort, consistency, and efficiency of garments with textile electrodes versus hydrogel electrodes for neuromuscular electrical stimulation in a randomized crossover trial

The efficacy and comfort of neuromuscular electrical stimulation (NMES) largely depend on the type of electrodes used. Traditional self-adhesive hydrogel electrodes, while effective, pose limitations in terms of wearability, skin compatibility, and reusability. This randomized crossover trial investigates the performance of a specific textile electrode integrated into garments for NMES of lower extremities, focusing on their potential rehabilitative applications for patients with neurological disorders such as stroke, multiple sclerosis (MS), and spinal cord injury (SCI). In this randomized crossover design, ten healthy subjects participated in the study. Each subject performed isometric knee extension exercises using both textile and hydrogel electrodes in random order. The electrodes were compared in terms of comfort, temporal consistency, stimulation efficiency, and electrical impedance under isometric conditions. Our findings revealed no significant difference between the two types of electrodes across all evaluated parameters. Textile electrodes, used after applying moisturizing lotion to enhance the electrode-skin interface, demonstrated comparable levels of comfort, consistency, and efficiency to hydrogel electrodes. The equivalence of textile and hydrogel electrodes, coupled with the advantages of washability and reusability, positions textile electrodes as a promising alternative for NMES applications, particularly in rehabilitation settings.

Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging

BACKGROUND

Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo.

METHODS

CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests.

RESULTS

77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively).

CONCLUSION

Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification.

CLINICAL TRIAL REGISTRATION

Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.

Investigation of Electrical and Wearing Properties of Wool Fabric Coated with PEDOT:PSS

The way to improve the properties (resistance to washing, delamination, and rubbing off) of the PEDOT:PSS coating applied on wool fabric without reduction of its electrical conductivity by introducing a commercially available combination of low formaldehyde content melamine resins into the printing paste is presented in this paper. Primarily, to improve the hydrophilicity and dyeability of wool fabric, the samples were modified using low-pressure nitrogen (N₂) gas plasma. Two commercially available PEDOT:PSS dispersions were used to treat wool fabric by the exhaust dyeing and screen printing methods, respectively. Spectrophotometric measurements of the color difference (ΔE*_ab) and visual evaluation of woolen fabric dyed and printed with PEDOT:PSS in different shades of the blue color showed that the sample modified with N₂ plasma obtained a more intense color compared to the unmodified one. SEM was used to examine the surface morphology and a cross-sectional view of wool fabric that had undergone various modifications. SEM image shows that the dye penetrates deeper into the wool fabric after plasma modification using dyeing and coating methods with a PEDOT:PSS polymer. In addition, with a Tubicoat fixing agent, HT coating looks more homogeneous and uniform. The chemical structure spectra of wool fabrics coated with PEDOT:PSS were investigated using FTIR-ATR characterization. The influence of melamine formaldehyde resins on the electrical properties, resistance to washing, and mechanical effects of PEDOT:PSS treated wool fabric was also evaluated. The resistivity measurement of the samples containing melamine-formaldehyde resins as an additive did not show a significant decrease in electrical conductivity, while the electrical conductivity was maintained after the washing and rubbing test as well. The best results of electrical conductivity for investigated wool fabrics before and after washing and mechanical action were determined for samples subjected to the combined processing-surface modification by low-pressure N₂ plasma, dyeing by exhaust with PEDOT:PSS, and coating by the screen-printing method of PEDOT:PSS and a 3 wt.% melamine formaldehyde resins mixture.

Washable PEDOT:PSS Coated Polyester with Submicron Sized Fibers for Wearable Technologies

The use of non-metallic conductive yarns in wearable technologies like smart textiles requires compliant washable fibers that can withstand domestic washing without losing their conductive properties. A one-pot coating with PEDOT:PSS conductive polymers was applied to polyester submicron fibers, increasing the water resistance and washability under various domestic washing conditions. Plasma treatment of the untreated samples improved the anchoring of the coating to the fibers, producing smooth and homogeneous coatings. The primary doping of PEDOT:PSS with ethylene glycol (EG), dimethyl sulfoxide (DMSO), and a non-ionic surfactant as well as the secondary doping of the composite fibers improved the sheet resistance at room temperature. The as-obtained composite materials showed similar mechanical properties as the parent fibers, indicating that the coating and post-treatment do not affect the overall mechanical property of the composite. The performance of the composites under different temperature and humidity conditions and washability using the standardized ISO 6330:2012 procedure for domestic washing and drying showed that the obtained composites are good candidates for reliable washable wearable technologies, such as all-organic washable Joule heaters in functional textiles.

ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patients : In collaboration with the Council on Stroke, the European Heart Rhythm Association, and the Digital Health Committee

The role of subclinical atrial fibrillation as a cause of cryptogenic stroke is unambiguously established. Long-term electrocardiogram (ECG) monitoring remains the sole method for determining its presence following a negative initial workup. This position paper of the European Society of Cardiology Working Group on e-Cardiology first presents the definition, epidemiology, and clinical impact of cryptogenic ischaemic stroke, as well as its aetiopathogenic association with occult atrial fibrillation. Then, classification methods for ischaemic stroke will be discussed, along with their value in providing meaningful guidance for further diagnostic efforts, given disappointing findings of studies based on the embolic stroke of unknown significance construct. Patient selection criteria for long-term ECG monitoring, crucial for determining pre-test probability of subclinical atrial fibrillation, will also be discussed. Subsequently, the two major classes of long-term ECG monitoring tools (non-invasive and invasive) will be presented, with a discussion of each method's pitfalls and related algorithms to improve diagnostic yield and accuracy. Although novel mobile health (mHealth) devices, including smartphones and smartwatches, have dramatically increased atrial fibrillation detection post ischaemic stroke, the latest evidence appears to favour implantable cardiac monitors as the modality of choice; however, the answer to whether they should constitute the initial diagnostic choice for all cryptogenic stroke patients remains elusive. Finally, institutional and organizational issues, such as reimbursement, responsibility for patient management, data ownership, and handling will be briefly touched upon, despite the fact that guidance remains scarce and widespread clinical application and experience are the most likely sources for definite answers.

Drawn-on-Skin Sensors from Fully Biocompatible Inks toward High-Quality Electrophysiology

The need to develop wearable devices for personal health monitoring, diagnostics, and therapy has inspired the production of innovative on-demand, customizable technologies. Several of these technologies enable printing of raw electronic materials directly onto biological organs and tissues. However, few of them have been thoroughly investigated for biocompatibility of the raw materials on the cellular, tissue, and organ levels or with different cell types. In addition, highly accurate multiday in vivo monitoring using such on-demand, in situ fabricated devices has yet to be done. Presented herein is the first fully biocompatible, on-skin fabricated electronics for multiple cell types and tissues that can capture electrophysiological signals with high fidelity. While also demonstrating improved mechanical and electrical properties, the drawn-on-skin ink retains its properties under various writing conditions, which minimizes the variation in electrical performance. Furthermore, the drawn-on-skin ink shows excellent biocompatibility with cardiomyocytes, neurons, mice skin tissue, and human skin. The high signal-to-noise ratios of the electrophysiological signals recorded with the DoS sensor over multiple days demonstrate its potential for personalized, long-term, and accurate electrophysiological health monitoring.

Advances in the Robustness of Wearable Electronic Textiles: Strategies, Stability, Washability and Perspective

Flexible electronic textiles are the future of wearable technology with a diverse application potential inspired by the Internet of Things (IoT) to improve all aspects of wearer life by replacing traditional bulky, rigid, and uncomfortable wearable electronics. The inherently prominent characteristics exhibited by textile substrates make them ideal candidates for designing user-friendly wearable electronic textiles for high-end variant applications. Textile substrates (fiber, yarn, fabric, and garment) combined with nanostructured electroactive materials provide a universal pathway for the researcher to construct advanced wearable electronics compatible with the human body and other circumstances. However, e-textiles are found to be vulnerable to physical deformation induced during repeated wash and wear. Thus, e-textiles need to be robust enough to withstand such challenges involved in designing a reliable product and require more attention for substantial advancement in stability and washability. As a step toward reliable devices, we present this comprehensive review of the state-of-the-art advances in substrate geometries, modification, fabrication, and standardized washing strategies to predict a roadmap toward sustainability. Furthermore, current challenges, opportunities, and future aspects of durable e-textiles development are envisioned to provide a conclusive pathway for researchers to conduct advanced studies.

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.

Smart E-Textile Systems: A Review for Healthcare Applications

E-textiles is a new hybrid field developed with the help of the integration of electronic components into our daily usage of textile products. These wearable e-textiles provide user-defined applications as well as normal textile clothing. The medical field is one of the major leading areas where these new hybrid products are being implemented, and relatively mature products can be observed in the laboratory as well as in commercial markets. These products are developed for continuous patient monitoring in large-scale hospital centers as well as for customized patient requirements. Meanwhile, these products are also being used for complex medical treatments and the replacement of conventional methods. This review manuscript contains a basic overview of e-textile systems, their components, applications, and usages in the field of medical innovations. E-textile systems, integrated into customized products for medical needs, are discussed with their proposed properties and limitations. Finally, some recommendations to enhance the e-textile system’s integration into the medical field are argued.

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.

The Effect of Sleeve Pattern and Fit on E-Textile Electromyography (EMG) Electrode Performance in Smart Clothing Design

When e-textile EMG electrodes are integrated into clothing, the fit of the clothing on the body, and therefore its pattern and cut become important factors affecting the EMG signal quality in relation to the seamless contact between the skin and the e-textile electrode. The research so far on these effects was conducted on commercially available clothing or in tubular sleeve forms for arms. There is no study that investigated different clothing pattern and fit conditions and their effect on e-textile EMG electrode performance. This study investigates the effect of clothing pattern and fit in EMG applications using e-textile electrodes integrated onto the sleeves of custom drafted t-shirts in set-in and raglan sleeve pattern variations. E-textile electrode resistance, signal-to-noise ratio (SNRdB), power spectral density and electrode–skin impedance are measured and evaluated in set-in sleeve and raglan sleeve conditions with participants during a standardized arm movement protocol in comparison to the conventional hydrogel Ag/AgCl electrodes. The raglan sleeve pattern, widely used in athletic wear to provide extra ease for the movement of the shoulder joint, showed superior performance and therefore indicated the pattern and cut of a garment could have significant effect on EMG signal quality in designing smart clothing.

Wearable Smart Textiles for Long-Term Electrocardiography Monitoring-A Review

The continuous and long-term measurement and monitoring of physiological signals such as electrocardiography (ECG) are very important for the early detection and treatment of heart disorders at an early stage prior to a serious condition occurring. The increasing demand for the continuous monitoring of the ECG signal needs the rapid development of wearable electronic technology. During wearable ECG monitoring, the electrodes are the main components that affect the signal quality and comfort of the user. This review assesses the application of textile electrodes for ECG monitoring from the fundamentals to the latest developments and prospects for their future fate. The fabrication techniques of textile electrodes and their performance in terms of skin–electrode contact impedance, motion artifacts and signal quality are also reviewed and discussed. Textile electrodes can be fabricated by integrating thin metal fiber during the manufacturing stage of textile products or by coating textiles with conductive materials like metal inks, carbon materials, or conductive polymers. The review also discusses how textile electrodes for ECG function via direct skin contact or via a non-contact capacitive coupling. Finally, the current intensive and promising research towards finding textile-based ECG electrodes with better comfort and signal quality in the fields of textile, material, medical and electrical engineering are presented as a perspective.

Integration of Conductive Materials with Textile Structures, an Overview

In the last three decades, the development of new kinds of textiles, so-called smart and interactive textiles, has continued unabated. Smart textile materials and their applications are set to drastically boom as the demand for these textiles has been increasing by the emergence of new fibers, new fabrics, and innovative processing technologies. Moreover, people are eagerly demanding washable, flexible, lightweight, and robust e-textiles. These features depend on the properties of the starting material, the post-treatment, and the integration techniques. In this work, a comprehensive review has been conducted on the integration techniques of conductive materials in and onto a textile structure. The review showed that an e-textile can be developed by applying a conductive component on the surface of a textile substrate via plating, printing, coating, and other surface techniques, or by producing a textile substrate from metals and inherently conductive polymers via the creation of fibers and construction of yarns and fabrics with these. In addition, conductive filament fibers or yarns can be also integrated into conventional textile substrates during the fabrication like braiding, weaving, and knitting or as a post-fabrication of the textile fabric via embroidering. Additionally, layer-by-layer 3D printing of the entire smart textile components is possible, and the concept of 4D could play a significant role in advancing the status of smart textiles to a new level.

Futuristic Clothes: Electronic Textiles and Wearable Technologies

This review summarizes the recent developments and importance of wearable electronic textiles in the past decade. Wearable electronic textiles are an emerging interdisciplinary research area that requires new design approaches. This challenging interdisciplinary research field brings together specialists in electronics, information technology, microsystems, and textiles to make an innovation in the development of wearable electronic products. Wearable electronic textiles play a key role among various technologies (clothing, communication, information, healthcare monitoring, military, sensors, magnetic shielding, etc.). In this review, applications of wearable electronic textiles are described, including an investigation of their fabrication techniques. This review highlights the basic processes, possible applications, and main materials to build wearable E-textiles and combines the fundamentals of E-textiles for the readers who have different backgrounds. Moreover, reliability, reusability, and efficiency of wearable electronic textiles are discussed together with the opportunities and drawbacks of the wearable E-textiles that are addressed in this review article.

PEDOT:PSS-Based Conductive Textiles and Their Applications

The conductive polymer complex poly (3,4-ethylene dioxythiophene):polystyrene sulfonate (PEDOT:PSS) is the most explored conductive polymer for conductive textiles applications. Since PEDOT:PSS is readily available in water dispersion form, it is convenient for roll-to-roll processing which is compatible with the current textile processing applications. In this work, we have made a comprehensive review on the PEDOT:PSS-based conductive textiles, methods of application onto textiles and their applications. The conductivity of PEDOT:PSS can be enhanced by several orders of magnitude using processing agents. However, neat PEDOT:PSS lacks flexibility and strechability for wearable electronics applications. One way to improve the mechanical flexibility of conductive polymers is making a composite with commodity polymers such as polyurethane which have high flexibility and stretchability. The conductive polymer composites also increase attachment of the conductive polymer to the textile, thereby increasing durability to washing and mechanical actions. Pure PEDOT:PSS conductive fibers have been produced by solution spinning or electrospinning methods. Application of PEDOT:PSS can be carried out by polymerization of the monomer on the fabric, coating/dyeing and printing methods. PEDOT:PSS-based conductive textiles have been used for the development of sensors, actuators, antenna, interconnections, energy harvesting, and storage devices. In this review, the application methods of PEDOT:SS-based conductive polymers in/on to a textile substrate structure and their application thereof are discussed.

Understanding the Washing Damage to Textile ECG Dry Skin Electrodes, Embroidered and Fabric-Based; set up of Equivalent Laboratory Tests

Reliability and washability are major hurdles facing the e-textile industry nowadays. The main fear behind the product's rejection is the inability to ensure its projected life span. The durability of e-textiles is based on an approximate lifetime of both the electronics and textiles integrated into the product. A detailed analysis of the wash process and the possibility of predicting product behavior are key factors for new standards implementation. This manuscript is focused on the washability issues of different types of woven, knitted, and embroidered, textile-based ECG electrodes. These electrodes are used without the addition of any ionic gel to the skin to reduce impedance. They were subjected to up to 50 wash cycles with two different types of wash processes, and changes in surface resistance, as well as the quality of ECG waves, were observed To investigate the wash damages in detail, the proposed mechanical (Martindale and Pilling box) and chemical test methods were investigated. The electrodes which increased resistance after washing showed the same trend in the proposed test methods. Copper-based electrodes suffered the most severe damage and increased resistance, as was also visible in an SEM analysis. These proposed test methods can be used to predict robustness behavior without washing.

Fabrics and Garments as Sensors: A Research Update

Properties critical to the structure of apparel and apparel fabrics (thermal and moisture transfer, elasticity, and flexural rigidity), those related to performance (durability to abrasion, cleaning, and storage), and environmental effects have not been consistently addressed in the research on fabric sensors designed to interact with the human body. These fabric properties need to be acceptable for functionalized fabrics to be effectively used in apparel. Measures of performance such as electrical conductivity, impedance, and/or capacitance have been quantified. That the apparel/human body system involves continuous transient conditions needs to be taken into account when considering performance. This review highlights gaps concerning fabric-related aspects for functionalized apparel and includes information on increasing the inclusion of such aspects. A multidisciplinary approach including experts in chemistry, electronics, textiles, and standard test methods, and the intended end use is key to widespread development and adoption.