title: Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study.
abstract: BACKGROUND
  12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care.
  
  
  OBJECTIVE
  To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG.
  
  
  METHODS
  6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory.
  
  
  RESULTS
  The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL.
  
  
  CONCLUSIONS
  Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology.
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT; The University of Utah, Department of Internal Medicine, Salt Lake City, UT.
authors.forename: Joseph Boone
authors.initials: JB
authors.lastname: Muhlestein
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT.
authors.forename: Viet
authors.initials: V
authors.lastname: Le
authors.affiliation: AliveCor™ Corporation, San Francisco, CA.
authors.forename: David
authors.initials: D
authors.lastname: Albert
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT.
authors.forename: Fidela Ll
authors.initials: FL
authors.lastname: Moreno
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT; The University of Utah, Department of Internal Medicine, Salt Lake City, UT.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT; The University of Utah, Department of Internal Medicine, Salt Lake City, UT.
authors.forename: Frank
authors.initials: F
authors.lastname: Yanowitz
authors.affiliation: Mary Washington Hospital, Fredericksburg, VA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Vranian
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Barsness
authors.affiliation: Integris Heart Hospital, Oklahoma City, OK.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bethea
authors.affiliation: Erlanger Institute for Clinical Research, UT College of Medicine, Chattanooga, TN.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Severance
authors.affiliation: New Mexico Heart Institute, Albuquerque, NM.
authors.forename: Barry
authors.initials: B
authors.lastname: Ramo
authors.affiliation: Duke University, Durham, NC.
authors.forename: John
authors.initials: J
authors.lastname: Pierce
authors.affiliation: Buenos Aires, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Barbagelata
authors.affiliation: Intermountain Heart Institute, Salt Lake City, UT; The University of Utah, Department of Internal Medicine, Salt Lake City, UT. Electronic address: brent.muhlestein@imail.org.
authors.forename: Joseph Brent
authors.initials: JB
authors.lastname: Muhlestein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040421:Cell Phone; D004562:Electrocardiography / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D010865:Pilot Projects
keywords: ECG; Heart attack; Ischemia; Myocardial infarction; STEMI; Smartphone; iPhone