Optimized Synthesis of 12-Lead ECG from Bipolar Torso Leads

Synthesizing a 12-lead electrocardiogram (ECG) from non-standard lead systems is increasingly relevant due to the widespread use of wearable ECG devices. This study investigates the synthesis of a 12-lead ECG using three bipolar leads derived from a 35-electrode multi-lead ECG (MECG) system, with a focus on optimizing electrode placement and transformation accuracy. A dataset comprising recordings from 20 healthy volunteers and 27 cardiac surgery patients was analyzed. The best three-lead combinations were identified using an exhaustive search approach, maximizing the minimum correlation coefficient between synthesized and target leads. Two synthesis approaches were evaluated: a universal approach, using a single transformation matrix for all subjects, and a combined approach, which incorporates personalized transformation matrices. Results indicate that only a small subset of lead combinations yield high-quality ECG synthesis, but sufficient flexibility exists for practical applications. The combined approach significantly outperforms the universal method, achieving higher correlation coefficients, improved STsegment accuracy, and better myocardial ischemia detection performance. These findings demonstrate the feasibility of optimizing lead selection for wearable ECG devices, enhancing diagnostic reliability while maintaining ergonomic and practical considerations.