Finger-to-Ear ECG: Systematic Evaluation of an Earbud-Based Cardiac Monitoring Approach

Ear-ECG enables unobtrusive cardiac monitoring, but existing approaches often struggle with low signal amplitudes and limited morphology preservation. We evaluate a finger-to-ear ECG paradigm that combines an in-ear electrode with a rear housing finger-contact electrode in a speaker-equipped earbud. A study with 30 participants investigated four finger-to-ear electrode geometries against chest-reference ECG and additionally assessed robustness under music playback, talking, and walking disturbances. Left-finger configurations achieved R peak detection F1-scores >99% with high agreement of key ECG morphology features. In contrast, right finger configurations as well as walking led to severe signal degradation. The results reveal a trade-off: while cross-body setups provided the highest signal fidelity, users preferred same-side contacts for comfort reasons. This establishes finger-to-ear ECG as a robust, morphology-aware paradigm for opportunistic sensing in earables.