ISSC 2010, UCC, June 23-24

A Low-Power Wireless ECG Processing Node and

Remote Monitoring System
(RLQ2&RQQHOO, SeQ2&RQQHOO
Robert P. McEvoy and William P. Marnane*
Department of Electrical and Electronic Engineering,
University College Cork, Ireland
E-mail: robertmce@eleceng.ucc.ie, *liam@eleceng.ucc.ie
_______________________________________________________________________________
AbstractThe Electrocardiogram (ECG) is an important physiological measurement that is
critical in the diagnosis of many cardiac disorders. In this paper, the design of a wireless
system for ambulatory ECG acquisition and analysis is discussed. The wireless ECG node
can operate in one of two configurations, where (i) raw ECG data is continuously
transmitted to a base station, or (ii) the Heart Rate (HR) is calculated on the node, and only
HR data is transmitted. The power requirements of the wireless node are also analysed.
Furthermore, the system design includes a complementary base station node, which can be
attached via USB WR WKH SDWLHQWV 3& 7KH V\VWHP EDFN-end is also presented, whereby
SDWLHQWGDWDLVXSORDGHGWRDUHPRWHVHUYHUDQGFDQEHDFFHVVHGE\WKHSDWLHQWVKHDOWKFDUH
team via a secure website.
Keywords Low-power biomedical signal processing, Electrocardiogram, Heart Rate Variability

_______________________________________________________________________________

I. INTRODUCTION
The Electrocardiogram (ECG) is a recording of
the electrical activity of the heart, produced as a
result of the cardiac cycle. ECG recordings are well
understood, and have been used in healthcare
diagnosis for more than 120 years [1]. In hospitalbased monitoring, twelve or more electrodes are
usually appliHG WR D SDWLHQWV FKHVW WR REWDLQ D
GHWDLOHG UHDGLQJ RI WKH SDWLHQWV FDUGLDF DFWLYLW\
However, such systems are not suitable for longterm, ambulatory patient monitoring, due to the
number of wires involved, and the difficulty and
discomfort of maintaining a large number of
electrodes in the correct positions on the chest. In
such cases, ambulatory ECG monitors, using fewer
electrodes, are preferable [2].
This paper describes the development of a small
form factor, low-power node for single-channel ECG
signal processing. In addition to ECG acquisition and
transmission, the node also has the capability to carry
out signal processing on the ECG signal, such as
Heart Rate (HR) calculations. Since the node is
designed to be battery-operated, and worn as part of
an ECG sHQVRU RQ D SDWLHQWV FKHVW ORZ-power
design techniques were employed throughout.
Additionally, the design of a base station and PC
interface are presented, which receive ECG data and
related signals from the wireless node. Finally, a

third part of the system comprises a web interface

running on a remote server, which allows a SDWLHQWV
healthcare team to close the loop and monitor the
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The work described in this paper was carried out as
part of a final year project for the BE Honours
Degree in Electrical and Electronic Engineering at
University College Cork.
The rest of this paper is organised as follows.
Section II provides a brief overview of the
Electrocardiogram, and its use in healthcare. The
components and processing algorithm of the wireless
ECG node are presented in Sections III and IV, and
the design of its complementary base station node is
described in Section V. The back-end of the system,
including the patient-physician remote web-based
interface, is discussed in Section VI. Section VII
concludes the paper.

II. THE ELECTROCARDIOGRAM

The heart is a muscular organ, responsible for
pumping blood around the human body. The actions
of the heart are controlled by the sinoatrial node,
which is a cluster of nerves located near the heart
wall. The sinoatrial node uses an electrical impulse
to trigger a heart beat, and can be thought of as an
impulse to a control system. The electrical response
to this impulse can be sensed using skin electrodes
SODFHG RQ D SHUVRQV FKHVW SURGXFLQJ DQ

Figure 1: Typical Electrocardiogram trace.

Electrocardiogram (ECG). A typical, noise-free ECG

trace is shown in Figure 1. Each section of the trace
is related to depolarization and repolarisation of the
chambers (atria and ventricles) within the heart.
An ECG trace usually comprises several
characteristic waves, labelled PU in Figure 1, which
correspond to distinctive actions within the cardiac
cycle. P-waves correspond to atrial depolarisation,
i.e. contraction of the muscles in the right and left
atria (upper chambers), which pump blood into the
ventricles (lower chambers). The QRS complex
corresponds to ventricular depolarisation, i.e.
contraction of the ventricles, whereby blood is
pumped out of the heart to the lungs and to the rest
of the body. Ventricular repolarisation is represented
by the T-wave on an ECG, and a U-wave may also
sometimes be present, representing a late
repolarisation of some of the fibres in the ventricles.
The duration and shape of the various waves
within the ECG trace are of interest to clinicians, and
can be used to aid with the diagnosis of medical
conditions. For example, a shortened QT interval can
indicate hypercalcaemia (elevated levels of calcium
in the blood). In the system described in this paper,
an ECG trace from a single channel is captured and
processed using a wireless processing node. While
single-channel ECG does not provide all the
information of a full 12-lead monitor, it can be used
to derive useful clinical information such as Heart
Rate (HR) and Heart Rate Variability (HRV).

III. WIRELESS ECG PROCESSING NODE

a) Related Work
Wireless ECG sensors for ambulatory health
monitoring have been commercially available for
several years. Recent trends in the design of such
systems have been towards small, light-weight
devices that can be non-invasively worn under
clothing. Many of these devices use wireless
protocols such as Bluetooth to communicate ECG or
related signals back to a base station [3]. The
development of portable heart rate monitors has also
been driven by companies in the sports and fitness
industry, e.g. [4]. A key requirement in the design of
such battery-powered devices is that the system
power consumption be kept to a minimum, to allow a

Figure 2: Block diagram and photograph of wireless

ECG node.

prolonged battery lifetime [5]. Typically, most of the

power in such systems is consumed by the radio
when transmitting raw ECG data to the base station.
Therefore, many systems adopt the philosophy of
LQWHOOLJHQFH-at-the-VHQVRU ZKHUHE\ IHDWXUHV RI
interest (such as HR) are extracted using a
microprocessor, and these low-bitrate features are
transmitted in place of the high-bitrate ECG data [6].
In this paper, the power consumption associated with
both approaches is investigated. A block diagram
and photograph of the node that was designed is
illustrated in Figure 2.
b) Node front-end
For this project, it was assumed that the ECG
signal has already been sensed using a skin electrode
DWWDFKHGWRDSDWLHQWVFKHVWDQGDVXLWDEOHXOWUD-lowpower biopotential amplifier, e.g. [7]. For testing
purposes, synthetic ECG signals were generated
using LabVIEW and the National Instruments
Biomedical Startup Kit 2.0, and digital-to-analog
conversion was performed using a 16-bit NI USB9263 Analog Output module. The LabVIEW GUI
allowed generation of a wide range of test ECG
signals with varying characteristics, such as heart
rate, amplitude, DC offset, and varying levels of 50
Hz noise and white noise. The single-channel ECG is
then pre-filtered on board the wireless node, prior to
sampling by the PIC24 microprocessor.
b) PIC24 Microcontroller
Several microcontrollers were investigated for
use on the wireless node, and these are compared in
Table I. The Flexipanel Toothpick 2.1 [8] has an
integrated Bluetooth radio, which would remove the
need for a separate transceiver. However, Bluetooth
is a relatively high-power transmission protocol;

TABLE I
COMPARISON OF MICROCONTROLLERS

TABLE II
COMPARISON OF TRANSCEIVERS

Microcontroller

Toothpick

MSP430

PIC24F

Transceiver

Supply Voltage
(V)

5.0

3.0 3.6

1.8 3.3

8-bit

16-bit

16-bit

88-bit

16-bit

1717-bit

3.5

1.5

24

16

32

Architecture
HW Multipliers
RAM (kB)
Clock Frequency
(MHz)
Current @ 16
MIPS
Low Current
Modes
Current in Deep
Sleep Mode

5 mA

8 mA

No

Yes

Yes

N/A

700 nA

20 nA

therefore, the Toothpick was not considered to be a

viable option. Both the Texas Instruments MSP430
[9] and Microchip PIC24F [10] boast 16-bit
architectures and hardware mathematical operations,
features which are of interest for the digital signal
processing that will be applied to the ECG signal.
However, the power modes offered by the PIC24F
are greater in variety and better in performance than
the MSP430. For example, with peripherals disabled,
the idle current for the PIC24F can be as little as 8
$LQUXQPRGH$LQLGOHPRGHDQGMXVWQ$LQ
deep sleep mode. For these reasons, the
PIC24F16KA101 microcontroller was chosen for use
in this work.
c) Si4420 Transceiver
A number of different transceivers were also
investigated for use in the wireless node; these are
compared in Table II. As noted above, the Toothpick
was deemed unsuitable due to its high current
consumption. The Texas Instruments CC2500
transceiver has lower power consumption; however,
its range is limited as it does not have an external
antenna [11]. A more suitable transceiver was found
in the Silicon Labs Si4420 (packaged as the HopeRF
RFM12 868B), which has lower power consumption
than the CC2550, and offers 300 metres (line of
sight) range at its -3 dBm power setting [12].
Configuration of the transceiver requires twelve
configuration registers to be programmed, which is
performed over a SPI interface with the PIC24F.
d) Node Operation Search Mode
Upon power-up, the PIC24F microcontroller
configures the Si4420 transceiver to transmit using
FSK at 868 MHz, and at a data-rate of 70 kbps. The
device then enters a Search mode, whereby the
wireless node will only broadcast ECG data if a base
station has been detected. The Si4420 has a built-in
wake-up timer that is used to keep both itself and the
PIC24F in sleep mode for 3 seconds. After 3 seconds
have elapsed, the Si4420 issues an interrupt to wake

Toothpick

CC2500

Si4420

Tx Current (mA)

30

20

18

Rx Current (mA)

40

18

14

Sleep Current

400 nA

< 300 nA

Range (m)

100

300

Frequency

2.4 GHz

2.4 GHz

868 MHz

1 Mbps

500 kbps
max

115 kpbs

Data Rate

TABLE III
POWER CONSUMPTION OF ECG NODE (SEARCH MODE)
Mode

Duration

Average
Current

Average
Power*

Average
Energy

Sleep

3s

1.8 $

4.5 :

13.5 -

1.5 ms

27 mA

67.5 mW

101.25 -

50 s

25 mA

62.5 mW

3.125 -

3.00155
s

15.71 $

39.27 :

117.875
-

Send
Packet
Listen
for Ack.
Total per
search
cycle

*assumes an average battery voltage of 2.5 V.

the microcontroller from sleep. The PIC24F (running

at 16 MIPS) then wakes the transceiver, and briefly
transmits a packet of data. Immediately after this
packet has been sent, the transceiver switches to
receive mode and listens for an acknowledgement. If
a valid acknowledge word is not received, the
devices will go back to sleep for 3 more seconds. If a
valid acknowledge word has been received, this
implies that a base station is in range, and the node
will begin transmitting biomedical data. The average
current consumption of the wireless node during
Search mode was measured using an Agilent
N6705A DC Power Analyzer, and a breakdown of
the power consumption is given in Table III. The
average power consumption for the node in Search
mode is approximately 39.3 :corresponding to an
average current of 15.7 $ :LWK D EDWWHU\ SDFN
lifetime of 2000 mAh (two standard AA batteries),
the expected theoretical lifetime of the device (in
Search mode) is 127,000 hours, or 14.5 years.
e) Node Operation Sending Raw ECG
The microcontroller has a 10-bit ADC which is
configured to sample an incoming ECG signal every
4.5 ms, giving an ECG sampling rate of 222 Hz.
When the wireless node is configured to stream the
raw ECG data to the base station, it takes
approximately 2.3 ms to package and transmit the
sample (including receipt of an acknowledge word),
with the processor running at 16 MIPS. Therefore,
the node can enter a low-power sleep mode for 2.2
ms between samples, equating to a duty cycle of

TABLE IV
POWER CONSUMPTION OF ECG NODE
STREAM RAW ECG MODE

TABLE V
POWER CONSUMPTION OF ECG NODE
TRANSMIT HR ONLY MODE

Mode

Duration

Average
Current

Average
Power*

Average
Energy

Sleep

2.3 ms

1.8 $

4.5 :

10.35 nJ

1.5 ms

27 mA

67.5 mW

101.25 -

800 s

25 mA

62.5 mW

50 -

4.5 ms

13.4 mA

33.6 mW

151.26 -

Send
Packet
Receive
Ack.
Total per
sample
cycle

*assumes an average battery voltage of 2.5 V.

approximately 50%. The data is robustly packaged

by the PIC24F, and a packet comprises pre-amble
pulses, a synchronisation word, Manchester-encoded
ECG data, a 2-bit CRC and 8-bit checksum, and a
stop bit. A breakdown of the power consumption of
the node in this continuous streaming mode is given
in Table IV. The average power consumption for the
node in continuous ECG streaming mode is 33.6
mW, which corresponds to an average current of
approximately 13.4 mA. With a battery pack lifetime
of 2000 mAh, the expected theoretical lifetime of the
device (in streaming mode) is 150 hours, or 6 days.
A sleep mode trigger is also included in the
PIC24F code, whereby the device reverts to its initial
Search mode if 10 sequential packets are transmitted
to the base station without having received an
acknowledgement. This failsafe method prevents the
wireless node from staying in its most powerconsuming state if the patient wearing the node
moves out of range of the base station, or if the base
station is switched off.
f) Node Operation Sending HR data only
The third mode of operation for the wireless
(&* QRGH DGRSWV WKH DSSURDFK RI intelligence-atthe-VHQVRU. In this mode, it assumed that only the
SDWLHQWV KHDUW UDWH LV RI FOLQLFDO LQWHUHVW WKHUHIRUH
the HR is calculated by the PIC24F and the raw ECG
data is discarded. The HR is calculated using a QRS
detection algorithm, which is detailed in Section IV.
With the PIC24F running at 16 MIPS, it takes
approximately 2 VWRUHFHLYHDQHZVDPSOHIURPWKH
$'& DQG  V WR SHUIRUP WKH FDOFXODWLRQV LQ WKH
QRS detection algorithm. Each time an R-peak is
detected by the algorithm, the HR estimate is
updated, and transmitted to the base station.
Therefore, the power consumption of the transceiver
in this mode is dependent on the heart rate of the
patient wearing the device.
Two further power-saving measures are
employed in this mode of operation. Firstly, while
the device is searching for the R-peak in the ECG, it
is placed in a sleep mode between successive
samples, similar to in the streaming mode described
above. Secondly, the device uses the concept of a

Mode
Sleep
after
sample

Duration

Average
Current

67x4.448 ms
1.8 $
= 298.016 ms

Average
Power*

Average
Energy

4.5 :

1.34 -

Sample
and
locate
R-peak

67x52 s
= 3.484 ms

8 mA

20 mW

69.68 -

Send
Packet

1.5 ms

27 mA

67.5 mW

101.25 -

Receive
Ack.

800 s

25 mA

62.5 mW

50 -

Sleep
between
R-peaks

1.8 $

4.5 :

4.5t nJ

Total per
cardiac
cycle

(303.8 + t)
ms

2.5 x

222.27 +
0.0045t
-

avg
I HR_mode

avg
I HR_mode

*assumes an average battery voltage of 2.5 V.

TXLHW]RQHLQWKH(&*LHDQLQWHUYDODIWHUDQ5peak in which another R-peak is unlikely to be

detected. Due to the delay associated with the digital
filter, an R-peak is actually detected by the algorithm
~150 ms after it occurs. Based on the current
HVWLPDWH RI WKH SDWLHQWV +5 WKH GHYLFH ZLOO then
sleep (and not read samples from the ADC) until 150
ms before the next expected R-peak. Therefore, if the
SDWLHQWV +5 LV VWHDG\ WKH device only needs to be
active (sampling and applying QRS detection) for
approximately 301.5 ms, or 67 samples. Since
transmission
(and
acknowledgement)
takes
approximately 2.3 ms, the time spent asleep is
GHSHQGHQWRQWKHSDWLHQWVheart rate, and is given by:
60000
t
303.8 ms
(1)
HR
where HR LV WKH SDWLHQWV KHDUW UDWH LQ %HDWV 3HU
Minute (BPM). For an average resting HR of 60
BPM, equation (1) implies that the wireless node can
operate in a low-power state for 696.2 ms out of
every 1000 ms (~30 % duty cycle). For extremely
high heart rates of 198 BPM and above, there is no
TXLHW]RQH, and the wireless node is not permitted
to sleep between successive R-peak detections.
The power consumption of the ECG node in
this intelligent mode is summarised in Table V. The
average current drawn by the device is given by:
88.91 0.0018t
avg
mA.
(2)
I HR_mode
303.8 t
For example, if a patient had an average
heart rate of 100 BPM, the power consumption of the
device would be  : RU  $ $ FRQVWDQW
current draw of this amount implies a battery lifetime
of approximately 13,000 hours, or 1.5 years.

Figure 3: Modified Pan-Tomkins algorithm.

IV. QRS DETECTION

QRS detection is the process by which the
QRS complex of the ECG signal is isolated, in order
to calculate the location of the R-peak, and derive
heart rate information. This is not a trivial task for
real ECG signals. One of the main problems is 50 Hz
mains noise, which is picked up on ECG electrode
leads. Another issue which can drastically affect the
ECG waveform is patient movement, which can
cause electrodes to shift and alter the DC offset of
WKH VLJQDO D SKHQRPHQRQ NQRZQ DV EDVHOLQH
ZDQGHU 7KHUH DUH D QXPEHU RI PHWKRGV LQ WKH
literature for detecting the QRS waveform. In this
paper, the QRS detection algorithm that was
implemented on the PIC24F of the wireless node is
based on the popular, well-established method of Pan
and Tomkins [13]. The Pan-Tomkins method
comprises the following steps: (i) bandpass filtering
to remove noise; (ii) differentiation to locate the
sharp slopes of the waveform, and reduce baseline
wander; (iii) squaring to accentuate the R-wave
relative to the P- or T-waves; (iv) moving window
integration to smooth the QRS complex; and (v) Rpeak detection using an adaptive threshold.
In this work, a modified version of the PanTomkins algorithm was used for R-peak detection on
the PIC24F processor, as illustrated in Figure 3.
Firstly, a 30-tap bandpass filter is applied to the ECG
signal. This filter was designed in MATLAB with
passband frequencies 5 12 Hz. Secondly, it was
found in testing that the differentiation stage made
the system very sensitive to quantisation noise;
therefore, it was omitted. Instead, the average value
of the P-T interval is monitored for a time, and
subtracted from the QRS segment of the waveform.
Squaring, moving window integration and peak
detection are subsequently applied. Tests have shown
that this modified version of the Pan-Tomkins
algorithm works well with synthetic ECG signals
generated using the National Instruments Biomedical
Startup Kit, and on ECG signals from the MIT
database [14], which have pronounced R-waves.
However, it is noted that this implementation is not
as robust as the original Pan-Tomkins method, and

Figure 4: Block diagram and photograph of USBpowered base station node.

problems may arise in ECG signals where the P- or

T-waves are amplified through noise or cardiac
dysfunction, and mask the R-wave. As noted in
Section III, when the PIC24F is running at 16 MIPS,
the QRS detection algorithm is calculated within 50
VRIDQHZ(&*VDPple being received.

V. BASE STATION NODE

The base station is a component which can be
FRQQHFWHGWRWKHSDWLHQWVODSWRSRU3&XVLQJD86%
2.0 connection. The function of the base station is to
receive and decode data coming from the wireless
ECG node, and send it to the PC. The base station is
also used to receive commands over the USB port
from the PC; for example, if the user wishes to
switch from receiving raw ECG data to HR data. The
base station comprises a 3.5 V regulator to step down
the USB supply voltage, a PIC18F2450 running at 12
MIPS to manage communications between the PC
and the base station, and an LCD display which
displays status messages. As in the case of the
wireless ECG node, the base station also includes a
Si4420 transceiver, and a PIC24F operating at 8
MIPS to drive the transceiver and receive commands
from the PIC18F. Power is received from the USB
port, and the node draws a maximum of 35 mA when
transmitting data. A block diagram and photograph
of the base station are shown in Figure 4.
While designing the base station, it was found
that there was a lack of interrupt support in the USB
software written for the PIC18F. The PIC18F is
required to wait in a loop for commands from the
USB, which would cause problems if simultaneously
attempting to receive data from the transceiver.
Therefore, the PIC18F controls all the interactions
between the PC and the base station. A simple 3-wire

Figure 6: Web-based GUI for remote access to ECG

data.
Figure 5: GUI for wireless ECG node control.

protocol (interrupt, clock and data) was devised for

the bi-directional communication between the two
microcontrollers. When a command is received from
the PC, it is passed by the PIC18F to the PIC24F,
which relays it to the wireless node using the
transceiver. Upon receipt of data from the wireless
node, the PIC24F passes the information to the
PIC18F, where it is packaged and sent to the PC
using a standard USB interrupt function.

VI. SYSTEM BACK-END

The back-end of the ECG monitoring system
consists firstly of control and display software, to
issue commands over USB to the wireless ECG node
(via the base station), and to graph the ECG or HR
data received from the node. A screenshot of the user
GUI that was developed is shown in Figure 5. This
PC application also has the ability to send SMS or email alerts when the received biomedical data moves
out of a certain range.
Secondly, a server running Windows with
Apache 2.2, PHP5, phpMyAdmin and a MySQL
GDWDEDVH ZDV VHW XS LQ RUGHU WR VWRUH WKH SDWLHQWV
heart rate data remotely. A secure, PHP-based
website was also designed using the Website Baker
CMS and the ChartDirector plug-in, which loads the
most recent data stored on the server and graphs
results with the appropriate timestamps, as shown in
Figure 6. Therefore, a physician or healthcare team
can access real-time data captured from a patient,
with negligible delay (if the network load is low).

has also been designed to control the node, and

XSORDGWKHSDWLHQWVKHDUWUDWHGDWDWRDUHPRWHVHUYHU
in real time, where it can be remotely monitored by
clinicians. Further extensions to this work could
examine replacement of the AA batteries with a
smaller cell, to reduce the size of the node, and make
it truly wearable by incorporating the ECG electrode
and biopotential amplifier. The system should also
be modified such that it is not overly sensitive to
quantisation noise, allowing the re-introduction of
the differentiation stage of the Pan-Tomkins
algorithm.

REFERENCES
[1]

[2]
[3]
[4]

[5]

[6]

[7]

[8]

VII. CONCLUSIONS

[9]

A complete system for remote, wireless

monitoring of a patients ECG has been presented. A
wireless ECG node has been designed, and special
design considerations have ensured that the device is
low-power. Powered using two AA batteries, the
node can continuously stream raw ECG data to a
base station for up to 6 days. Alternatively, the node
could EH XVHG WR FRQWLQXRXVO\ PRQLWRU D SDWLHQWV
heart rate for approximately 1.5 years (assuming
average heart rates of 60-150 BPM). A PC interface

[10]

[11]
[12]

[13]

[14]

$' :DOOHU A demonstration on man of electromotive

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