# XBeats: A Real-Time Electrocardiogram Monitoring and Analysis System
## 1 Introduction  
The World Health Organization (WHO) in 2019 identified that cardiovascular diseases (CVDs) are the number one cause of death [1]. Electrocardiogram (ECG or EKG) is the oldest and most used test by cardiologists for understanding heartbeat \"rhythms\". Cardiologists build their diagnoses on heart conditions by analyzing the heart's electrical activity displayed in waveform format. Diagnosing heart diseases is commonly a manual process [2]. Holter monitors are widely known devices used by practicing specialists and cardiologists to perform ECG testing. There are multiple configurations of ECG tests using Holter monitors, like the number of leads or data acquisition period. The selection between the common two to three leads or the standard 12 leads is left to the cardiologist's discretion or as the patient's heart condition develops [3]. The 2- to 3-lead Holter monitors are used for detecting heart rate and its rhythm. Conversely, a standard 12-lead ECG would be needed to screen patients for possible cardiac ischemia and help healthcare providers quickly identify patients who have ST-elevation myocardial infarction (i.e., heart attack) and perform the appropriate medical intervention in time [4]. A standard 12-lead ECG requires a Holter monitor that can be installed at hospitals or carried by the patients. Usually, Holter monitors installed at hospitals come with diagnostic tools to analyze heartbeats in real-time. However, previous ECG charts are not available for comparison with ECG current signalsto observe any potential correlation between previous ECG charts and current ECG charts. Furthermore, heart conditions could be misdiagnosed (or an anomaly entirely missed) due to intermittent heart irregularity (aka arrhythmia) [4]. Notably, similar devices provide similar functionality to Holter monitors, also called event monitors [5]. Event monitors are portable devices that a person can carry around day and night until symptoms occur. The main difference is that Holter monitors record ECG signals regardless of the heart conditions during the recording period. In contrast, event monitors are designed to be automatically activated when symptoms are experienced and then record current heartbeats. Alternatively, the patient can manually activate them if an abnormal heart rhythm is felt. Accordingly, recent event monitors can now be configured to be worn continuously, and others are applied to the skin and are activated automatically when any symptoms are experienced [5]. Event monitors overcome Holter monitors' shortcomings as they can provide heart monitoring for extended periods that can last for weeks. However, event monitors are not designed to trigger an emergency response for life-threatening arrhythmia due to a processing lag at the order of several minutes. Given the requirements mentioned above, the patient is recommended to stay in bed and be hospitalized for the test period. Consequently, in response to the rapid digital revolution and the COVID-19 pandemic, the healthcare landscape has seen a rapid shift from physical to virtual care and telemedicine. The provision of remote patient monitoring has changed the traditional healthcare abilities to monitor and manage patients [6]. Despite the significant research efforts brought by MedTech companies and the research community, continuous remote ECG monitoring still lacks comprehensiveness and completeness compared to the services offered in hospitals and clinics [6; 7]. This paper proposes XBeats, a new platform for continuous remote ECG monitoring using a lightweight standard 12-lead ECG smart patch that integrates intelligent signal analysis and offers two heartbeat classification phases. The platform encompasses hardware components that are responsible for the data acquisition represented in our proposed smart patch for ECG monitoring. The ECG patch gathers the ECG data and transmits it to the backend system.