Beyond Single-Lead ECG-Derived Respiration Analysis: Use of Vectorcardiograms from the EASI-System for Breathing Frequency Estimation-A Feasibility Study.

Precise respiration assessment is crucial for heart rate variability (HRV) interpretation as respiratory components-particularly respiratory sinus arrhythmia (RSA)-provide essential information on vagally mediated regulation. Conventional single-lead electrocardiogram-derived respiration (EDR) methods measure the amplitude modulation of the QRS-waveform caused by respiratory chest movements. This causes a displacement of the electrical heart axis in relation to the ECG lead axis, typically within the 2D frontal plane of the Einthoven electrode montage. Another approach is based on heartbeat acceleration and deceleration during respective inspiration and expiration causing RR interval modulation. However, interval-based methods depend on the complexity of sympathovagal factors that affect RSA. The present feasibility study accounts for the 3D rotational movement of the electrical heart axis during the respiratory cycle and avoids non-respiratory neuromodulatory confounds. The beat-to-beat cardiac rotation was extracted from Frank-XYZ coordinates reconstructed via a four-electrode EASI device. In a pilot study with data from 19 healthy adults performing acoustically paced breathing (6-18 bpm), three surrogates (RR-IntervalEDR, R-AmplitudeEDR, HeartmovementEDR) were compared using a unified Python 3.11.13 pipeline (3D VCG R-peak detection, multivariate Mahalanobis artifact correction, wavelet-based analysis) against a synthetic reference derived from the instructed breathing schedule. The results demonstrated a consistently lower estimation error and higher reference-based signal-to-noise ratio (refSNR), measuring spectral alignment with the paced-breathing trajectory for HeartmovementEDR and achieving a mean refSNR of 6.01 dB (vs. 4.62 dB for RR-IntervalEDR and 3.20 dB for R-AmplitudeEDR) and a mean absolute estimation error of 0.016 Hz (vs. 0.050 Hz and 0.032 Hz, respectively). Notably, HeartmovementEDR and R-AmplitudeEDR performance slightly improved at higher heart rates, consistent with the interpretation that higher cardiac sampling density benefits spectral resolution for chest movement-based methods, whereas RR-IntervalEDR showed no significant heart rate dependence. Furthermore, HeartmovementEDR was compared with the EDR results obtained by applying the Kubios-HRV Premium software (version 3.5.0). Kubios-EDR yielded higher precision at elevated breathing frequencies, whereas HeartmovementEDR outperformed Kubios-EDR at breathing rates below 10 bpm-a range that is particularly relevant for vagally activating slow breathing protocols or treatments. Future work should validate this method using a direct respiration measurement under spontaneous natural breathing conditions.