Comprehensive Signal Quality Evaluation of a Wearable Textile ECG Garment: A Sex-Balanced Study

--We introduce a novel wearable textile-garment featuring an innovative electrode placement aimed at minimizing noise and motion artifacts, thereby enhancing signal fidelity in Electrocardiography (ECG) recordings. We present a comprehensive, sex-balanced evaluation involving 15 healthy males and 15 healthy female participants to ensure the device's suitability across anatomical and physiological variations. The assessment framework encompasses distinct evaluation approaches: quantitative signal quality indices to objectively benchmark device performance; rhythm-based analyzes of physiological parameters such as heart rate (HR) and heart rate variability (HRV); machine learning classification tasks to assess application-relevant predictive utility; morphological analysis of ECG features including amplitude and interval parameters; and investigations of the effects of electrode projection angle given by the textile / body shape, with all analyzes stratified by sex to elucidate sex-specific influences. Evaluations were conducted across various activity phases representing real-world conditions. The results demonstrate that the textile system achieves signal quality highly concordant with reference devices in both rhythm and morphological analyses, exhibits robust classification performance, and enables identification of key sex-specific determinants affecting signal acquisition. These findings underscore the practical viability of textile-based ECG garments for physiological monitoring as well as psychophysiological state detection. Moreover, we identify the importance of incorporating sex-specific design considerations to ensure equitable and reliable cardiac diagnostics in wearable health technologies. NTRODUCTION This is a preprint of a manuscript submitted for publication. It has not yet been peer-reviewed, and the final version may differ . The authors acknowledge the funding by the EU TEF-Health project which is part of the Digital Europe Program of the EU (DIGIT AL-2022-CLOUD-AI-02-TEFHEAL TH). LECTROCARDIOGRAPHIC recordings serve as a fundamental diagnostic tool in modern medicine, providing invaluable noninvasive insights into the electrical activity of the heart and therefore the health of the cardiovascular system. Introduced by Willem Einthoven in the early 20th century, Electrocardiography (ECG) remains a cornerstone in clinical cardiology. Einthoven's pioneering work laid the foundation for understanding the principles underlying ECG acquisition and interpretation [1], [2]. ECG signals are acquired through electrodes placed on the skin, capturing the electrical impulses generated by cardiac muscle de-and repolarization. In modern medicine, ECG is used in applications ranging from diagnosing cardiac arrhythmias [4] and ischemic heart disease [5] to monitoring patients during surgery [6] and assessing the effects of pharmacological interventions [7], [8].