Complexity of Atrial Fibrillation Electrograms Through Nonlinear Signal Analysis: In Silico Approach

Identification of atrial fibrillation (AF) mechanisms could improve the rate of ablation success. However, the incomplete understanding of those mechanisms makes difficult the decision of targeting sites for ablation. This work is focused on the importance of EGM analysis for detecting and modulating rotors to guide ablation procedures and improve its outcomes. Virtual atrial models are used to show how nonlinear measures can be used to generate electroanatomical maps to detect critical sites in AF. A description of the atrial cell mathematical models, and the procedure of coupling them within two‐dimensional and three‐dimensional virtual atrial models in order to simulate arrhythmogenic mechanisms, is given. Mathematical modeling of unipolar and bipolar electrogramas (EGM) is introduced. It follows a discussion of EGM signal processing. Nonlinear descriptors, such as approximate entropy and multifractal analysis, are used to study the dynamical behavior of EGM signals, which are not well described by a linear law. Our results evince that nonlinear analysis of EGM can provide information about the dynamics of rotors and other mechanisms of AF. Furthermore, these fibrillatory patterns can be simulated using virtual models. The combination of features using machine learning tools can be used for identifying arrhythmogenic sources of AF

Review and classification of variability analysis techniques with clinical applications

Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis

A Review of Atrial Fibrillation Detection Methods as a Service

Atrial Fibrillation (AF) is a common heart arrhythmia that often goes undetected, and even if it is detected, managing the condition may be challenging. In this paper, we review how the RR interval and Electrocardiogram (ECG) signals, incorporated into a monitoring system, can be useful to track AF events. Were such an automated system to be implemented, it could be used to help manage AF and thereby reduce patient morbidity and mortality. The main impetus behind the idea of developing a service is that a greater data volume analyzed can lead to better patient outcomes. Based on the literature review, which we present herein, we introduce the methods that can be used to detect AF efficiently and automatically via the RR interval and ECG signals. A cardiovascular disease monitoring service that incorporates one or multiple of these detection methods could extend event observation to all times, and could therefore become useful to establish any AF occurrence. The development of an automated and efficient method that monitors AF in real time would likely become a key component for meeting public health goals regarding the reduction of fatalities caused by the disease. Yet, at present, significant technological and regulatory obstacles remain, which prevent the development of any proposed system. Establishment of the scientific foundation for monitoring is important to provide effective service to patients and healthcare professionals

Detection of abnormalities in ECG using Deep Learning

A significant part of healthcare is focused on the information that the physiological signals offer about the health state of an individual. The Electrocardiogram (ECG) cyclic behaviour gives insight on a subject’s emotional, behavioral and cardiovascular state. These signals often present abnormal events that affects their analysis. Two examples are the noise, that occurs during the acquisition, and symptomatic patterns, that are produced by pathologies. This thesis proposes a Deep Neural Networks framework that learns the normal behaviour of an ECG while detecting abnormal events, tested in two different settings: detection of different types of noise, and; symptomatic events caused by different pathologies. Two algorithms were developed for noise detection, using an autoencoder and Convolutional Neural Networks (CNN), reaching accuracies of 98,18% for the binary class model and 70,74% for the multi-class model, which is able to discern between base wandering, muscle artifact and electrode motion noise. As for the arrhythmia detection algorithm was developed using an autoencoder and Recurrent Neural Networks with Gated Recurrent Units (GRU) architecture. With an accuracy of 56,85% and an average sensitivity of 61.13%, compared to an average sensitivity of 75.22% for a 12 class model developed by Hannun et al. The model detects 7 classes: normal sinus rhythm, paced rhythm, ventricular bigeminy, sinus bradycardia, atrial fibrillation, atrial flutter and pre-excitation. It was concluded that the process of learning the machine learned features of the normal ECG signal, currently sacrifices the accuracy for higher generalization. It performs better at discriminating the presence of abnormal events in ECG than classifying different types of events. In the future, these algorithms could represent a huge contribution in signal acquisition for wearables and the study of pathologies visible in not only in ECG, but also EMG and respiratory signals, especially applied to active learning

Wavelet-Based Kernel Construction for Heart Disease Classification

© 2019 ADVANCES IN ELECTRICAL AND ELECTRONIC ENGINEERINGHeart disease classification plays an important role in clinical diagnoses. The performance improvement of an Electrocardiogram classifier is therefore of great relevance, but it is a challenging task too. This paper proposes a novel classification algorithm using the kernel method. A kernel is constructed based on wavelet coefficients of heartbeat signals for a classifier with high performance. In particular, a wavelet packet decomposition algorithm is applied to heartbeat signals to obtain the Approximation and Detail coefficients, which are used to calculate the parameters of the kernel. A principal component analysis algorithm with the wavelet-based kernel is employed to choose the main features of the heartbeat signals for the input of the classifier. In addition, a neural network with three hidden layers in the classifier is utilized for classifying five types of heart disease. The electrocardiogram signals in nine patients obtained from the MIT-BIH database are used to test the proposed classifier. In order to evaluate the performance of the classifier, a multi-class confusion matrix is applied to produce the performance indexes, including the Accuracy, Recall, Precision, and F1 score. The experimental results show that the proposed method gives good results for the classification of the five mentioned types of heart disease.Peer reviewedFinal Published versio

A real-time data mining technique applied for critical ECG rhythm on handheld device

Sudden cardiac arrest is often caused by ventricular arrhythmias and these episodes can lead to death for patients with chronic heart disease. Hence, detection of such arrhythmia is crucial in mobile ECG monitoring. In this research, a systematic study is carried out to investigate the possible limitations that are preventing the realisation of a real-time ECG arrhythmia data-mining algorithm suitable for application on mobile devices. Based on the findings, a computationally lightweight algorithm is devised and tested. Ventricular tachycardia (VT) is the most common type of ventricular arrhythmias and is also the deadliest.. A ventricular tachycardia (VT) episode is due to a disorder ofthe regular contractions ofthe heart. It occurs when the human heart ventricles generate a rapid heartbeat which disrupts the regular physiology cycle. The normal sinus rhythm (NSR) of a regular human heart beat signal has its signature PQRST waveform and in regular pattern. Whereas, the characteristics of a ventricular tachycardia (VT) signal waveforms are short R-R intervals, widen QRS duration and the absence of P-waves. Each type of ECG arrhythmia previously mentioned has a unique waveform signature that can be exploited as features to be used for the realization of an automated ECG analysis application. In order to extract this known ECG waveform feature, a time-domain analysis is proposed for feature extraction. Cross-correlation allows the computation of a co-efficient that quantifies the similarity between two times-series. Hence, by cross-correlating known ECG waveform templates with an unknown ECG signal, the coefficient can indicate the similarities. In previous published work, a preliminary study was carried out. The cross-correlation coefficient wave (CCW) technique was introduced for feature extraction. The outcome ofthis work presents CCW as a promising feature to differentiate between NSR, VT and Vfib signals. Moreover, cross-correlation computation does not require high computational overhead. Next, an automated detection algorithm requires a classification mechanism to make sense of the feature extracted. A further study is conducted and published, a fuzzy set k-NN classifier was introduced for the classification of CCW feature extracted from ECG signal segments. A training set of size 180 is used. The outcome of the study indicates that the computationally light-weight fuzzy k-NN classifier can reliably classify between NSR and VT signals, the class detection rate is low for classifying Vfib signal using the fuzzy k-NN classifier. Hence, a modified algorithm known as fuzzy hybrid classifier is proposed. By implementing an expert knowledge based fuzzy inference system for classification of ECG signal; the Vfib signal detection rate was improved. The comparison outcome was that the hybrid fuzzy classifier is able to achieve 91.1% correct rate, 100% sensitivity and 100% specificity. The previously mentioned result outperforms the compared classifiers. The proposed detection and classification algorithm is able to achieve high accuracy in analysing ECG signal feature of NSR, VT and Vfib nature. Moreover, the proposed classifier is successfully implemented on a smart mobile device and it is able to perform data-mining of the ECG signal with satisfiable results

Automatic analysis and classification of cardiac acoustic signals for long term monitoring

Objective: Cardiovascular diseases are the leading cause of death worldwide resulting in over 17.9 million deaths each year. Most of these diseases are preventable and treatable, but their progression and outcomes are significantly more positive with early-stage diagnosis and proper disease management. Among the approaches available to assist with the task of early-stage diagnosis and management of cardiac conditions, automatic analysis of auscultatory recordings is one of the most promising ones, since it could be particularly suitable for ambulatory/wearable monitoring. Thus, proper investigation of abnormalities present in cardiac acoustic signals can provide vital clinical information to assist long term monitoring. Cardiac acoustic signals, however, are very susceptible to noise and artifacts, and their characteristics vary largely with the recording conditions which makes the analysis challenging. Additionally, there are challenges in the steps used for automatic analysis and classification of cardiac acoustic signals. Broadly, these steps are the segmentation, feature extraction and subsequent classification of recorded signals using selected features. This thesis presents approaches using novel features with the aim to assist the automatic early-stage detection of cardiovascular diseases with improved performance, using cardiac acoustic signals collected in real-world conditions. Methods: Cardiac auscultatory recordings were studied to identify potential features to help in the classification of recordings from subjects with and without cardiac diseases. The diseases considered in this study for the identification of the symptoms and characteristics are the valvular heart diseases due to stenosis and regurgitation, atrial fibrillation, and splitting of fundamental heart sounds leading to additional lub/dub sounds in the systole or diastole interval of a cardiac cycle. The localisation of cardiac sounds of interest was performed using an adaptive wavelet-based filtering in combination with the Shannon energy envelope and prior information of fundamental heart sounds. This is a prerequisite step for the feature extraction and subsequent classification of recordings, leading to a more precise diagnosis. Localised segments of S1 and S2 sounds, and artifacts, were used to extract a set of perceptual and statistical features using wavelet transform, homomorphic filtering, Hilbert transform and mel-scale filtering, which were then fed to train an ensemble classifier to interpret S1 and S2 sounds. Once sound peaks of interest were identified, features extracted from these peaks, together with the features used for the identification of S1 and S2 sounds, were used to develop an algorithm to classify recorded signals. Overall, 99 features were extracted and statistically analysed using neighborhood component analysis (NCA) to identify the features which showed the greatest ability in classifying recordings. Selected features were then fed to train an ensemble classifier to classify abnormal recordings, and hyperparameters were optimized to evaluate the performance of the trained classifier. Thus, a machine learning-based approach for the automatic identification and classification of S1 and S2, and normal and abnormal recordings, in real-world noisy recordings using a novel feature set is presented. The validity of the proposed algorithm was tested using acoustic signals recorded in real-world, non-controlled environments at four auscultation sites (aortic valve, tricuspid valve, mitral valve, and pulmonary valve), from the subjects with and without cardiac diseases; together with recordings from the three large public databases. The performance metrics of the methodology in relation to classification accuracy (CA), sensitivity (SE), precision (P+), and F1 score, were evaluated. Results: This thesis proposes four different algorithms to automatically classify fundamental heart sounds – S1 and S2; normal fundamental sounds and abnormal additional lub/dub sounds recordings; normal and abnormal recordings; and recordings with heart valve disorders, namely the mitral stenosis (MS), mitral regurgitation (MR), mitral valve prolapse (MVP), aortic stenosis (AS) and murmurs, using cardiac acoustic signals. The results obtained from these algorithms were as follows: • The algorithm to classify S1 and S2 sounds achieved an average SE of 91.59% and 89.78%, and F1 score of 90.65% and 89.42%, in classifying S1 and S2, respectively. 87 features were extracted and statistically studied to identify the top 14 features which showed the best capabilities in classifying S1 and S2, and artifacts. The analysis showed that the most relevant features were those extracted using Maximum Overlap Discrete Wavelet Transform (MODWT) and Hilbert transform. • The algorithm to classify normal fundamental heart sounds and abnormal additional lub/dub sounds in the systole or diastole intervals of a cardiac cycle, achieved an average SE of 89.15%, P+ of 89.71%, F1 of 89.41%, and CA of 95.11% using the test dataset from the PASCAL database. The top 10 features that achieved the highest weights in classifying these recordings were also identified. • Normal and abnormal classification of recordings using the proposed algorithm achieved a mean CA of 94.172%, and SE of 92.38%, in classifying recordings from the different databases. Among the top 10 acoustic features identified, the deterministic energy of the sound peaks of interest and the instantaneous frequency extracted using the Hilbert Huang-transform, achieved the highest weights. • The machine learning-based approach proposed to classify recordings of heart valve disorders (AS, MS, MR, and MVP) achieved an average CA of 98.26% and SE of 95.83%. 99 acoustic features were extracted and their abilities to differentiate these abnormalities were examined using weights obtained from the neighborhood component analysis (NCA). The top 10 features which showed the greatest abilities in classifying these abnormalities using recordings from the different databases were also identified. The achieved results demonstrate the ability of the algorithms to automatically identify and classify cardiac sounds. This work provides the basis for measurements of many useful clinical attributes of cardiac acoustic signals and can potentially help in monitoring the overall cardiac health for longer duration. The work presented in this thesis is the first-of-its-kind to validate the results using both, normal and pathological cardiac acoustic signals, recorded for a long continuous duration of 5 minutes at four different auscultation sites in non-controlled real-world conditions.Open Acces

Evaluating and comparing performance of feature combinations of heart rate variability measures for cardiac rhythm classification

Abstract Automatic classification of cardiac arrhythmias using heart rate variability (HRV) analysis has been an important research topic in recent years. Explorations reveal that various HRV feature combinations can provide highly accurate models for some rhythm disorders. However, the proposed feature combinations lack a direct and carefully designed comparison. The goal of this work is to assess the various HRV feature combinations in classification of cardiac arrhythmias. In this setting, a total of 56 known HRV features are grouped in eight feature combinations. We evaluate and compare the combinations on a difficult problem of automatic classification between nine types of cardiac rhythms using three classification algorithms: support vector machines, AdaBoosted C4.5, and random forest. The effect of analyzed segment length on classification accuracy is also examined. The results demonstrate that there are three combinations that stand out the most, with total classification accuracy of roughly 85% on time segments of 20 seconds duration. A simple combination of time domain features is shown to be comparable to the more informed combinations, with only 1-4% worse results on average than the three best ones. Random forest and AdaBoosted C4.5 are shown to be comparably accurate, while support vector machines was less accurate (4-5%) on this problem. We conclude that the nonlinear features exhibit only a minor influence on the overall accuracy in discerning different arrhythmias. The analysis also shows that reasonably accurate arrhythmia classification lies in the range of 10 to 40 seconds, with a peak at 20 seconds, and a significant drop after 40 seconds

Stress detection using wearable physiological and sociometric sensors

Stress remains a significant social problem for individuals in modern societies. This paper presents a machine learning approach for the automatic detection of stress of people in a social situation by combining two sensor systems that capture physiological and social responses. We compare the performance using different classifiers including support vector machine, AdaBoost, and k-nearest neighbour. Our experimental results show that by combining the measurements from both sensor systems, we could accurately discriminate between stressful and neutral situations during a controlled Trier social stress test (TSST). Moreover, this paper assesses the discriminative ability of each sensor modality individually and considers their suitability for real time stress detection. Finally, we present an study of the most discriminative features for stress detection