Abductive reasoning as the basis to reproduce expert criteria in ECG Atrial Fibrillation identification

Objective: This work aims at providing a new method for the automatic detection of atrial fibrillation, other arrhythmia and noise on short single lead ECG signals, emphasizing the importance of the interpretability of the classification results. Approach: A morphological and rhythm description of the cardiac behavior is obtained by a knowledge-based interpretation of the signal using the \textit{Construe} abductive framework. Then, a set of meaningful features are extracted for each individual heartbeat and as a summary of the full record. The feature distributions were used to elucidate the expert criteria underlying the labeling of the 2017 Physionet/CinC Challenge dataset, enabling a manual partial relabeling to improve the consistency of the classification rules. Finally, state-of-the-art machine learning methods are combined to provide an answer on the basis of the feature values. Main results: The proposal tied for the first place in the official stage of the Challenge, with a combined $F_1$ score of 0.83, and was even improved in the follow-up stage to 0.85 with a significant simplification of the model. Significance: This approach demonstrates the potential of \textit{Construe} to provide robust and valuable descriptions of temporal data even with significant amounts of noise and artifacts. Also, we discuss the importance of a consistent classification criteria in manually labeled training datasets, and the fundamental advantages of knowledge-based approaches to formalize and validate that criteria.Comment: 15 pages, 6 figures, 6 table

Detecting and interpreting myocardial infarction using fully convolutional neural networks

Objective: We aim to provide an algorithm for the detection of myocardial infarction that operates directly on ECG data without any preprocessing and to investigate its decision criteria. Approach: We train an ensemble of fully convolutional neural networks on the PTB ECG dataset and apply state-of-the-art attribution methods. Main results: Our classifier reaches 93.3% sensitivity and 89.7% specificity evaluated using 10-fold cross-validation with sampling based on patients. The presented method outperforms state-of-the-art approaches and reaches the performance level of human cardiologists for detection of myocardial infarction. We are able to discriminate channel-specific regions that contribute most significantly to the neural network's decision. Interestingly, the network's decision is influenced by signs also recognized by human cardiologists as indicative of myocardial infarction. Significance: Our results demonstrate the high prospects of algorithmic ECG analysis for future clinical applications considering both its quantitative performance as well as the possibility of assessing decision criteria on a per-example basis, which enhances the comprehensibility of the approach.Comment: 11 pages, 4 figure