Low Power Circuits for Smart Flexible ECG Sensors

Cardiovascular diseases (CVDs) are the world leading cause of death. In-home heart condition monitoring effectively reduced the CVD patient hospitalization rate. Flexible electrocardiogram (ECG) sensor provides an affordable, convenient and comfortable in-home monitoring solution. The three critical building blocks of the ECG sensor i.e., analog frontend (AFE), QRS detector, and cardiac arrhythmia classifier (CAC), are studied in this research. A fully differential difference amplifier (FDDA) based AFE that employs DC-coupled input stage increases the input impedance and improves CMRR. A parasitic capacitor reuse technique is proposed to improve the noise/area efficiency and CMRR. An on-body DC bias scheme is introduced to deal with the input DC offset. Implemented in 0.35m CMOS process with an area of 0.405mm2, the proposed AFE consumes 0.9W at 1.8V and shows excellent noise effective factor of 2.55, and CMRR of 76dB. Experiment shows the proposed AFE not only picks up clean ECG signal with electrodes placed as close as 2cm under both resting and walking conditions, but also obtains the distinct -wave after eye blink from EEG recording. A personalized QRS detection algorithm is proposed to achieve an average positive prediction rate of 99.39% and sensitivity rate of 99.21%. The user-specific template avoids the complicate models and parameters used in existing algorithms while covers most situations for practical applications. The detection is based on the comparison of the correlation coefficient of the user-specific template with the ECG segment under detection. The proposed one-target clustering reduced the required loops. A continuous-in-time discrete-in-amplitude (CTDA) artificial neural network (ANN) based CAC is proposed for the smart ECG sensor. The proposed CAC achieves over 98% classification accuracy for 4 types of beats defined by AAMI (Association for the Advancement of Medical Instrumentation). The CTDA scheme significantly reduces the input sample numbers and simplifies the sample representation to one bit. Thus, the number of arithmetic operations and the ANN structure are greatly simplified. The proposed CAC is verified by FPGA and implemented in 0.18m CMOS process. Simulation results show it can operate at clock frequencies from 10KHz to 50MHz. Average power for the patient with 75bpm heart rate is 13.34W

Continuous-time acquisition of biosignals using a charge-based ADC topology

This paper investigates continuous-time (CT) signal acquisition as an activity-dependent and nonuniform sampling alternative to conventional fixed-rate digitisation. We demonstrate the applicability to biosignal representation by quantifying the achievable bandwidth saving by nonuniform quantisation to commonly recorded biological signal fragments allowing a compression ratio of ≈5 and 26 when applied to electrocardiogram and extracellular action potential signals, respectively. We describe several desirable properties of CT sampling, including bandwidth reduction, elimination/reduction of quantisation error, and describe its impact on aliasing. This is followed by demonstration of a resource-efficient hardware implementation. We propose a novel circuit topology for a charge-based CT analogue-to-digital converter that has been optimized for the acquisition of neural signals. This has been implemented in a commercially available 0.35 μm CMOS technology occupying a compact footprint of 0.12 mm 2 . Silicon verified measurements demonstrate an 8-bit resolution and a 4 kHz bandwidth with static power consumption of 3.75 μW from a 1.5 V supply. The dynamic power dissipation is completely activity-dependent, requiring 1.39 pJ energy per conversion

Precision medicine and artificial intelligence : a pilot study on deep learning for hypoglycemic events detection based on ECG

Tracking the fluctuations in blood glucose levels is important for healthy subjects and crucial diabetic patients. Tight glucose monitoring reduces the risk of hypoglycemia, which can result in a series of complications, especially in diabetic patients, such as confusion, irritability, seizure and can even be fatal in specific conditions. Hypoglycemia affects the electrophysiology of the heart. However, due to strong inter-subject heterogeneity, previous studies based on a cohort of subjects failed to deploy electrocardiogram (ECG)-based hypoglycemic detection systems reliably. The current study used personalised medicine approach and Artificial Intelligence (AI) to automatically detect nocturnal hypoglycemia using a few heartbeats of raw ECG signal recorded with non-invasive, wearable devices, in healthy individuals, monitored 24 hours for 14 consecutive days. Additionally, we present a visualisation method enabling clinicians to visualise which part of the ECG signal (e.g., T-wave, ST-interval) is significantly associated with the hypoglycemic event in each subject, overcoming the intelligibility problem of deep-learning methods. These results advance the feasibility of a real-time, non-invasive hypoglycemia alarming system using short excerpts of ECG signal

Precision medicine and artificial intelligence : a pilot study on deep learning for hypoglycemic events detection based on ECG

Tracking the fluctuations in blood glucose levels is important for healthy subjects and crucial diabetic patients. Tight glucose monitoring reduces the risk of hypoglycemia, which can result in a series of complications, especially in diabetic patients, such as confusion, irritability, seizure and can even be fatal in specific conditions. Hypoglycemia affects the electrophysiology of the heart. However, due to strong inter-subject heterogeneity, previous studies based on a cohort of subjects failed to deploy electrocardiogram (ECG)-based hypoglycemic detection systems reliably. The current study used personalised medicine approach and Artificial Intelligence (AI) to automatically detect nocturnal hypoglycemia using a few heartbeats of raw ECG signal recorded with non-invasive, wearable devices, in healthy individuals, monitored 24 hours for 14 consecutive days. Additionally, we present a visualisation method enabling clinicians to visualise which part of the ECG signal (e.g., T-wave, ST-interval) is significantly associated with the hypoglycemic event in each subject, overcoming the intelligibility problem of deep-learning methods. These results advance the feasibility of a real-time, non-invasive hypoglycemia alarming system using short excerpts of ECG signal

Clockless Continuous-Time Neural Spike Sorting: Method, Implementation and Evaluation

In this paper, we present a new method for neural spike sorting based on Continuous Time (CT) signal processing. A set of CT based features are proposed and extracted from CT sampled pulses, and a complete event-driven spike sorting algorithm that performs classification based on these features is developed. Compared to conventional methods for spike sorting, the hardware implementation of the proposed method does not require any synchronisation clock for logic circuits, and thus its power consumption depend solely on the spike activity. This has been implemented using a variable quantisation step CT analogue to digital converter (ADC) with custom digital logic that is driven by level crossing events. Simulation results using synthetic neural data shows a comparable accuracy compared to template matching (TM) and Principle Components Analysis (PCA) based discrete sampled classification

An Error-Based Approximation Sensing Circuit for Event-Triggered, Low Power Wearable Sensors

Event-based sensors have the potential to optimize energy consumption at every stage in the signal processing pipeline, including data acquisition, transmission, processing and storage. However, almost all state-of-the-art systems are still built upon the classical Nyquist-based periodic signal acquisition. In this work, we design and validate the Polygonal Approximation Sampler (PAS), a novel circuit to implement a general-purpose event-based sampler using a polygonal approximation algorithm as the underlying sampling trigger. The circuit can be dynamically reconfigured to produce a coarse or a detailed reconstruction of the analog input, by adjusting the error threshold of the approximation. The proposed circuit is designed at the Register Transfer Level and processes each input sample received from the ADC in a single clock cycle. The PAS has been tested with three different types of archetypal signals captured by wearable devices (electrocardiogram, accelerometer and respiration data) and compared with a standard periodic ADC. These tests show that single-channel signals, with slow variations and constant segments (like the used single-lead ECG and the respiration signals) take great advantage from the used sampling technique, reducing the amount of data used up to 99% without significant performance degradation. At the same time, multi-channel signals (like the six-dimensional accelerometer signal) can still benefit from the designed circuit, achieving a reduction factor up to 80% with minor performance degradation. These results open the door to new types of wearable sensors with reduced size and higher battery lifetime

Robust Algorithms for Unattended Monitoring of Cardiovascular Health

Cardiovascular disease is the leading cause of death in the United States. Tracking daily changes in one’s cardiovascular health can be critical in diagnosing and managing cardiovascular disease, such as heart failure and hypertension. A toilet seat is the ideal device for monitoring parameters relating to a subject’s cardiac health in his or her home, because it is used consistently and requires no change in daily habit. The present work demonstrates the ability to accurately capture clinically relevant ECG metrics, pulse transit time based blood pressures, and other parameters across subjects and physiological states using a toilet seat-based cardiovascular monitoring system, enabled through advanced signal processing algorithms and techniques. The algorithms described herein have been designed for use with noisy physiologic signals measured at non-standard locations. A key component of these algorithms is the classification of signal quality, which allows automatic rejection of noisy segments before feature delineation and interval extractions. The present delineation algorithms have been designed to work on poor quality signals while maintaining the highest possible temporal resolution. When validated on standard databases, the custom QRS delineation algorithm has best-in-class sensitivity and precision, while the photoplethysmogram delineation algorithm has best-in-class temporal resolution. Human subject testing on normative and heart failure subjects is used to evaluate the efficacy of the proposed monitoring system and algorithms. Results show that the accuracy of the measured heart rate and blood pressure are well within the limits of AAMI standards. For the first time, a single device is capable of monitoring long-term trends in these parameters while facilitating daily measurements that are taken at rest, prior to the consumption of food and stimulants, and at consistent times each day. This system has the potential to revolutionize in-home cardiovascular monitoring

Acoustic sensing as a novel approach for cardiovascular monitoring at the wrist

Cardiovascular diseases are the number one cause of deaths globally. An increased cardiovascular risk can be detected by a regular monitoring of the vital signs including the heart rate, the heart rate variability (HRV) and the blood pressure. For a user to undergo continuous vital sign monitoring, wearable systems prove to be very useful as the device can be integrated into the user's lifestyle without affecting the daily activities. However, the main challenge associated with the monitoring of these cardiovascular parameters is the requirement of different sensing mechanisms at different measurement sites. There is not a single wearable device that can provide sufficient physiological information to track the vital signs from a single site on the body. This thesis proposes a novel concept of using acoustic sensing over the radial artery to extract cardiac parameters for vital sign monitoring. A wearable system consisting of a microphone is designed to allow the detection of the heart sounds together with the pulse wave, an attribute not possible with existing wrist-based sensing methods. Methods: The acoustic signals recorded from the radial artery are a continuous reflection of the instantaneous cardiac activity. These signals are studied and characterised using different algorithms to extract cardiovascular parameters. The validity of the proposed principle is firstly demonstrated using a novel algorithm to extract the heart rate from these signals. The algorithm utilises the power spectral analysis of the acoustic pulse signal to detect the S1 sounds and additionally, the K-means method to remove motion artifacts for an accurate heartbeat detection. The HRV in the short-term acoustic recordings is found by extracting the S1 events using the relative information between the short- and long-term energies of the signal. The S1 events are localised using three different characteristic points and the best representation is found by comparing the instantaneous heart rate profiles. The possibility of measuring the blood pressure using the wearable device is shown by recording the acoustic signal under the influence of external pressure applied on the arterial branch. The temporal and spectral characteristics of the acoustic signal are utilised to extract the feature signals and obtain a relationship with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Results: This thesis proposes three different algorithms to find the heart rate, the HRV and the SBP/ DBP readings from the acoustic signals recorded at the wrist. The results obtained by each algorithm are as follows: 1. The heart rate algorithm is validated on a dataset consisting of 12 subjects with a data length of 6 hours. The results demonstrate an accuracy of 98.78%, mean absolute error of 0.28 bpm, limits of agreement between -1.68 and 1.69 bpm, and a correlation coefficient of 0.998 with reference to a state-of-the-art PPG-based commercial device. A high statistical agreement between the heart rate obtained from the acoustic signal and the photoplethysmography (PPG) signal is observed. 2. The HRV algorithm is validated on the short-term acoustic signals of 5-minutes duration recorded from each of the 12 subjects. A comparison is established with the simultaneously recorded electrocardiography (ECG) and PPG signals respectively. The instantaneous heart rate for all the subjects combined together achieves an accuracy of 98.50% and 98.96% with respect to the ECG and PPG signals respectively. The results for the time-domain and frequency-domain HRV parameters also demonstrate high statistical agreement with the ECG and PPG signals respectively. 3. The algorithm proposed for the SBP/ DBP determination is validated on 104 acoustic signals recorded from 40 adult subjects. The experimental outputs when compared with the reference arm- and wrist-based monitors produce a mean error of less than 2 mmHg and a standard deviation of error around 6 mmHg. Based on these results, this thesis shows the potential of this new sensing modality to be used as an alternative, or to complement existing methods, for the continuous monitoring of heart rate and HRV, and spot measurement of the blood pressure at the wrist.Open Acces

Resource-Constrained Acquisition Circuits for Next Generation Neural Interfaces

The development of neural interfaces allowing the acquisition of signals from the cortex of the brain has seen an increasing amount of interest both in academic research as well as in the commercial space due to their ability to aid people with various medical conditions, such as spinal cord injuries, as well as their potential to allow more seamless interactions between people and machines. While it has already been demonstrated that neural implants can allow tetraplegic patients to control robotic arms, thus to an extent returning some motoric function, the current state of the art often involves the use of heavy table-top instruments connected by wires passing through the patient’s skull, thus making the applications impractical and chronically infeasible. Those limitations are leading to the development of the next generation of neural interfaces that will overcome those issues by being minimal in size and completely wireless, thus paving a way to the possibility of their chronic application. Their development however faces several challenges in numerous aspects of engineering due to constraints presented by their minimal size, amount of power available as well as the materials that can be utilised. The aim of this work is to explore some of those challenges and investigate novel circuit techniques that would allow the implementation of acquisition analogue front-ends under the presented constraints. This is facilitated by first giving an overview of the problematic of recording electrodes and their electrical characterisation in terms of their impedance profile and added noise that can be used to guide the design of analogue front-ends. Continuous time (CT) acquisition is then investigated as a promising signal digitisation technique alternative to more conventional methods in terms of its suitability. This is complemented by a description of practical implementations of a CT analogue-to-digital converter (ADC) including a novel technique of clockless stochastic chopping aimed at the suppression of flicker noise that commonly affects the acquisition of low-frequency signals. A compact design is presented, implementing a 450 nW, 5.5 bit ENOB CT ADC, occupying an area of 0.0288 mm2 in a 0.18 μm CMOS technology, making this the smallest presented design in literature to the best of our knowledge. As completely wireless neural implants rely on power delivered through wireless links, their supply voltage is often subject to large high frequency variations as well voltage uncertainty making it necessary to design reference circuits and voltage regulators providing stable reference voltage and supply in the constrained space afforded to them. This results in numerous challenges that are explored and a design of a practical implementation of a reference circuit and voltage regulator is presented. Two designs in a 0.35 μm CMOS technology are presented, showing respectively a measured PSRR of ≈60 dB and ≈53 dB at DC and a worst-case PSRR of ≈42 dB and ≈33 dB with a less than 1% standard deviation in the output reference voltage of 1.2 V while consuming a power of ≈7 μW. Finally, ΣΔ modulators are investigated for their suitability in neural signal acquisition chains, their properties explained and a practical implementation of a ΣΔ DC-coupled neural acquisition circuit presented. This implements a 10-kHz, 40 dB SNDR ΣΔ analogue front-end implemented in a 0.18 μm CMOS technology occupying a compact area of 0.044 μm2 per channel while consuming 31.1 μW per channel.Open Acces