Quantification of Ventricular Repolarization Dispersion Using Digital Processing of the Surface ECG

Digital processing of electrocardiographic records was one of the first applications of signal processing on medicine. There are many ways to analyze and study electrical cardiac activity using the surface electrocardiogram (ECG) and nowadays a good clinical diagnostic and prevention of cardiac risk are the principal goal to be achieved. One aim of digital processing of ECG signals has been quantification of ventricular repolarization dispersion (VRD), phenomenon which mainly is determined by heterogeneity of action potential durations (APD) in different myocardial regions. The APD differs not only between myocytes of apex and the base of both ventricles, but those of endocardial and epicardial surfaces (transmural dispersion) and between both ventricles. Also, it was demonstrated that several electrophysiologically and functionally different myocardial cells, like epicardial, endocardial and mid-myocardial M cells. The APD inequalities develop global and/or local voltage gradients that play an important role in the inscription of ECG T-wave morphology. In this way, we can assume that T-wave is a direct expression of ventricular repolarization inhomogeneities on surface ECG. Experimental and clinical studies have demonstrated a relationship between VRD and severe ventricular arrhythmias. In addition, patients having increased VRD values have a higher risk of developing reentrant arrhythmias. Frequently the heart answer to several pathological states produced an increase of VRD; this phenomenon may develop into malignant ventricular arrhythmia (MVA) and/or sudden cardiac death (SCD). Moreover, it has been showed that the underlying mechanisms in MVA and/or SCD are cardiac re-entry, increased automation, influence of autonomic nervous system and arrhythmogenic substrates linked with cardiac pathologies. These cardiac alterations could presented ischemia, hypothermia, electrolyte imbalance, long QT syndrome, autonomic system effects and others. Digital processing of ECG has been proved to be useful for cardiac risk assessment, with additional advantages like of being non invasive treatments and applicable to the general population. With the aim to identify high cardiac risk patients, the researchers have been tried to quantify the VRD with different parameters obtained by mathematic-computational processing of the surface ECG. These parameters are based in detecting changes of T-wave intervals and T-wave morphology during cardiac pathologies, linking these changes with VRD. In this chapter, we have presented a review of VRD indexes based on digital processing of ECG signals to quantify cardiac risk. The chapter is organized as follows: Section 2 explains ECG preprocessing and delineation of fiducial points. In Section 3, indexes of VRD quantification, such as: QT interval dispersion, QT interval variability and T-wave duration, are described. In Section 4, different repolarization indexes describing T-wave morphology and energy are examined, including complexity of repolarization, T-wave residuum, angle between the depolarization and repolarization dominant vectors, micro T-wave alternans, T-wave area and amplitude and T-wave spectral variability. Finally, in Section 5 conclusions are presented.Fil: Vinzio Maggio, Ana Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Argentino de Matemática Alberto Calderón; ArgentinaFil: Bonomini, Maria Paula. Universidad de Buenos Aires. Facultad de Ingeniería. Instituto de Ingeniería Biomédica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Laciar Leber, Eric. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Juan. Facultad de Ingeniería; ArgentinaFil: Arini, Pedro David. Universidad de Buenos Aires. Facultad de Ingeniería. Instituto de Ingeniería Biomédica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Argentino de Matemática Alberto Calderón; Argentin

MS

thesisAccurate QRS detection is essential in online computerized rhythm monitoring systems. A major cause of error in QRS detection schemes arises from artifacts superimposed on the input signal. To a lesser extent identification of P or T waves as QRS complexes can represent another source of error. In an effort to reduce the incidence of false and missed alarms generated by the rhythm monitoring system currently used in the LDS Hospital Coronary Care Unit, a project was undertaken to improve the accuracy and reliability of the QRS detection algorithm, specifically in contaminated single lead electrocardiographic data. The algorithm uses a dual scan of the sample data combined with a peak detection scheme to locate a reference point on a QRS candidate. The candidate is then checked for evidence of baseline shift or an excessively low signal-to-noise ratio. If neither of these criteria is met, the candidate is assumed to be QRS and a fiducial point is located on the complex. To assess the sensitivity and specificity of the QRS detection algorithm, an off-line evaluation was performed on forty-one patient records collected in the Coronary Care Unit. Arrhythmias included in the evaluation were fast ventricular and atrial rhythms and heart block. Over 90 percent of the data base was contaminated with excessive muscle artifacts. Of a total of 7,205 beats used in the evaluation, and positive predictive accuracy were .9641 and .9573, respectively. Of the error, 92.16 percent of the false positives and 84.17 percent of the false negatives were due to excessive noise spike superimposition on the data. None of the false positive error (.0071) was due to P or T wave misidentification of a QRS complex. These results indicate that a signal-in-noise approach to automated QRS detection is effective in identifying QRS complexes in the contaminated single lead electrocardiogram with minimal error

Simulation of 12 Lead ECG

Master's thesis in Cybernetics and signal processingSimulation is commonly used in the training of medical professionals; including nurses, emergency responders and doctors. By using real equipment with medical simulators it allows for a much more realistic experience, allowing the students to get experience with the actual equipment to be used later with real patients. The idea behind this project is to develop methods to allow the simulation of 12 Lead ECG based on real recordings, such that users can connect devices such as patient monitors, defibrillators and electrocardiographs to a simulator and record realistic ECG. In the report it is presented how a 12 Lead ECG with synchronized leads can be calculated into the voltage potentials, which in turn can be generated to the ECG electrodes. It is then showed how the QRS complexes and waves of the ECG is detected. This is used to segment the ECG recording into beats, and a representative beat is found as the median beat of all the segmented beats fulfilling different criteria. The representative beat of the ECG is then modeled by a simple parametric model and it is showed how this can be used for realistic simulation of normal sinus rhythms at different heart rates, as well as presenting signs of conditions like myocardial infarction. In the project the simulations were based on the PTB Diagnostic ECG database, a database consisting of 549 ECG recordings from 290 different healthy volunteers or subjects with different heart diseases. In the report it is showed how the voltage potentials required for simulation could be calculated from the records in the database. The ECG was then reconstructed from the voltage potentials with low errors on most records in the database. The parametric model was fit to all the records of the database, and for many records the model seems to represent the ECG quite well. Finally it is showed how rate adjustment and myocardial infarction simulation would look on some of the records in the database

Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation

[EN] Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-R) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann-Whitney U-test. PWD was correlated with the remaining features. Only PWD (non-scaling: & UDelta;=-9.84%, p=0.0085, scaling: & UDelta;=-17.96%, p=0.0442) and PWDpeak-off (non-scaling: & UDelta;=-22.03%, p=0.0250, scaling: & UDelta;=-27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p < 0.0001), showing the highest value between PWD and PWon-R (rho max=0.855). PWD correlated more with PWDon-peak (rho= 0.540-0.805) than PWDpeak-off (rho= 0.419-0.710). PWD shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.This research received financial support from public grants DPI2017-83952-C3, PID2021-00X128525-IV0 and PID2021-123804OB-I00 of the Spanish Government 10.13039/501100011033 jointly with the European Regional Development Fund (EU), SBPLY/17/180501/000411 from Junta de Comunidades de Castilla-La Mancha and AICO/2021/286 from Generalitat Valenciana.Vraka, A.; Bertomeu-González, V.; Hornero, F.; Quesada, A.; Alcaraz, R.; Rieta, JJ. (2022). Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation. Sensors. 22(1):1-13. https://doi.org/10.3390/s2201029011322

Automatic diagnosis of strict left bundle branch block using a wavelet-based approach

Patients with left bundle branch block (LBBB) are known to have a good clinical response to cardiac resynchronization therapy. However, the high number of false positive diagnosis obtained with the conventional LBBB criteria limits the effectiveness of this therapy, which has yielded to the definition of new stricter criteria. They require prolonged QRS duration, a QS or rS pattern in the QRS complexes at leads V1 and V2 and the presence of mid-QRS notch/slurs in 2 leads within V1, V2, V5, V6, I and aVL. The aim of this work was to develop and assess a fully-automatic algorithm for strict LBBB diagnosis based on the wavelet transform. Twelve-lead, high-resolution, 10-second ECGs from 602 patients enrolled in the MADIT-CRT trial were available. Data were labelled for strict LBBB by 2 independent experts and divided into training (n = 300) and validation sets (n = 302) for assessing algorithm performance. After QRS detection, a wavelet-based delineator was used to detect individual QRS waves (Q, R, S), QRS onsets and ends, and to identify the morphological QRS pattern on each standard lead. Then, multilead QRS boundaries were defined in order to compute the global QRS duration. Finally, an automatic algorithm for notch/slur detection within the QRS complex was applied based on the same wavelet approach used for delineation. In the validation set, LBBB was diagnosed with a sensitivity and specificity of Se = 92.9% and Sp = 65.1% (Acc = 79.5%, PPV = 74% and NPV = 89.6%). The results confirmed that diagnosis of strict LBBB can be done based on a fully automatic extraction of temporal and morphological QRS features. However, it became evident that consensus in the definition of QRS duration as well as notch and slurs definitions is necessary in order to guarantee accurate and repeatable diagnosis of complete LBBB

A study on stability analysis of atrial repolarization variability using ARX model in sinus rhythm and atrial tachycardia ECGs

© 2016 Elsevier Ireland Ltd Background The interaction between the PTa and PP interval dynamics from the surface ECG is seldom explained. Mathematical modeling of these intervals is of interest in finding the relationship between the heart rate and repolarization variability. Objective The goal of this paper is to assess the bounded input bounded output (BIBO) stability in PTa interval (PTaI) dynamics using autoregressive exogenous (ARX) model and to investigate the reason for causing instability in the atrial repolarization process. Methods Twenty-five male subjects in normal sinus rhythm (NSR) and ten male subjects experiencing atrial tachycardia (AT) were included in this study. Five minute long, modified limb lead (MLL) ECGs were recorded with an EDAN SE-1010 PC ECG system. The number of minute ECGs with unstable segments (N us ) and the frequency of premature activation (PA) (i.e. atrial activation) were counted for each ECG recording and compared between AT and NSR subjects. Results The instability in PTaI dynamics was quantified by measuring the numbers of unstable segments in ECG data for each subject. The unstable segments in the PTaI dynamics were associated with the frequency of PA. The presence of PA is not the only factor causing the instability in PTaI dynamics in NSR subjects, and it is found that the cause of instability is mainly due to the heart rate variability (HRV). C onclusion The ARX model showed better prediction of PTa interval dynamics in both groups. The frequency of PA is significantly higher in AT patients than NSR subjects. A more complex model is needed to better identify and characterize healthy heart dynamics