Decoding atrial fibrillation:Personalized identification and quantification of electropathology

Electrophysiological mapping-guided ablation strategies targeting atrial fibrillation (AF) have improved considerably over the past few years. However, it remains a major challenge to design effective strategies for particularly persistent AF. This can be partially explained by the inadequate understanding of the mechanisms and electropathological substrate underlying AF. Progression of AF is accompanied by structural and electrical remodeling, resulting in complex electrical conduction disorders, which is defined as electropathology. The severity of electropathology thus defines the stage of AF and is a major determinant of the effectiveness of AF therapy. In this thesis, features of electrophysiological properties of atrial tissue have been explored, developed and quantified during normal sinus rhythm, programmed electrical stimulation and AF. In addition, inter- and intra-individual variation in these quantified parameters has been examined in patients with and without prior episodes of AF. The most suitable objective parameters will aid in the identification of patients at risk for early onset or progression of AF. Part I of this thesis focusses on quantified electrogram features related to electropathology. In part II, abnormalities in wavefront propagation due to heterogeneous conduction properties were explored. Part III focusses on identification of post-operative AF and the relation with electropathology. In part IV of this thesis, some clinical implications of high-resolution mapping during cardiac surgery and application of quantified electrophysiological features are discussed

Characterization of the Substrate Modification in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Tesis por compendio[ES] La fibrilación auricular (FA) es la arritmia cardíaca más común. A pesar de la gran popularidad de la ablación con catéter (AC) como tratamiento principal, todavía hay margen de mejora. Aunque las venas pulmonares (VPs) son los principales focos de FA, muchos sitios pueden contribuir a su propagación, formando el sustrato de la FA (SFA). El mapeo preciso del SFA y el registro de la modificación del SFA, como marcador positivo después de AC, son fundamentales. Los electrocardiogramas (ECG) y los electrogramas (EGM) se reclutan para este propósito. Los EGM se utilizan para detectar candidatos de AC como áreas que provocan o perpetúan la FA. Por lo tanto, el análisis de EGM es una parte indispensable de AC. Con la capacidad de observar las aurículas globalmente, la principal aplicación de los ECG es evaluar la modificación del SFA analizando las ondas f o P. A pesar del extenso análisis de cualquiera de los tipos de registro, existen algunas brechas. La AC no-VP aumenta el tiempo en quirófano, provocando mayores riesgos y costos. En cuanto al análisis de la modificación del SFA, se utilizan varios umbrales para definir una onda P prolongada. El principal objetivo de la presente Tesis es contribuir al esfuerzo de análisis de SFA y de modificación de SFA. Para ello, la presente Tesis se desarrolló bajo dos hipótesis principales. Que la calidad de la información extraída durante el SFA y el análisis de modificación del SFA se puede mejorar mediante la introducción de pasos innovadores. Además, la combinación de análisis de ECG y EGM puede aumentar la resolución del mapeo y revelar nueva información sobre los mecanismos de FA. Para cumplir con el objetivo principal, el análisis se divide en 4 partes, conformando los 4 capítulos del Compendio de articulos. En primer lugar, se reclutó la dimensión de correlación de grano grueso (DCGG). DCGG localizó de manera confiable EGM complejos y la clasificación por tipos de FA arrojó una precisión del 84 %. Luego, se adoptó un análisis alternativo de la onda P, estudiando por separado su primera y su segunda parte, correspondientes a la aurícula derecha (AD) e izquierda (AI). Los resultados indicaron LA como la principal fuente de modificación del SFA y subrayaron la importancia de estudiar partes integrales de ECG. Los hallazgos de este estudio también sugieren la implementación de partes integrales de ondas P como un posible alivio de las discrepancias en los umbrales de ondas P para definir el tejido fibrótico. Posteriormente, se estudió el efecto diferente del aislamiento de la VP izquierda (AVPI) y derecha (AVPD) sobre la modificación del SFA. AVPI fue la parte crítica, siendo la fuente exclusiva de acortamiento de onda P. El análisis de los registros durante la AC también permitió una observación más cercana de las fluctuaciones de la variabilidad de la frecuencia cardíaca (VFC) a lo largo del procedimiento de CA, lo que reveló información sobre el efecto de la energía de radiofrecuencia (RF) en el tejido auricular. La última parte se centró en el seno coronario (SC), una estructura fundamental en el mapeo de FA para aumentar la resolución de la información. Se definieron los canales más y menos robustos durante el ritmo sinusal (RS) y se investigó la utilidad de SC en la evaluación de la modificación del SFA. Aunque CS no proporcionó una imagen global de la alteración del SFA, pudo registrar con mayor sensibilidad las fluctuaciones en la respuesta auricular durante la AC. Los hallazgos presentados en esta Tesis Doctoral ofrecen una perspectiva alternativa sobre la modificación del SFA y contribuyen al esfuerzo general sobre el mapeo de FA y la evaluación del sustrato posterior a la CAAC, abriendo futuras líneas de investigación hacia una resolución más alta y un mapeo más eficiente de los mecanismos desencadenantes de la FA.[CA] La fibril·lació auricular (FA) és l'arítmia cardíaca més comú. Tot i la gran popularitat de l'ablació amb catèter (AC) com a tractament principal, encara hi ha marge de millora. Tot i que les venes pulmonars (VPs) són els principals focus de FA, molts llocs poden contribuir a la seva propagació, formant el substrat de la FA (SFA). El mapatge precís de l'SFA i el registre de la modificació de l'SFA, com a marcador positiu després d'AC, són fonamentals. Els electrocardiogrames (ECG) i els electrogrames (EGM) es recluten per a aquest propòsit. Els EGM es fan servir per detectar candidats d'AC com a àrees que provoquen o perpetuen la FA. Per tant, lanàlisi dEGM és una part indispensable dAC. Amb la capacitat d'observar les aurícules globalment, la principal aplicació dels ECG és avaluar la modificació de l'SFA analitzant les ones f o P. Tot i l'extensa anàlisi de qualsevol dels tipus de registre, hi ha algunes bretxes. L'AC no-VP augmenta el temps a quiròfan, provocant majors riscos i costos. Pel que fa a l'anàlisi de la modificació de l'SFA, s'utilitzen diversos llindars per definir una ona P perllongada. L'objectiu principal d'aquesta Tesi és contribuir a l'esforç d'anàlisi de SFA i de modificació de SFA. Per això, aquesta Tesi es va desenvolupar sota dues hipòtesis principals. Que la qualitat de la informació extreta durant el SFA i lanàlisi de modificació de lSFA es pot millorar mitjançant la introducció de passos innovadors. A més, la combinació d'anàlisi d'ECG i EGM pot augmentar la resolució del mapatge i revelar informació nova sobre els mecanismes de FA. Per complir amb l'objectiu principal, l'anàlisi es divideix en 4 parts i es conforma els 4 capítols del Compendi d'articles. En primer lloc, es va reclutar la dimensió de correlació de gra gruixut (DCGG). DCGG va localitzar de manera fiable EGM complexos i la classificació per tipus de FA va donar una precisió del 84%. Després, es va adoptar una anàlisi alternativa de l'ona P, estudiant per separat la primera i la segona part corresponents a l'aurícula dreta (AD) i esquerra (AI). Els resultats van indicar LA com la font principal de modificació de l'SFA i van subratllar la importància d'estudiar parts integrals d'ECG. Les troballes d'aquest estudi també suggereixen la implementació de parts integrals d'ones P com a possible alleugeriment de les discrepàncies als llindars d'ones P per definir el teixit fibròtic. Posteriorment, es va estudiar l'efecte diferent de l'aïllament de la VP esquerra (AVPI) i la dreta (AVPD) sobre la modificació de l'SFA. AVPI va ser la part crítica, sent la font exclusiva d'escurçament d'ona P. L'anàlisi dels registres durant l'AC també va permetre una observació més propera de les fluctuacions de la variabilitat de la freqüència cardíaca (VFC) al llarg del procediment de CA , cosa que va revelar informació sobre l'efecte de l'energia de radiofreqüència (RF) en el teixit auricular. L'última part es va centrar al si coronari (SC), una estructura fonamental al mapeig de FA per augmentar la resolució de la informació. Es van definir els canals més i menys robustos durant el ritme sinusal (RS) i es va investigar la utilitat de SC a l'avaluació de la modificació de l'SFA. Tot i que CS no va proporcionar una imatge global de l'alteració de l'SFA, va poder registrar amb més sensibilitat les fluctuacions a la resposta auricular durant l'AC. Les troballes presentades en aquesta Tesi Doctoral ofereixen una perspectiva alternativa sobre la modificació de l'SFA i contribueixen a l'esforç general sobre el mapeig de FA i l'avaluació del substrat posterior a la CAAC, obrint futures línies de recerca cap a una resolució més alta i un mapeig més eficient dels mecanismes desencadenants de la FA.[EN] Atrial fibrillation (AF) is the commonest cardiac arrhythmia. Despite the high popularity of catheter ablation (CA) as the main treatment, there is still room for improvement. Time spent in AF affects the AF confrontation and evolution, with 1,15% of paroxysmal AF patients progressing to persistent annually. Therefore, from diagnosis to follow-up, every aspect that contributes to the AF confrontation is of utmost importance. Although pulmonary veins (PVs) are the main AF foci, many sites may contribute to the AF propagation, by triggering or sustaining the AF, forming the AF substrate. Precise AF substrate mapping and recording of the AF substrate modification, as a positive marker after CA sessions, are critical. Electrocardiograms (ECGs) and electrograms (EGMs) are vastly recruited for this purpose. EGMs are used to detect candidate CA targets as areas that provoke or perpetuate AF. Hence, EGMs analysis is an indispensable part of the CA procedure. With the ability to observe the atria globally, ECGs' main application is to assess the AF substrate modification by analyzing f- or P-waves from recordings before and after CA. Despite the extensive analysis on either recording types, some gaps exist. Non-PV CA increases the time in operation room, provoking higher risks and costs. Furthermore, whether non-PV CA is beneficial is under dispute. As for the AF substrate modification analysis, various thresholds are used to define a prolonged P-wave, related with poor CA prognostics. The main objective of the present Thesis is to contribute to the effort of AF substrate and AF substrate modification analysis. For this purpose, the present Thesis was developed under two main hypotheses. That the information quality extracted during AF substrate and AF substrate modification analysis can be improved by introducing innovative steps. Also, that combining ECG and EGM analysis can augment the mapping resolution and reveal new information regarding AF mechanisms. To accomplish the main objective, the analysis is split in 4 parts, forming the 4 chapters of the Compendium of publications. Firstly, coarse-grained correlation dimension (CGCD) was recruited. CGCD reliably localized highly complex EGMs and classification by AF types yielded 84% accuracy. Then, an alternative P-wave analysis was suggested, studying separately the first and second P-wave parts, corresponding to the right (RA) and left (LA) atrium. The findings indicated LA as the main AF substrate modification source and underlined the importance of studying integral ECG parts. The findings of this study additionally suggest the implementation of integral P-wave parts as a possible alleviation for the discrepancies in P-wave thresholds to define fibrotic tissue. Afterwards, the different effect of left (LPVI) and right pulmonary vein isolation (RPVI) on the AF substrate modification was studied. LPVI was the critical part, being the exclusive source of P-wave shortening. Analysis of recordings during CA also allowed a closer observation of the heart rate variability (HRV) fluctuations throughout the CA procedure, revealing information on the effect of radiofrequency (RF) energy on the atrial tissue. The last part was focused on coronary sinus (CS), a fundamental structure in AF mapping to increase the information resolution. The most and least robust channels during sinus rhythm (SR) were defined and the utility of CS in AF substrate modification evaluation was investigated. Although CS did not provide a global picture of the AF substrate alteration, it was able to record with higher sensitivity the fluctuations in the atrial response during the application of RF energy. The findings presented in this Doctoral Thesis offer an alternative perspective on the AF substrate modification and contribute to the overall effort on AF mapping and post-CA substrate evaluation, opening future lines of research towards a higher resolution and more efficient mapping of the AF drivers.Vraka, A. (2022). Characterization of the Substrate Modification in Patients Undergoing Catheter Ablation of Atrial Fibrillation [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/191410Compendi

Signal Processing Methods for the Analysis of the Electrocardiogram

Das Elektrokardiogramm (EKG) zeichnet die elektrische Aktivität des Herzens auf der Brust- oberfläche auf. Dieses Signal kann einfach und kostengünstig aufgenommen werden und wird daher in einer Vielzahl von mobilen und stationären Anwendungen genutzt. Es ist über die letzten 100 Jahre zum Goldstandard bei der Diagnose vieler kardiologischer Krankheiten geworden. Herzerkrankungen bleiben ein relevantes Thema in unserer Gesellschaft, da sie zu 30 % aller Todesfälle weltweit führen. Allein die koronare Herzkrankheit ist die häufigste Todesursache überhaupt. Weiterhin sind 2 bis 3 % der Europäer von Herzrhythmusstörungen wie Vorhofflimmern und Vorhofflattern betroffen. Die damit verbundenen geschätzten Kosten in der Europäischen Union belaufen sich auf 26 Milliarden Euro pro Jahr. In allen diesen Fällen ist die Aufzeichnung des EKGs der erste unumgängliche Schritt für eine verlässliche Diagnose und erfolgreiche Therapie. Im Rahmen dieser Dissertation wurden eine Reihe von Algorithmen zur Signalver- arbeitung des EKG entwickelt, die automatisch die rhythmischen und morphologischen Eigenschaften aus dem EKG extrahieren und dadurch den diagnostischen Prozess und die Entscheidungsfindung des Arztes unterstützen. In einem ersten Projekt wurde das Phänomen der postextrasystolischen T-Wellen-Änderung (PEST) untersucht. Die aus der PEST ex- trahierten Biomarker haben wir als Prädiktoren für Herzversagen postuliert. Ein zweites Projekt handelte vom Entwurf eines akkuraten Algorithmus zur Detektion und Annotation der P-Welle im EKG. Als Referenz während der Entwicklung wurden intrakardial gemessene Signale verwendet. Eine dritte Untersuchg hatte das Ziel, das physiologische Phänomen der respiratorischen Sinusarrhythmie (RSA) besser zu verstehen. In diesem Projekt wurde ein Algorithmus zur Trennung der Herzratenvariabilität (HRV) in ihre atmungsabhängige und ihre atmungsunabhn ̈gige Komponente untersucht. Letzterer Anteil der HRV könnte neue Erkenntnisse über die Regulationsmechanismen des kardiovaskulären Systems liefern. In der vierten und letzten Studie wurde der Einfluss mentaler Belastung auf das EKG während der Autofahrt untersucht. Eine Vielzahl von Deskriptoren wurden gefunden, die eine gefährliche mentale Beanspruchung detektieren und somit den Fahrer vor einem möglichen Unfall schützen können. Wir schließen aus diesen Untersuchungen, dass gut entwickelte Methoden der Signalver- arbeitung des EKG das Potential haben, die Belastung der Patienten, die an Herzerkrankungen leiden, und die Anzahl der Verkehrsunfälle zu reduzieren

Analyse des ondes P et T des signaux ECG à l'aide de méthodes Bayésienne

Cette thèse a pour objet l étude de méthodes Bayésiennes pour l analyse des ondes P et T des signaux ECG. Différents modèles statistiques et des méthodes Bayésiennes associées sont proposés afin de réaliser la détection des ondes P et T et leur caractérisation (détermination du sommet et des limites des ondes ainsi que l estimation des formes d onde). Ces modèles prennent en compte des lois a priori pour les paramètres inconnus (les positions des ondes, les amplitudes et les coefficients de ces formes d'onde) associés aux signaux ECG. Ces lois a priori sont ensuite combinées avec la vraisemblance des données observées pour fournir les lois a posteriori des paramètres inconnus. En raison de la complexité des lois a posteriori obtenues, des méthodes de Monte Carlo par Chaînes de Markov sont proposées pour générer des échantillons distribués asymptotiquement suivant les lois d intérêt. Ces échantillons sont ensuite utilisés pour approcher les estimateurs Bayésiens classiques (MAP ou MMSE). D'autre part, pour profiter de la nature séquentielle du signal ECG, un modèle dynamique est proposé. Une méthode d'inférence Bayésienne similaire à celle développée précédemment et des méthodes de Monte Carlo séquentielles (SMC) sont ensuite étudiées pour ce modèle dynamique. Dans la dernière partie de ce travail, deux modèles Bayésiens introduits dans cette thèse sont adaptés pour répondre à un sujet de recherche clinique spécifique appelé détection de l'alternance des ondes T. Une des approches proposées a servi comme outil d'analyse dans un projet en collaboration avec St. Jude Medical, Inc et l'hôpital de Rangueil à Toulouse, qui vise à évaluer prospectivement la faisabilité de la détection des alternances des ondes T dans les signaux intracardiaques.This thesis studies Bayesian estimation/detection algorithms for P and T wave analysis in ECG signals. In this work, different statistical models and associated Bayesian methods are proposed to solve simultaneously the P and T wave delineation task (determination of the positions of the peaks and boundaries of the individual waves) and the waveform-estimation problem. These models take into account appropriate prior distributions for the unknown parameters (wave locations and amplitudes, and waveform coefficients). These prior distributions are combined with the likelihood of the observed data to provide the posterior distribution of the unknown parameters. Due to the complexity of the resulting posterior distributions, Markov chain Monte Carlo algorithms are proposed for (sample-based) detection/estimation. On the other hand, to take full advantage of the sequential nature of the ECG, a dynamic model is proposed under a similar Bayesian framework. Sequential Monte Carlo methods (SMC) are also considered for delineation and waveform estimation. In the last part of the thesis, two Bayesian models introduced in this thesis are adapted to address a specific clinical research problem referred to as T wave alternans (TWA) detection. One of the proposed approaches has served as an efficient analysis tool in the Endocardial T wave Alternans Study (ETWAS) project in collaboration with St. Jude Medical, Inc and Toulouse Rangueil Hospital. This project was devoted to prospectively assess the feasibility of TWA detection in repolarisation on EGM stored in ICD memories.TOULOUSE-INP (315552154) / SudocSudocFranceF

P and T wave analysis in ECG signals using Bayesian methods

Cette thèse a pour objet l’étude de méthodes Bayésiennes pour l’analyse des ondes P et T des signaux ECG. Différents modèles statistiques et des méthodes Bayésiennes associées sont proposés afin de réaliser la détection des ondes P et T et leur caractérisation (détermination du sommet et des limites des ondes ainsi que l’estimation des formes d’onde). Ces modèles prennent en compte des lois a priori pour les paramètres inconnus (les positions des ondes, les amplitudes et les coefficients de ces formes d'onde) associés aux signaux ECG. Ces lois a priori sont ensuite combinées avec la vraisemblance des données observées pour fournir les lois a posteriori des paramètres inconnus. En raison de la complexité des lois a posteriori obtenues, des méthodes de Monte Carlo par Chaînes de Markov sont proposées pour générer des échantillons distribués asymptotiquement suivant les lois d’intérêt. Ces échantillons sont ensuite utilisés pour approcher les estimateurs Bayésiens classiques (MAP ou MMSE). D'autre part, pour profiter de la nature séquentielle du signal ECG, un modèle dynamique est proposé. Une méthode d'inférence Bayésienne similaire à celle développée précédemment et des méthodes de Monte Carlo séquentielles (SMC) sont ensuite étudiées pour ce modèle dynamique. Dans la dernière partie de ce travail, deux modèles Bayésiens introduits dans cette thèse sont adaptés pour répondre à un sujet de recherche clinique spécifique appelé détection de l'alternance des ondes T. Une des approches proposées a servi comme outil d'analyse dans un projet en collaboration avec St. Jude Medical, Inc et l'hôpital de Rangueil à Toulouse, qui vise à évaluer prospectivement la faisabilité de la détection des alternances des ondes T dans les signaux intracardiaques. ABSTRACT : This thesis studies Bayesian estimation/detection algorithms for P and T wave analysis in ECG signals. In this work, different statistical models and associated Bayesian methods are proposed to solve simultaneously the P and T wave delineation task (determination of the positions of the peaks and boundaries of the individual waves) and the waveform-estimation problem. These models take into account appropriate prior distributions for the unknown parameters (wave locations and amplitudes, and waveform coefficients). These prior distributions are combined with the likelihood of the observed data to provide the posterior distribution of the unknown parameters. Due to the complexity of the resulting posterior distributions, Markov chain Monte Carlo algorithms are proposed for (sample-based) detection/estimation. On the other hand, to take full advantage of the sequential nature of the ECG, a dynamic model is proposed under a similar Bayesian framework. Sequential Monte Carlo methods (SMC) are also considered for delineation and waveform estimation. In the last part of the thesis, two Bayesian models introduced in this thesis are adapted to address a specific clinical research problem referred to as T wave alternans (TWA) detection. One of the proposed approaches has served as an efficient analysis tool in the Endocardial T wave Alternans Study (ETWAS) project in collaboration with St. Jude Medical, Inc and Toulouse Rangueil Hospital. This project was devoted to prospectively assess the feasibility of TWA detection in repolarisation on EGM stored in ICD memories

Novel ECG and Intracardiac Electrograms Signal Processing Schemes for Predicting the Outcome of Atrial Fibrillation Catheter Ablation

Atrial fibrillation (AF) is the most common encountered cardiac rhythm disorder (arrhythmia) in clinical practice. It is responsible for about one third of arrhythmia-related hospitalizations. This arrhythmia, which increases in prevalence with age, leads to severe complications and subsequently decreases the quality of life for the affected patients. Lifetime risks for developing AF are ~25% in subjects older than 40 years old. Currently, this arrhythmia is considered as a major public health concern. AF is a progressive disease, starting by short and rare episodes which further develop into longer and more frequent occurrences. When the arrhythmia becomes sustained for more than one year, it is labelled as long-standing persistent. AF advancement gives rise to an electrical of the atria (the upper chambers of the heart) resulting from abnormal high frequency atrial activations. The main goals of therapeutic management for patients with AF are to prevent severe complications associated with this arrhythmia, and ultimately to restore a normal rhythm. Currently, the cornerstone of non-pharmacological therapy is the radiofrequency catheter ablation of AF, which consists in delivering at strategic locations within the atria high-frequency electrical impulses. However, catheter ablation for patients with long-standing persistent AF involves extensive ablation of the atria and the success rate reported in various publications is associated with conflicting results. Over the last twenty years, an important effort has been made by the scientific community to develop signal processing algorithms to quantify the complexity of temporal or spectral characteristics of AF dynamics in terms of organization. As such, multiple approaches have been proposed to quantify AF organization either based on time-domain or frequency-domain analysis. All these methods shared one common goal: the development of organization indices which are interpretable from an electrophyisiological viewpoint. In the context of catheter ablation of patients with long-standing persistent AF, the success rate appears limited as the "classical" organization indices are not performant in assessing the amount of ablation required to achieve AF termination. Thus, there is a strong interest in predicting the procedural outcome from the surface electrocardiogram (ECG) recorded at baseline, i.e., prior to ablation. The main objective of this thesis was to derive novel organization indices from surface ECG and intracardiac signals acquired at baseline which could discriminate patients in whom AF was terminated from patients in whom AF persisted during catheter ablation within the left atrium. As the standard surface ECG is not appropriate for measuring the atrial activity, we aimed at adapting the placement of at least one ECG lead such that additional electrical information from the atria was provided. In our ECG signals study, we hypothesized that a quantification of the harmonic structure of AF signals brings more insight into AF complexity. Time-invariant and time-varying approaches were used to derive the ECG organization indices, and their performance for predicting the acute outcome of catheter ablation were compared. In the first scheme, the harmonic components of AF waves were extracted using linear time-invariant filters. In the second one, the components were extracted using an adaptive harmonic frequency tracking algorithm. [...

Current Issues and Recent Advances in Pacemaker Therapy

Patients with implanted pacemakers or defibrillators are frequently encountered in various healthcare settings. As these devices may be responsible for, or contribute to a variety of clinically significant issues, familiarity with their function and potential complications facilitates patient management. This book reviews several clinically relevant issues and recent advances of pacemaker therapy: implantation, device follow-up and management of complications. Innovations and research on the frontiers of this technology are also discussed as they may have wider utilization in the future. The book should provide useful information for clinicians involved in the management of patients with implanted antiarrhythmia devices and researchers working in the field of cardiac implants

Advanced robust non-invasive foetal heart detection techniques during active labour using one pair of transabdominal electrodes

The thesis proposes and evaluates three state-of-the-art signal processing techniques to detect fetal heartbeats within each maternal cardiac cycle, during labour contractions, using only a pair of transabdominal electrodes. The first and second techniques are, namely, the structured third- order cumulant-slice-template matching and the bispectral-contours-template matching for fetal QRS identification, respectively. The third technique is based on the modified and appropriately weighted spectral multiple signal classification (MUSIC) with incorporated covariance matrix for uterine contraction noise-like interfering signals also contaminated with noise. Essentially, two modifications to the standard MUSIC have been developed in order to enhance the performance of the spectral estimator in our applied work. The first modification involves the introduction of an optimised weighting function to the segmented ECG covariance matrix, and is chiefly aimed at enhancing the fetal QRS major spectral peak which occurs at around 30 Hz against the mother QRS major spectral peak usually occurring around 17 Hz and all other noise contributions. Additional optional pseudo-bispectral enhancement to sharpen the maternal and fetal spectral peaks, in particular when the mother and fetal R-waves are temporally coincident, have been achieved. The second modification to the spectral MUSIC is the removal of the unjustified assumption that only white Gaussian noise is present and the incorporation of the actual measured labour uterine contraction covariance matrix in reconfigured subspace analysis. This inevitably leads to the generalised eigenvectors - eigenvalues decomposition modern signal processing. This is now coined the modified, interference incorporated pseudo-spectral MUSIC. The above mentioned first and second techniques are higher-order statistics-based (HOS) and hybrid involving both signal processing and NN classifiers. The third technique is second-order statistics-based (SOS). In all techniques, the removal of signal non-linearity with the aid of non-linear Volterra synthesisers plays a crucial part in the fetal detection integrity. Accurately assessed fetal heart classification rates as high as 95% have been achieved during labour, thus helping to provide non-invasive transparency to fetal intrapartum welfare. Performance analysis and evaluation processes involved more than 30 critical cases classified as “fetal under stress in labour” recorded in a London hospital database and used both transbadominal ECG electrodes and fetal scalp electrodes. The latter facilitates detection of the instantaneous fetal heart rate which is then used as the Reference Fetal Heart Rate in the assessment of the classification rate of each of the above mentioned techniques. It will be shown that the fetal heartbeats are completely masked by uterine activity and noise artefacts in all the recorded transabdominal maternal ECG signals. The fetal scalp electrode was, therefore, deemed necessary to provide the highest accurate measure of fetal heart functionality (from the hospital viewpoint), and in the assessment of the three non-invasive techniques presented in this thesis. The techniques may also be used during gestation and as early as 10 weeks

Libro de actas. XXXV Congreso Anual de la Sociedad Española de Ingeniería Biomédica

596 p.CASEIB2017 vuelve a ser el foro de referencia a nivel nacional para el intercambio científico de conocimiento, experiencias y promoción de la I D i en Ingeniería Biomédica. Un punto de encuentro de científicos, profesionales de la industria, ingenieros biomédicos y profesionales clínicos interesados en las últimas novedades en investigación, educación y aplicación industrial y clínica de la ingeniería biomédica. En la presente edición, más de 160 trabajos de alto nivel científico serán presentados en áreas relevantes de la ingeniería biomédica, tales como: procesado de señal e imagen, instrumentación biomédica, telemedicina, modelado de sistemas biomédicos, sistemas inteligentes y sensores, robótica, planificación y simulación quirúrgica, biofotónica y biomateriales. Cabe destacar las sesiones dedicadas a la competición por el Premio José María Ferrero Corral, y la sesión de competición de alumnos de Grado en Ingeniería biomédica, que persiguen fomentar la participación de jóvenes estudiantes e investigadores

Detection of cardiac arrhythmias through singular spectrum analysis of a time-distorted EGM signal

International Conference on Soft Computing Models in Industrial and Environmental Applications, SOCO 2017 (12th. 2017)International Conference on Computational Intelligence in Security for Information Systems, CISIS (10th. 2017) International Conference on European Transnational Education, ICEUTE (8th. 2017. Leon; Spain