Is the diagnostic function of pacemakers a reliable source of information about ventricular arrhythmias?

Background: The aim of this study was to evaluate the reliability of pacemaker diagnostic function in diagnosing ventricular arrhythmias. Methods: We compared the occurrence of ventricular ectopic beats in 51 simultaneous 24-hour electrocardiogram (ECG) recordings and pacemaker event counters printouts. The diagnostic function of a pacemaker allowed also for a qualitative assessment in 38 patients. In these cases, the occurrence of complex forms of ventricular arrhythmias was cross-checked for accelerated ventricular rhythms together with ventricular tachycardia, and triplets and couplets. The detection of at least one type of complex ventricular form of arrhythmia, diagnosed by both methods, was considered as an agreement between the methods. Results: The results of ventricular ectopic beat counts differed significantly between the methods. In three (6%) patients, the results were consistent; in 20 (39%) the pacemaker underestimated results; in 28 (55%) they were overestimated. When more liberal criteria of agreement were applied, clinically significant differences were observed in 24 (47%) patients; in seven (29%) patients the count made by the pacemaker was lowered; and in 17 (71%) it was overestimated. Ventricular tachycardias were recorded in 24-hour ECG in eight patients. In three, they were identified by the pacemaker diagnostic function. In five, the pacemaker did not recognize tachycardia (because of its frequency being below 120/min). In nine, tachycardia was recognized falsely. The sensitivity in ventricular tachycardia diagnosis by pacemaker diagnostic function was 38%, specificity - 70%, the value of a positive result - 25%, negative - 81%. Conclusions: The evaluation of ventricular arrhythmias by pacemaker cannot serve as the only reliable diagnostic method of arrhythmias. The presence of a large number of sequences that may correspond to ventricular arrhythmia or failure to sense, should result in verification via 24-hour ECG monitoring. (Cardiol J 2010; 17, 5: 495-502

Personalized Monitoring and Advance Warning System for Cardiac Arrhythmias

Each year more than 7 million people die from cardiac arrhythmias. Yet no robust solution exists today to detect such heart anomalies right at the moment they occur. The purpose of this study was to design a personalized health monitoring system that can detect early occurrences of arrhythmias from an individual's electrocardiogram (ECG) signal. We first modelled the common causes of arrhythmias in the signal domain as a degradation of normal ECG beats to abnormal beats. Using the degradation models, we performed abnormal beat synthesis which created potential abnormal beats from the average normal beat of the individual. Finally, a Convolutional Neural Network (CNN) was trained using real normal and synthesized abnormal beats. As a personalized classifier, the trained CNN can monitor ECG beats in real time for arrhythmia detection. Over 34 patients' ECG records with a total of 63,341 ECG beats from the MIT-BIH arrhythmia benchmark database, we have shown that the probability of detecting one or more abnormal ECG beats among the first three occurrences is higher than 99.4% with a very low false-alarm rate. 1 2017 The Author(s).Scopu

Quality Control in ECG-based Atrial Fibrillation Screening

This thesis comprises an introductory chapter and four papers related to quality control in ECG-based atrial fibrillation (AF) screening. Atrial fibrillation is a cardiac arrhythmia characterized by an irregular rhythm and constitutes a major risk factor for stroke. Anticoagulation therapy significantly reduces this risk, and therefore, AF screening is motivated. Atrial fibrillation screening is often done using ECGs recorded outside the clinical environment. However, the higher susceptibility of such ECGs to noise and artifacts makes the identification of patients with AF challenging. The present thesis addresses these challenges at different levels in the data analysis chain. Paper I presents a convolutional neural network (CNN)-based approach to identify transient noise and artifacts in the detected beat sequence before AF detection. The results show that by inserting a CNN, prior to the AF detector, the number of false AF detections is reduced by 22.5% without any loss in the sensitivity, suggesting that the number of recordings requiring expert review can be significantly reduced. Paper II investigates the signal quality of a novel wet electrode technology, and how the improved signal quality translates to improved beat detection and AF detection performance. The novel electrode technology is designed for reduction of motion artifacts typically present in Holter ECG recordings. The novel electrode technology shows a better signal quality and detection performance when compared to a commercially available counterpart, especially when the subject becomes more active. Thus, it has the potential to reduce the review burden and costs associated with ambulatory monitoring.Paper III introduces a detector for short-episode supraventricular tachycardia (sSVT) in AF screening recordings, which has been shown to be associated with an increased risk for future AF. Therefore, the identification of subjects with suchepisodes may increase the usefulness of AF screening. The proposed detector is based on the assumption that the beats in an sSVT episode display similar morphology, and that episodes including detections of deviating morphology should be excluded. The results show that the number of false sSVT detections can be significantly reduced (by a factor of 6) using the proposed detector.Paper IV introduces a novel ECG simulation tool, which is capable of producing ECGs with various arrhythmia patterns and with several different types of noise and artifacts. Specifically, the ECG simulator includes models to generate noise observed in ambulatory recordings, and when recording using handheld recording devices. The usefulness of the simulator is illustrated in terms of AF detection performance when the CNN training in Paper I is performed using simulated data. The results show a very similar performance when training with simulated data compared to when training with real data. Thus, the proposed simulator is a valuable tool in the development and training of automated ECG processing algorithms. Together, the four parts, in different ways, contribute to improved algorithmic efficiency in AF screening

Global ECG Classification by Self-Operational Neural Networks with Feature Injection

Objective: Global (inter-patient) ECG classification for arrhythmia detection over Electrocardiogram (ECG) signal is a challenging task for both humans and machines. The main reason is the significant variations of both normal and arrhythmic ECG patterns among patients. Automating this process with utmost accuracy is, therefore, highly desirable due to the advent of wearable ECG sensors. However, even with numerous deep learning approaches proposed recently, there is still a notable gap in the performance of global and patient-specific ECG classification performances. This study proposes a novel approach to narrow this gap and propose a real-time solution with shallow and compact 1D Self-Organized Operational Neural Networks (Self-ONNs). Methods: In this study, we propose a novel approach for inter-patient ECG classification using a compact 1D Self-ONN by exploiting morphological and timing information in heart cycles. We used 1D Self-ONN layers to automatically learn morphological representations from ECG data, enabling us to capture the shape of the ECG waveform around the R peaks. We further inject temporal features based on RR interval for timing characterization. The classification layers can thus benefit from both temporal and learned features for the final arrhythmia classification. Results: Using the MIT-BIH arrhythmia benchmark database, the proposed method achieves the highest classification performance ever achieved, i.e., 99.21% precision, 99.10% recall, and 99.15% F1-score for normal (N) segments; 82.19% precision, 82.50% recall, and 82.34% F1-score for the supra-ventricular ectopic beat (SVEBs); and finally, 94.41% precision, 96.10% recall, and 95.2% F1-score for the ventricular-ectopic beats (VEBs)

Intuitively Assessing ML Model Reliability through Example-Based Explanations and Editing Model Inputs

Interpretability methods aim to help users build trust in and understand the capabilities of machine learning models. However, existing approaches often rely on abstract, complex visualizations that poorly map to the task at hand or require non-trivial ML expertise to interpret. Here, we present two visual analytics modules that facilitate an intuitive assessment of model reliability. To help users better characterize and reason about a model's uncertainty, we visualize raw and aggregate information about a given input's nearest neighbors. Using an interactive editor, users can manipulate this input in semantically-meaningful ways, determine the effect on the output, and compare against their prior expectations. We evaluate our interface using an electrocardiogram beat classification case study. Compared to a baseline feature importance interface, we find that 14 physicians are better able to align the model's uncertainty with domain-relevant factors and build intuition about its capabilities and limitations