An optimization method based on genetic algorithm for heart rate variability analysis in the prediction of the onset of cardiac arrhythmia

Heart rate variability (HRV) is one of the common biological markers for developing a diagnostic system of cardiovascular disease. HRV analysis is used to extract statistical, geometrical, spectral and non-linear features in such diagnostic system. The diagnostic accuracy can be maximized by applying a feature selection step that selects an optimal feature subset from the extracted features. However, there are shortcomings in using only the feature selection for optimizing a diagnostic system that is based on HRV analysis. One of the main limitations is that the parameters of HRV feature extraction algorithms are not optimized for maximal performance. In addition, the feature selection process does not consider the feature cost and misclassification error of the selected optimal feature subset. Therefore, this thesis proposes a multi-objective optimization method that is based on the non-dominated sorting genetic algorithm to overcome these shortcomings in a cardiac arrhythmia prediction system. It optimizes the HRV feature extraction parameters, selects the best feature subset, and tunes the classifier parameters simultaneously for maximum prediction performance. The proposed optimization algorithm is applied in two cardiac arrhythmia cases, namely the prediction of the onsets of paroxysmal atrial fibrillation (PAF) and ventricular tachyarrhythmia (VTA). In the proposed approach, trade-off between multiple optimization objectives that contradict to each other are also analyzed. The optimization objectives include the feature count, measurement cost, prediction sensitivity, specificity and accuracy rate. The following results prove the effectiveness of the proposed optimization algorithm in the two arrhythmia cases. Firstly, the PAF onset prediction achieves an accuracy rate of 89.6%, which significantly outperforms most of the previous works. This accuracy rate is achieved even with the HRV signal length being reduced from the typical 30 minutes to just 5 minutes (a reduction of 83%). In the case of VTA onset prediction, the accuracy rate of 78.15% is achieved with 5-minute signal length. This result outperforms previous works. Another significant result is the sensitivity rate improvement with the tradeoff of lower specificity and accuracy rate for both PAF and VTA onset predictions. For instance, the sensitivity rate of the VTA onset prediction system improved from 81.48% to 92.59% while the accuracy rate reduced from 78.15% to 72.59%

Heart Rate Variability analysis in patients undergoing local anesthesia

The analysis of Heart Rate Variability (HRV), the beat to beat fluctuation in the heart rate, is a non-invasive technique with a main aim in gaining information about the autonomic neural regulation of the heart. Assessment of HRV has been shown to aid clinical diagnosis and intervention strategies. However, there are quite a few conflicting reports on HRV that perhaps impede its use as a reliable clinical tool. The complex nature of different mechanisms that affect the HRV and the large number of signal processing techniques that have been used for HRV analysis are the contributing factors of these conflicting results. The aim of this study was to investigate for the first time the effect of HRV during Brachial plexus block (local anaesthesia), applied using the axillary approach. The hypothesis was that, such investigation will enable the detection of possible changes in the dynamics of the cardiovascular system due to the intravenous introduction of anaesthetic drugs during local anaesthesia. For this purpose advanced HRV signals processing techniques were developed and evaluated on data collected before and after the application of the Brachial plexus block from fourteen patients undergoing local anaesthesia. Signal processing techniques for R-wave detection, signal representation, ectopic beat detection and detrending were first developed and validated with the help of simulated signals and physiological signals from Physionet data base. After the validation stage these methods were then used to analyse the data from the locally anaesthetised patients. The ECG R-wave peak detection was carried out using the wavelet transform with first derivative of Gaussian smoothing function as the mother wavelet. The algorithm achieved accuracy and sensitivity of over 90%. The heart timing signal was used for the HRV signal representation and also for the correction of missing and/or ectopic beats. The results obtained from the ectopic beat correction algorithm showed that the algorithm managed to significantly reduce the error caused by missing and/or ectopic beats. Detrending of the HRV signal was carried out using the wavelet packet analysis algorithm which was specifically developed for this study. The respiration signal was also estimaited from the ECG signal using the ECG Derived Respiration (EDR) technique. In order to take better account of slow respiration rates and/or irregular respiratory patterns in the HRV analysis, a new method for the estimation of the variable boundaries associated with the LF and the HF band of the HRV signal was implemented. This method relies on the frequency contents of both the HRV signal and the respiration signal and uses the cross-spectrum between these two signals to obtain the boundaries related to the HF band of the signal. The boundaries related to the LF band were defined using the HRV signal spectrum alone. The boundary estimation technique was applicable in all the spectral analysis methods that were used in this study. After the pre-processing steps the clinical data was analysed using frequency and timefrequency analysis methods to obtain the parameters related to the HRV signals. Initially spectral analysis was carried out using the traditional non-parametric (Welch’s periodogram) and parametric (Autoregressive modelling) methods. Statistical analysis of the parameters obtained from both the non-parametric and the parametric methods showed significant decrease in the LF/HF ratio values within an hour of application of the block in nine out of fourteen patients. In order to overcome the inability of these methods to deal with non-stationary, time-frequency analysis techniques were used to further analyse the HRV signals. The three time-frequency analysis methods used were the ContinuousWavelet Transform (CWT), theWigner-Ville Distribution (SPWVD) and the Empirical Mode Decomposition (EMD). The analysis of the parameters estimated from these three techniques on the clinical data showed that the CWT and the EMD techniques have performed equivalently, meaning that both these methods have detected significant decrease in thirteen out of fourteen patients for the ratio values after the application of the,anaesthetic block. The presence of interference terms has caused the degradation in the performance of the SPWVD method and due to this reason it was only able to detect significant changes in the LF/HF ratio values in ten of the fourteen patients. The results suggest that due to anxiety and/or adrenaline present in the local anaesthetic mixture, the LF/HF ratio values showed a transient increase shortly after the application of the block. After this transient increase the ratio values decreased considerably and remained low as compared to the values before the application of the block. This decrease could represent the shift of the sympathovagal balance towards parasympathetic predominance and/or inhabitation of sympathetic activity due to local anaesthesia. The use of timefrequency analysis such as EMD and CWT could provide useful information about the changes caused in the dynamics of the cardiovascular system when a local anaesthetic drug is administered in a patient

Morphological and electrophysiological differences between the Caucasian and South Asian Atrium

Introduction: South Asians (SAs) have a low prevalence of atrial fibrillation (AF) compared with Caucasians despite a higher prevalence of hypertension, diabetes mellitus and coronary artery disease. The aim of this thesis was to determine whether this was related to an under-detection of the arrhythmia and if not, whether differences in left atrial (LA) size, electrophysiological properties or autonomic function in SAs might help to explain this disparity. Methods: Retrospective and prospective cohort studies were performed on SA and Caucasian participants using data from implantable cardiac devices, cardiac magnetic resonance imaging scans, invasive electrophysiology studies and a range of non-invasive cardiac investigations. Results: The cumulative incidence of subclinical AF was significantly lower in SAs compared with Caucasians (log rank p=0.002) with an annual event rate of 6.9% versus 13.9%. In comparison with Caucasians, SAs were of a smaller height with lower lean body mass and higher waist:hip ratio; had lower minimum (27.7±11.1 ml vs 34.9±12.3 ml, p=0.002) and maximum LA volumes (64.7±21.1 ml vs 80.9±22.5 ml, p<0.001) even after matching for body surface area; lower P wave dispersion (males 28.0(12)ms vs 25.0(12)ms, p=0.039; females 24.0(12)ms vs 22.0(12)ms, p=0.004) and P wave terminal force in lead V1 (males 0.031(0.04)mm•s vs 0.021(0.03) mm•s, p=0.023; females 0.036(0.04)mm•s vs 0.034(0.04)mm•s, p=0.030), electrophysiological variations related to the inhomogeneity of LA conduction and LA size respectively; increased heart rate (82.5(18)bpm vs 78.0(18)bpm, p=0.024), lower atrioventricular (280(50)ms vs 300(60)ms, p=0.001) and ventriculoatrial (300(60)ms vs 320(93)ms, p=0.013) effective refractory periods and lower heart rate variability (in SA males), suggestive of sympathetic predominance. Conclusions: SAs have reduced LA size and evidence of increased sympathetic tone and reduced inhomogeneity in LA conduction. The morphological, electrophysiological and autonomic differences identified in SAs may help to explain why this ethnic group has a lower prevalence of AF

Autonomic function in epilepsy

Autonomic function may help to localize and manage the epilepsies. It is likely that the mechanisms of Sudden Unexpected death in Epilepsy (SUDEP) involve autonomic disturbance and a better understanding of these might lead to measures that would help reduce the mortality in patients afflicted with epilepsy. In this thesis, I first provide a comprehensive literature review of the association between epilepsy and the autonomic nervous system. I then evaluate heart rate variability and other cardiac and endocrine parameters as indices of cardiac autonomic function to test three hypothesis; 1) Changes in heart rate variability (HRV), can occur in the peri-ictal period during both (a) subclinical electrographic seizures and (b) clinically overt partial seizures, and can help to localise and lateralise the ictal discharge. 2) Intractable epilepsy can disrupt the heart rate variability and its circadian rhythm. 3) Epileptic seizures affect the serum concentration of the catecholamines and the electrolytes and that these changes could impact on the corrected QT interval. Subjects (n=207) with intractable epilepsy who were being evaluated with video-EEG telemetry for epilepsy surgery were recruited for this study. I found that subclinical seizures have no effect on the HRV. However, in overt partial seizures, HRV decreases, corrected QT is prolonged and plasma catecholamines increases. The reduction in HRV during seizures is not affected by the hemispheric or lobar location of the epileptic focus. However, in the interictal period, reduced HRV differs in left vs. right hemisphere, and in temporal vs. extratemporal areas. The diurnal pattern of HRV is not altered in epilepsy and the mean day HRV were significantly different from mean night HRV. The reduction in HRV is also associated with the following clinical factors: prolonged medical history of epilepsy, the cortical pathology itself, the nature of the seizures, higher seizure frequency and the antiepileptic drug treatment. The plasma electrolytes: Na, K+, Ca2+ and cardiac troponin are not affected after a seizure. However, plasma Mg2+ was seen to increase after a seizure. These abnormalities in autonomic control, particularly the reduction in HRV might be one contributory mechanism of Sudden Unexpected Death in Epilepsy (SUDEP)

Advances in Electrocardiograms

Electrocardiograms have become one of the most important, and widely used medical tools for diagnosing diseases such as cardiac arrhythmias, conduction disorders, electrolyte imbalances, hypertension, coronary artery disease and myocardial infarction. This book reviews recent advancements in electrocardiography. The four sections of this volume, Cardiac Arrhythmias, Myocardial Infarction, Autonomic Dysregulation and Cardiotoxicology, provide comprehensive reviews of advancements in the clinical applications of electrocardiograms. This book is replete with diagrams, recordings, flow diagrams and algorithms which demonstrate the possible future direction for applying electrocardiography to evaluating the development and progression of cardiac diseases. The chapters in this book describe a number of unique features of electrocardiograms in adult and pediatric patient populations with predilections for cardiac arrhythmias and other electrical abnormalities associated with hypertension, coronary artery disease, myocardial infarction, sleep apnea syndromes, pericarditides, cardiomyopathies and cardiotoxicities, as well as innovative interpretations of electrocardiograms during exercise testing and electrical pacing

Cardiovascular data analytics for real time patient monitoring

Improvements in wearable sensor devices make it possible to constantly monitor physiological parameters such as electrocardiograph (ECG) signals for long periods. Remote patient monitoring with wearable sensors has an important role to play in health care, particularly given the prevalence of chronic conditions such as cardiovascular disease (CVD)—one of the prominent causes of morbidity and mortality worldwide. Approximately 4.2 million Australians suffer from long-term CVD with approximately one death every 12 minutes. The assessment of ECG features, especially heart rate variability (HRV), represents a non-invasive technique which provides an indication of the autonomic nervous system (ANS) function. Conditions such as sudden cardiac death, hypertension, heart failure, myocardial infarction, ischaemia, and coronary heart disease can be detected from HRV analysis. In addition, the analysis of ECG features can also be used to diagnose many types of life-threatening arrhythmias, including ventricular fibrillation and ventricular tachycardia. Non-cardiac conditions, such as diabetes, obesity, metabolic syndrome, insulin resistance, irritable bowel syndrome, dyspepsia, anorexia nervosa, anxiety, and major depressive disorder have also been shown to be associated with HRV. The analysis of ECG features from real time ECG signals generated from wearable sensors provides distinctive challenges. The sensors that receive and process the signals have limited power, storage and processing capacity. Consequently, algorithms that process ECG signals need to be lightweight, use minimal storage resources and accurately detect abnormalities so that alarms can be raised. The existing literature details only a few algorithms which operate within the constraints of wearable sensor networks. This research presents four novel techniques that enable ECG signals to be processed within the limitations of resource constraints on devices to detect some key abnormalities in heart function. - The first technique is a novel real-time ECG data reduction algorithm, which detects and transmits only those key points that are critical for the generation of ECG features for diagnoses. - The second technique accurately predicts the five-minute HRV measure using only three minutes of data with an algorithm that executes in real-time using minimal computational resources. - The third technique introduces a real-time ECG feature recognition system that can be applied to diagnose life threatening conditions such as premature ventricular contractions (PVCs). - The fourth technique advances a classification algorithm to enhance the performance of automated ECG classification to determine arrhythmic heart beats based on noisy ECG signals. The four novel techniques are evaluated in comparison with benchmark algorithms for each task on the standard MIT-BIH Arrhythmia Database and with data generated from patients in a major hospital using Shimmer3 wearable ECG sensors. The four techniques are integrated to demonstrate that remote patient monitoring of ECG using HRV and ECG features is feasible in real time using minimal computational resources. The evaluation show that the ECG reduction algorithm is significantly better than existing algorithms that can be applied within sensor nodes, such as time-domain methods, transformation methods and compressed sensing methods. Furthermore, the proposed ECG reduction is found to be computationally less complex for resource constrained sensors and achieves higher compression ratios than existing algorithms. The prediction of a common HRV measure, the five-minute standard deviation of inter-beat variations (SDNN) and the accurate detection of PVC beats was achieved using a Count Data Model, combined with a Poisson-generated function from three-minute ECG recordings. This was achieved with minimal computational resources and was well suited to remote patient monitoring with wearable sensors. The PVC beats detection was implemented using the same count data model together with knowledge-based rules derived from clinical knowledge. A real-time cardiac patient monitoring system was implemented using an ECG sensor and smartphone to detect PVC beats within a few seconds using artificial neural networks (ANN), and it was proven to provide highly accurate results. The automated detection and classification were implemented using a new wrapper-based hybrid approach that utilized t-distributed stochastic neighbour embedding (t-SNE) in combination with self-organizing maps (SOM) to improve classification performance. The t-SNE-SOM hybrid resulted in improved sensitivity, specificity and accuracy compared to most common hybrid methods in the presence of noise. It also provided a better, more accurate identification for the presence of many types of arrhythmias from the ECG recordings, leading to a more timely diagnosis and treatment outcome.Doctor of Philosoph

Signal processing techniques for cardiovascular monitoring applications using conventional and video-based photoplethysmography

Photoplethysmography (PPG)-based monitoring devices will probably play a decisive role in healthcare environment of the future, which will be preventive, predictive, personalized and participatory. Indeed, this optical technology presents several practical advantages over gold standard methods based on electrocardiography, because PPG wearable devices can be comfortably used for long-term continuous monitoring during daily life activities. Contactless video-based PPG technique, also known as imaging photoplethysmography (iPPG), has also attracted much attention recently. In that case, the cardiac pulse is remotely measured from the subtle skin color changes resulting from the blood circulation, using a simple video camera. PPG/iPPG have a lot of potential for a wide range of cardiovascular applications. Hence, there is a substantial need for signal processing techniques to explore these applications and to improve the reliability of the PPG/iPPG-based parameters. \par A part of the thesis is dedicated to the development of robust processing schemes to estimate heart rate from the PPG/iPPG signals. The proposed approaches were built on adaptive frequency tracking algorithms that were previously developed in our group. These tools, based on adaptive band-pass filters, provide instantaneous frequency estimates of the input signal(s) with a very low time delay, making them suitable for real-time applications. In case of conventional PPG, a prior adaptive noise cancellation step involving the use of accelerometer signals was also necessary to reconstruct clean PPG signals during the regions corrupted by motion artifacts. Regarding iPPG, after comparing different regions of interest on the subject face, we hypothesized that the simultaneous use of different iPPG signal derivation methods (i.e. methods to derive the iPPG time series from the pixel values of the consecutive frames) could be advantageous. Methods to assess signal quality online and to incorporate it into instantaneous frequency estimation were also examined and successfully applied to improve system reliability. \par This thesis also explored different innovative applications involving PPG/iPPG signals. The detection of atrial fibrillation was studied. Novel features derived directly from the PPG waveforms, designed to reflect the morphological changes observed during arrhythmic episodes, were proposed and proven to be successful for atrial fibrillation detection. Arrhythmia detection and robust heart rate estimation approaches were combined in another study aimed at reducing the number of false arrhythmia alarms in the intensive care unit by exploiting signals from independent sources, including PPG. Evaluation on a hidden dataset demonstrated that the number of false alarms was drastically reduced while almost no true alarm was suppressed. Finally, other aspects of the iPPG technology were examined, such as the measurement of pulse rate variability indexes from the iPPG signals and the estimation of respiratory rate from the iPPG interbeat intervals