A Review of Atrial Fibrillation Detection Methods as a Service

Atrial Fibrillation (AF) is a common heart arrhythmia that often goes undetected, and even if it is detected, managing the condition may be challenging. In this paper, we review how the RR interval and Electrocardiogram (ECG) signals, incorporated into a monitoring system, can be useful to track AF events. Were such an automated system to be implemented, it could be used to help manage AF and thereby reduce patient morbidity and mortality. The main impetus behind the idea of developing a service is that a greater data volume analyzed can lead to better patient outcomes. Based on the literature review, which we present herein, we introduce the methods that can be used to detect AF efficiently and automatically via the RR interval and ECG signals. A cardiovascular disease monitoring service that incorporates one or multiple of these detection methods could extend event observation to all times, and could therefore become useful to establish any AF occurrence. The development of an automated and efficient method that monitors AF in real time would likely become a key component for meeting public health goals regarding the reduction of fatalities caused by the disease. Yet, at present, significant technological and regulatory obstacles remain, which prevent the development of any proposed system. Establishment of the scientific foundation for monitoring is important to provide effective service to patients and healthcare professionals

Continuous 24-h Photoplethysmogram Monitoring Enables Detection of Atrial Fibrillation

Aim: Atrial fibrillation (AF) detection is challenging because it is often asymptomatic and paroxysmal. We evaluated continuous photoplethysmogram (PPG) for signal quality and detection of AF.Methods: PPGs were recorded using a wrist-band device in 173 patients (76 AF, 97 sinus rhythm, SR) for 24 h. Simultaneously recorded 3-lead ambulatory ECG served as control. The recordings were split into 10-, 20-, 30-, and 60-min time-frames. The sensitivity, specificity, and F1-score of AF detection were evaluated for each time-frame. AF alarms were generated to simulate continuous AF monitoring. Sensitivities, specificities, and positive predictive values (PPVs) of the alarms were evaluated. User experiences of PPG and ECG recordings were assessed. The study was registered in the Clinical Trials database (NCT03507335).Results: The quality of PPG signal was better during night-time than in daytime (67.3 +/- 22.4% vs. 30.5 +/- 19.4%, p < 0.001). The 30-min time-frame yielded the highest F1-score (0.9536), identifying AF correctly in 72/76 AF patients (sensitivity 94.7%), only 3/97 SR patients receiving a false AF diagnosis (specificity 96.9%). The sensitivity and PPV of the simulated AF alarms were 78.2 and 97.2% at night, and 49.3 and 97.0% during the daytime. 82% of patients were willing to use the device at home.Conclusion: PPG wrist-band provided reliable AF identification both during daytime and night-time. The PPG data's quality was better at night. The positive user experience suggests that wearable PPG devices could be feasible for continuous rhythm monitoring.Peer reviewe

Photoplethysmography based atrial fibrillation detection: an updated review from July 2019

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant health ramifications, including an elevated susceptibility to ischemic stroke, heart disease, and heightened mortality. Photoplethysmography (PPG) has emerged as a promising technology for continuous AF monitoring for its cost-effectiveness and widespread integration into wearable devices. Our team previously conducted an exhaustive review on PPG-based AF detection before June 2019. However, since then, more advanced technologies have emerged in this field. This paper offers a comprehensive review of the latest advancements in PPG-based AF detection, utilizing digital health and artificial intelligence (AI) solutions, within the timeframe spanning from July 2019 to December 2022. Through extensive exploration of scientific databases, we have identified 59 pertinent studies. Our comprehensive review encompasses an in-depth assessment of the statistical methodologies, traditional machine learning techniques, and deep learning approaches employed in these studies. In addition, we address the challenges encountered in the domain of PPG-based AF detection. Furthermore, we maintain a dedicated website to curate the latest research in this area, with regular updates on a regular basis

A real-time ppg peak detection method for accurate determination of heart rate during sinus rhythm and cardiac arrhythmia

Objective: We have developed a peak detection algorithm for accurate determination of heart rate, using photoplethysmographic (PPG) signals from a smartwatch, even in the presence of various cardiac rhythms, including normal sinus rhythm (NSR), premature atrial contraction (PAC), premature ventricle contraction (PVC), and atrial fibrillation (AF). Given the clinical need for accurate heart rate estimation in patients with AF, we developed a novel approach that reduces heart rate estimation errors when compared to peak detection algorithms designed for NSR. Methods: Our peak detection method is composed of a sequential series of algorithms that are combined to discriminate the various arrhythmias described above. Moreover, a novel Poincaré plot scheme is used to discriminate between basal heart rate AF and rapid ventricular response (RVR) AF, and to differentiate PAC/PVC from NSR and AF. Training of the algorithm was performed only with Samsung Simband smartwatch data, whereas independent testing data which had more samples than did the training data were obtained from Samsung’s Gear S3 and Galaxy Watch 3. Results: The new PPG peak detection algorithm provides significantly lower average heart rate and interbeat interval beat-to-beat estimation errors—30% and 66% lower—and mean heart rate and mean interbeat interval estimation errors—60% and 77% lower—when compared to the best of the seven other traditional peak detection algorithms that are known to be accurate for NSR. Our new PPG peak detection algorithm was the overall best performers for other arrhythmias. Conclusion: The proposed method for PPG peak detection automatically detects and discriminates between various arrhythmias among different waveforms of PPG data, delivers significantly lower heart rate estimation errors for participants with AF, and reduces the number of false negative peaks. Significance: By enabling accurate determination of heart rate despite the presence of AF with rapid ventricular response or PAC/PVCs, we enable clinicians to make more accurate recommendations for heart rate control from PPG data

Atrial Fibrillation Detection Using RR-Intervals for Application in Photoplethysmographs

Atrial Fibrillation is a common form of irregular heart rhythm that can be very dangerous. Our primary goal is to analyze Atrial Fibrillation data within ECGs to develop a model based only on RR-Intervals, or the length between heart-beats, to create a real time classification model for Atrial Fibrillation to be implemented in common heart-rate monitors on the market today. Physionet's MIT-BIH Atrial Fibrillation Database \cite{goldberger2000physiobank} and 2017 Challenge Database \cite{clifford2017af} were used to identify patterns of Atrial Fibrillation and test classification models on. These two datasets are very different. The MIT-BIH database contains long samples taken with a medical grade device, which is not useful for simulating a consumer device, but is useful for Atrial Fibrillation pattern detection. The 2017 Challenge database includes short ($<60sec$) samples taken with a portable device and reveals many of the challenges of Atrial Fibrillation classification in a real-time device. We developed multiple SVM models with three sets of extracted features as predictor variables which gave us moderately high accuracies with low computational intensity. With robust filtering techniques already applied in many Photoplethysmograph-based consumer heart-rate monitors, this method can be used to develop a reliable real time model for Atrial Fibrillation detection in consumer-grade heart-rate monitors

A Deep Learning Classifier for Detecting Atrial Fibrillation in Hospital Settings Applicable to Various Sensing Modalities

Cardiac signals provide variety of information related to the patient\u27s health. One of the most important is for medical experts to diagnose the functionality of a patient’s heart. This information helps the medical experts monitor heart disease such as atrial fibrillation and heart failure. Atrial fibrillation (AF) is one of the most major diseases that are threatening patients’ health. Medical experts measure cardiac signals usng the Electrocardiogram (ECG or EKG), the Photoplethysmogram (PPG), and more recently the Videoplethysmogram (VPG). Then they can use these measurements to analyze the heart functionality to detect heart diseases. In this study, these three major cardiac signals were used with different classification methodologies such as Basic Thresholding Classifiers (BTC), Machine Learning (SVM) classifiers, and deep learning classifiers based on Convolutional Neural Networks (CNN) to detect AF. To support the work, cardiac signals were acquired from forty-six AF subjects scheduled for cardioversion who were enrolled in a clinical study that was approved by the Internal Review Committees to protect human subjects at the University of Rochester Medical Center (URMC, Rochester, NY), and the Rochester Institute of Technology (RIT, Rochester, NY). The study included synchronized measurements of 5 minutes and 30 seconds of ECG, PPG, VPG 180Hz (High-quality camera), VPG 30 Hz (low quality webcam), taken before and after cardioversion of AF subjects receiving treatment at the AF Clinic of URMC. These data are subjected to BTC, SVM, and CNN classifiers to detect AF and compare the result for each classifier depending on the signal type. We propose a deep learning approach that is applicable to different kinds of cardiac signals to detect AF in a similar manner. By building this technique for different sensors we aim to provide a framework to implement a technique that can be used for most devices, such as, phones, tablets, PCs, ECG devices, and wearable PPG sensors. This conversion of the different sensing platforms provides a single AF detection classifier that can support a complete monitoring cycle that is referring to screen the patient whether at a hospital or home. By using that, the risk factor of heart attack, stroke, or other kind of heart complications can be reduced to a low level to prevent major dangers, since increasing monitoring AF patients helps to predict the disease at an early stage as well as track its progress. We show that the proposed approach provides around 99% accuracy for each type of classifier on the test dataset, thereby helping generalize AF detection by simplifying implementation using a sensor-agnostic deep learning model

BayesBeat: A Bayesian Deep Learning Approach for Atrial Fibrillation Detection from Noisy Photoplethysmography Data

The increasing popularity of smartwatches as affordable and longitudinal monitoring devices enables us to capture photoplethysmography (PPG) sensor data for detecting Atrial Fibrillation (AF) in real-time. A significant challenge in AF detection from PPG signals comes from the inherent noise in the smartwatch PPG signals. In this paper, we propose a novel deep learning based approach, BayesBeat that leverages the power of Bayesian deep learning to accurately infer AF risks from noisy PPG signals, and at the same time provide the uncertainty estimate of the prediction. Bayesbeat is efficient, robust, flexible, and highly scalable which makes it particularly suitable for deployment in commercially available wearable devices. Extensive experiments on a recently published large dataset reveal that our proposed method BayesBeat substantially outperforms the existing state-of-the-art methods.Comment: 8 pages, 5 figure