Enhancing ECG Analysis of Implantable Cardiac Monitor Data: An Efficient Pipeline for Multi-Label Classification

Implantable Cardiac Monitor (ICM) devices are demonstrating as of today, the fastest-growing market for implantable cardiac devices. As such, they are becoming increasingly common in patients for measuring heart electrical activity. ICMs constantly monitor and record a patient's heart rhythm and when triggered - send it to a secure server where health care professionals (denote HCPs from here on) can review it. These devices employ a relatively simplistic rule-based algorithm (due to energy consumption constraints) to alert for abnormal heart rhythms. This algorithm is usually parameterized to an over-sensitive mode in order to not miss a case (resulting in relatively high false-positive rate) and this, combined with the device's nature of constantly monitoring the heart rhythm and its growing popularity, results in HCPs having to analyze and diagnose an increasingly growing amount of data. In order to reduce the load on the latter, automated methods for ECG analysis are nowadays becoming a great tool to assist HCPs in their analysis. While state-of-the-art algorithms are data-driven rather than rule-based, training data for ICMs often consist of specific characteristics which make its analysis unique and particularly challenging. This study presents the challenges and solutions in automatically analyzing ICM data and introduces a method for its classification that outperforms existing methods on such data. As such, it could be used in numerous ways such as aiding HCPs in the analysis of ECGs originating from ICMs by e.g. suggesting a rhythm type

Visualization of ECG Data on Variant Maps

This chapter presents variant maps for showing potential features in ECG data sets. The variant map is a visualization method different from a traditional ECG. In this chapter, the ECG data sets obtained by clinical ECG monitoring are used as the data source, and the corresponding variant maps are obtained by the variant statistics method. This chapter mainly introduces the variant statistics method about converting ECG data into variant maps. From sample results, various visual properties can be observed, and further explorations are required

Using Three-Dimensional Lorenz Scatter Plots to Detect Patients with Atrioventricular Node Double Path Caused by Interpolated Ventricular Premature Systoles: A Case Study

A series of related electrophysiology phenomena can be caused by the occurrence of interpolated ventricular premature contraction. In our recent three-dimensional Lorenz R-R scatter plot research, we found that atrioventricular node double path caused by interpolated ventricular premature contraction imprints a specific pattern on three-dimensional Lorenz plots generated from 24-hour Holter recordings. We found two independent subclusters separated from the interpolated premature beat precluster, the interpolated premature beat cluster, and the interpolated premature beat postcluster, respectively. Combined with use of the trajectory tracking function and the leap phenomenon, our results reveal the presence of the atrioventricular node double conduction path. </p

From 12 to 1 ECG lead: multiple cardiac condition detection mixing a hybrid machine learning approach with a one-versus-rest classification strategy

Objective. Detecting different cardiac diseases using a single or reduced number of leads is still challenging. This work aims to provide and validate an automated method able to classify ECG recordings. Performance using complete 12-lead systems, reduced lead sets, and single-lead ECGs is evaluated and compared.Approach. Seven different databases with 12-lead ECGs were provided during thePhysioNet/Computing in Cardiology Challenge2021, where 88 253 annotated samples associated with none, one, or several cardiac conditions among 26 different classes were released for training, whereas 42 896 hidden samples were used for testing. After signal preprocessing, 81 features per ECG-lead were extracted, mainly based on heart rate variability, QRST patterns and spectral domain. Next, a One-versus-Rest classification approach made of independent binary classifiers for each cardiac condition was trained. This strategy allowed each ECG to be classified as belonging to none, one or several classes. For each class, a classification model among two binary supervised classifiers and one hybrid unsupervised-supervised classification system was selected. Finally, we performed a 3-fold cross-validation to assess the system's performance.Main results. Our classifiers received scores of 0.39, 0.38, 0.39, 0.38, and 0.37 for the 12, 6, 4, 3 and 2-lead versions of the hidden test set with the Challenge evaluation metric (CM). Also, we obtained a meanG-score of 0.80, 0.78, 0.79, 0.79, 0.77 and 0.74 for the 12, 6, 4, 3, 2 and 1-lead subsets with the public training set during our 3-fold cross-validation.Significance. We proposed and tested a machine learning approach focused on flexibility for identifying multiple cardiac conditions using one or more ECG leads. Our minimal-lead approach may be beneficial for novel portable or wearable ECG devices used as screening tools, as it can also detect multiple and concurrent cardiac conditions

P and R Wave Detection in Complete Congenital Atrioventricular Block

Complete atrioventricular block (type III AVB) is characterized by an absence of P wave transmission to ventricles. This implies that QRS complexes are generated in an autonomous way and are not coordinated with P waves. This work introduces a new algorithm for the detection of P waves for this type of pathology using non-invasive electrocardiographic surface leads. The proposed algorithm is divided into three stages. In the first stage, the R waves located by a QRS detector are used to generate the RR series and time references for the other stages of the algorithm. In the second stage, the ventricular activity (QT segment) is removed by using an adaptive filter that obtains an averaged pattern of the QT segment. In the third stage, a new P wave detector is applied to the residual signal obtained after QT cancellation in order to detect P wave locations and get the PP time series. Eight Holter records from patients with congenital type III AVB were used to verify the proposed algorithm. Although further improvements should be made to improve the algorithm¿s performance, the results obtained show high average values of sensitivity (90.52 %) and positive prediction (90.98%)

From 12 to 1 ECG lead: multiple cardiac condition detection mixing a hybrid machine learning approach with a one-vs-rest classification strategy

[EN] Objective: Detecting different cardiac diseases using a single or reduced number of leads is still challenging. This work aims to provide and validate an automated method able to classify ECG recordings. Performance using complete 12-lead systems, reduced lead sets, and single-lead ECGs is evaluated and compared. Approach: Seven different databases with 12-lead ECGs were provided during the PhysioNet/Computing in Cardiology Challenge 2021, where 88,253 annotated samples associated with none, one, or several cardiac conditions among 26 different classes were released for training, whereas 42,896 hidden samples were used for testing. After signal preprocessing, 81 features per ECG-lead were extracted, mainly based on heart rate variability, QRST patterns and spectral domain. Next, a One-vs-Rest classification approach made of independent binary classifiers for each cardiac condition was trained. This strategy allowed each ECG to be classified as belonging to none, one or several classes. For each class, a classification model among two binary Supervised Classifiers and one Hybrid Unsupervised-Supervised classification system was selected. Finally, we performed a 3-fold cross-validation to assess the system's performance. Main results: Our classifiers received scores of 0.39, 0.38, 0.39, 0.38, and 0.37 for the 12, 6, 4, 3 and 2-lead versions of the hidden test set with the Challenge evaluation metric (CM). Also, we obtained a mean G-score of 0.80, 0.78, 0.79, 0.79, 0.77 and 0.74 for the 12, 6, 4, 3, 2 and 1-lead subsets with the public training set during our 3-fold cross-validation. Significance: We proposed and tested a machine learning approach focused on flexibility for identifying multiple cardiac conditions using one or more ECG leads. Our minimal-lead approach may be beneficial for novel portable or wearable ECG devices used as screening tools, as it can also detect multiple and concurrent cardiac conditions.This work was supported by PID2019-109547RB-I00 (National Research Program, Ministerio de Ciencia e Innovación, Spanish Government) and CIBERCV CB16/11/00486 (Instituto de Salud Carlos III).Jiménez-Serrano, S.; Rodrigo, M.; Calvo Saiz, CJ.; Millet Roig, J.; Castells, F. (2022). From 12 to 1 ECG lead: multiple cardiac condition detection mixing a hybrid machine learning approach with a one-vs-rest classification strategy. Physiological Measurement. 43(6):1-17. https://doi.org/10.1088/1361-6579/ac72f511743

Non-linear dynamical analysis of biosignals

Biosignals are physiological signals that are recorded from various parts of the body. Some of the major biosignals are electromyograms (EMG), electroencephalograms (EEG) and electrocardiograms (ECG). These signals are of great clinical and diagnostic importance, and are analysed to understand their behaviour and to extract maximum information from them. However, they tend to be random and unpredictable in nature (non-linear). Conventional linear methods of analysis are insufficient. Hence, analysis using non-linear and dynamical system theory, chaos theory and fractal dimensions, is proving to be very beneficial. In this project, ECG signals are of interest. Changes in the normal rhythm of a human heart may result in different cardiac arrhythmias, which may be fatal or cause irreparable damage to the heart when sustained over long periods of time. Hence the ability to identify arrhythmias from ECG recordings is of importance for clinical diagnosis and treatment and also for understanding the electrophysiological mechanism of arrhythmias. To achieve this aim, algorithms were developed with the help of MATLAB® software. The classical logic of correlation was used in the development of algorithms to place signals into the various categories of cardiac arrhythmias. A sample set of 35 known ECG signals were obtained from the Physionet website for testing purposes. Later, 5 unknown ECG signals were used to determine the efficiency of the algorithms. A peak detection algorithm was written to detect the QRS complex. This complex is the most prominent waveform within an ECG signal and its shape, duration and time of occurrence provides valuable information about the current state of the heart. The peak detection algorithm gave excellent results with very good accuracy for all the downloaded ECG signals, and was developed using classical linear techniques. Later, a peak detection algorithm using the discrete wavelet transform (DWT) was implemented. This code was developed using nonlinear techniques and was amenable for implementation. Also, the time required for execution was reduced, making this code ideal for real-time processing. Finally, algorithms were developed to calculate the Kolmogorov complexity and Lyapunov exponent, which are nonlinear descriptors and enable the randomness and chaotic nature of ECG signals to be estimated. These measures of randomness and chaotic nature enable us to apply correct interrogative methods to the signal to extract maximum information. The codes developed gave fair results. It was possible to differentiate between normal ECGs and ECGs with ventricular fibrillation. The results show that the Kolmogorov complexity measure increases with an increase in pathology, approximately 12.90 for normal ECGs and increasing to 13.87 to 14.39 for ECGs with ventricular fibrillation and ventricular tachycardia. Similar results were obtained for Lyapunov exponent measures with a notable difference between normal ECG (0 – 0.0095) and ECG with ventricular fibrillation (0.1114 – 0.1799). However, it was difficult to differentiate between different types of arrhythmias.Biosignals are physiological signals that are recorded from various parts of the body. Some of the major biosignals are electromyograms (EMG), electroencephalograms (EEG) and electrocardiograms (ECG). These signals are of great clinical and diagnostic importance, and are analysed to understand their behaviour and to extract maximum information from them. However, they tend to be random and unpredictable in nature (non-linear). Conventional linear methods of analysis are insufficient. Hence, analysis using non-linear and dynamical system theory, chaos theory and fractal dimensions, is proving to be very beneficial. In this project, ECG signals are of interest. Changes in the normal rhythm of a human heart may result in different cardiac arrhythmias, which may be fatal or cause irreparable damage to the heart when sustained over long periods of time. Hence the ability to identify arrhythmias from ECG recordings is of importance for clinical diagnosis and treatment and also for understanding the electrophysiological mechanism of arrhythmias. To achieve this aim, algorithms were developed with the help of MATLAB® software. The classical logic of correlation was used in the development of algorithms to place signals into the various categories of cardiac arrhythmias. A sample set of 35 known ECG signals were obtained from the Physionet website for testing purposes. Later, 5 unknown ECG signals were used to determine the efficiency of the algorithms. A peak detection algorithm was written to detect the QRS complex. This complex is the most prominent waveform within an ECG signal and its shape, duration and time of occurrence provides valuable information about the current state of the heart. The peak detection algorithm gave excellent results with very good accuracy for all the downloaded ECG signals, and was developed using classical linear techniques. Later, a peak detection algorithm using the discrete wavelet transform (DWT) was implemented. This code was developed using nonlinear techniques and was amenable for implementation. Also, the time required for execution was reduced, making this code ideal for real-time processing. Finally, algorithms were developed to calculate the Kolmogorov complexity and Lyapunov exponent, which are nonlinear descriptors and enable the randomness and chaotic nature of ECG signals to be estimated. These measures of randomness and chaotic nature enable us to apply correct interrogative methods to the signal to extract maximum information. The codes developed gave fair results. It was possible to differentiate between normal ECGs and ECGs with ventricular fibrillation. The results show that the Kolmogorov complexity measure increases with an increase in pathology, approximately 12.90 for normal ECGs and increasing to 13.87 to 14.39 for ECGs with ventricular fibrillation and ventricular tachycardia. Similar results were obtained for Lyapunov exponent measures with a notable difference between normal ECG (0 – 0.0095) and ECG with ventricular fibrillation (0.1114 – 0.1799). However, it was difficult to differentiate between different types of arrhythmias