Spatiotemporal blind source separation approach to atrial activity estimation in atrial tachyarrhythmias

The analysis and characterization of atrial tachyarrhythmias requires, in a previous step, the extraction of the atrial activity (AA) free from ventricular activity and other artefacts. This contribution adopts the blind source separation (BSS) approach to AA estimation from multilead electrocardiograms (ECGs). Previously proposed BSS methods for AA extraction-e.g., independent component analysis (ICA)-exploit only the spatial diversity introduced by the multiple spatially-separated electrodes. However, AA typically shows certain degree of temporal correlation, with a narrowband spectrum featuring a main frequency peak around 3.5-9 Hz. Taking advantage of this observation, we put forward a novel two-step BSS-based technique which exploits both spatial and temporal information contained in the recorded ECG signals. The spatiotemporal BSS algorithm is validated on simulated and real ECGs from a significant number of atrial fibrillation (AF) and atrial flutter (AFL) episodes, and proves consistently superior to a spatial-only ICA method. In simulated ECGs, a new methodology for the synthetic generation of realistic AF episodes is proposed, which includes a judicious comparison between the known AA content and the estimated AA sources. Using this methodology, the ICA technique obtains correlation indexes of 0.751, whereas the proposed approach obtains a correlation of 0.830 and an error in the estimated signal reduced by a factor of 40%. In real ECG recordings, we propose to measure performance by the spectral concentration (SC) around the main frequency peak. The spatiotemporal algorithm outperforms the ICA method, obtaining a SC of 58.8% and 44.7%, respectively.     

Comparison of atrial signal extraction algorithms in 12-lead ECGs with atrial fibrillation

Analysis of atrial rhythm is important in the treatment and management of patients with atrial fibrillation. Several algorithms exist for extracting the atrial signal from the electrocardiogram (ECG) in atrial fibrillation, but there are few reports on how well these techniques are able to recover the atrial signal. We assessed and compared three algorithms for extracting the atrial signal from the 12-lead ECG. The 12-lead ECGs of 30 patients in atrial fibrillation were analyzed. Atrial activity was extracted by three algorithms, Spatiotemporal QRST cancellation (STC), principal component analysis (PCA), and independent component analysis (ICA). The amplitude and frequency characteristics of the extracted atrial signals were compared between algorithms and against reference data. Mean (standard deviation) amplitude of QRST segments of V1 was 0.99 (0.54) mV, compared to 0.18 (0.11) mV (STC), 0.19 (0.13) mV (PCA), and 0.29 (0.22) mV (ICA). Hence, for all algorithms there were significant reductions in the amplitude of the ventricular activity compared with that in V1. Reference atrial signal amplitude in V1 was 0.18 (0.11) mV, compared to 0.17 (0.10) mV (STC), 0.12 (0.09) mV (PCA), and 0.18 (0.13) mV (ICA) in the extracted atrial signals. PCA tended to attenuate the atrial signal in these segments. There were no significant differences for any of the algorithms when comparing the amplitude of the reference atrial signal with that of the extracted atrial signals in segments in which ventricular activity had been removed. There were no significant differences between algorithms in the frequency characteristics of the extracted atrial signals. There were discrepancies in amplitude and frequency characteristics of the atrial signal in only a few cases resulting from notable residual ventricular activity for PCA and ICA algorithms. In conclusion, the extracted atrial signals from these algorithms exhibit very similar amplitude and frequency characteristics. Users of these algorithms should be observant of residual ventricular activities which can affect the analysis of the fibrillatory waveform in clinical practice.     

Noninvasive ECG as a tool for predicting termination of paroxysmal atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia and entails an increased risk of thromboembolic events. Prediction of the termination of an AF episode, based on noninvasive techniques, can benefit patients, doctors and health systems. The method described in this paper is based on two-lead surface electrocardiograms (ECGs): 1-min ECG recordings of AF episodes including N-type (not terminating within an hour after the end of the record), S-type (terminating 1 min after the end of the record) and T-type (terminating immediately after the end of the record). These records are organised into three learning sets (N, S and T) and two test sets (A and B). Starting from these ECGs, the atrial and ventricular activities were separated using beat classification and class averaged beat subtraction, followed by the evaluation of seven parameters representing atrial or ventricular activity. Stepwise discriminant analysis selected the set including dominant atrial frequency (DAF, index of atrial activity) and average HR (HRmean, index of ventricular activity) as optimal for discrimination between N/T-type episodes. The linear classifier, estimated on the 20 cases of the N and T learning sets, provided a performance of 90% on the 30 cases of a test set for the N/T-type discrimination. The same classifier led to correct classification in 89% of the 46 cases for N/S-type discrimination. The method has shown good results and seems to be suitable for clinical application, although a larger dataset would be very useful for improvement and validation of the algorithms and the development of an earlier predictor of paroxysmal AF spontaneous termination time.     

Waveform Characterization of Atrial Fibrillation Using Phase Information

A novel method for characterization of f-wave morphology in atrial fibrillation (AF) is presented. The method decomposes atrial activity into fundamental and harmonic components, dividing each component into short blocks for which the amplitudes, frequencies, and phases are estimated. The phase delays between the fundamental and each of the harmonics, here referred to as harmonic phase relationships, are used as features of f-wave morphology. The estimated waves are clustered into typical morphologic patterns. The performance of the method is illustrated by simulated signals, ECG signals recorded from 36 patients with organized AF, and an ECG signal recorded during drug loading with flecainide. The results show that the method can distinguish a wide variety of f-wave morphologies, and that typical morphologies can be established for further analysis of AF.      

A robust method for ECG-based estimation of the respiratory frequency during stress testing

A robust method is presented for electrocardiogram (ECG)-based estimation of the respiratory frequency during stress testing. Such ECGs contain highly nonstationary noise and exhibit changes in QRS morphology which, when combined with the dynamic nature of the respiratory frequency, make most existing methods break down. The present method exploits the oscillatory pattern of the rotation angles of the heart's electrical axis as induced by respiration. The series of rotation angles, obtained from least-squares loop alignment, is subject to power spectral analysis and estimation of the respiratory frequency. Robust techniques are introduced to handle the nonstationary properties of exercise ECGs. The method is evaluated by means of both simulated signals, and ECG/airflow signals recorded from 14 volunteers and 20 patients during stress testing. The resulting respiratory frequency estimation error is, for simulated signals, equal to 0.5% +/- 0.2%, mean +/- SD (0.002 +/- 0.001 Hz), whereas the error between respiratory frequencies of the ECG-derived method and the airflow signals is 5.9% +/- 4% (0.022 +/- 0.016Hz). The results suggest that the method is highly suitable for analysis of noisy ECG signals recorded during stress testing.     

Sequential characterization of atrial tachyarrhythmias based on ECG time-frequency analysis

A new method for characterization of atrial arrhythmias is presented which is based on the time-frequency distribution of an atrial electrocardiographic signal. A set of parameters are derived which describe fundamental frequency, amplitude, shape, and signal-to-noise ratio. The method uses frequency-shifting of an adaptively updated spectral profile, representing the shape of the atrial waveforms, in order to match each new spectrum of the distribution. The method tracks how well the spectral profile fits each spectrum as well as if a valid atrial signal is present. The results are based on the analysis of a learning database with signals from 40 subjects, of which 24 have atrial arrhythmias, and an evaluation database with 211 patients diagnosed with atrial fibrillation. It is shown that the method robustly estimates fibrillation frequency and amplitude and produces spectral profiles with narrower peaks and more discernible harmonics when compared to the conventional power spectrum. The results suggest that a rather strong correlation exist between atrial fibrillation frequency and f wave shape. The developed set of parameters may be used as a basis for automated classification of different atrial rhythms.     

Frequency tracking of atrial fibrillation using hidden Markov models.

A hidden Markov model (HMM) is employed to improve noise robustness when tracking the dominant frequency of atrial fibrillation (AF) in the electrocardiogram (ECG). Following QRST cancellation, a sequence of observed frequency states is obtained from the residual ECG, using the short-time Fourier transform. Based on the observed state sequence, the Viterbi algorithm retrieves the optimal state sequence by exploiting the state transition matrix, incorporating knowledge on AF characteristics, and the observation matrix, incorporating knowledge of the frequency estimation method and signal-to-noise ratio (SNR). The tracking method is evaluated with simulated AF signals to which noise, obtained from ECG recordings, has been added at different SNRs. The results show that the use of HMM improves performance considerably by reducing the rms error associated with frequency tracking: at 4-dB SNR, the rms error drops from 0.2 to 0.04 Hz.     

Convolutive blind source separation algorithms applied to the electrocardiogram of atrial fibrillation: study of performance

The analysis of the surface electrocardiogram (ECG) is the most extended noninvasive technique in medical diagnosis of atrial fibrillation (AF). In order to use the ECG as a tool for the analysis of AF, we need to separate the atrial activity (AA) from other cardioelectric signals. In this matter, statistical signal processing techniques, like blind source separation (BSS), are able to perform a multilead statistical analysis with the aim to obtain the AA. Linear BSS techniques can be divided in two groups depending on the mixing model: algorithms where instantaneous mixing of sources is assumed, and convolutive BSS (CBSS) algorithms. In this work, a comparison of performance between one relevant CBSS algorithm, namely Infomax, and one of the most effective independent component analysis (ICA) algorithms, namely FastICA, is developed. To carry out the study, pseudoreal AF ECGs have been synthesized by adding fibrillation activity to normal sinus rhythm. The algorithm performances are expressed by two indexes: the signal to interference ratio (SIRAA) and the cross-correlation (RAA) between the original and the estimated AA. Results empirically prove that the instantaneous mixing model is the one that obtains the best results in the AA extraction, given that the mean SIRAA obtained by the FastICA algorithm (37.6 +/- 17.0 dB) is higher than the main SIRAA obtained by Infomax (28.5 +/- 14.2 dB). Also the RAA obtained by FastICA (0.92 +/- 0.13) is higher than the one obtained by Infomax (0.78 +/- 0.16).     

Physiological parameter monitoring from optical recordings with a mobile phone

We show that a mobile phone can serve as an accurate monitor for several physiological variables, based on its ability to record and analyze the varying color signals of a fingertip placed in contact with its optical sensor. We confirm the accuracy of measurements of breathing rate, cardiac R-R intervals, and blood oxygen saturation, by comparisons to standard methods for making such measurements (respiration belts, ECGs, and pulse-oximeters, respectively). Measurement of respiratory rate uses a previously reported algorithm developed for use with a pulse-oximeter, based on amplitude and frequency modulation sequences within the light signal. We note that this technology can also be used with recently developed algorithms for detection of atrial fibrillation or blood loss.     

Detection of atrial activity from high-voltage leads of implantableventricular defibrillators using a cancellation technique

The inability to detect atrial activity limits implantable ventricular cardioverter defibrillators (ICD) in discriminating tachycardias and can result in inappropriate therapy. This study attempted to detect atrial activity on the wide-spaced bipole signals formed by the high-voltage (HV) leads of the ICD during device implantation and to develop an algorithm for the detection of atrial fibrillation (AFib) from these signals. The authors used a method that cancelled ventricular and correlated atrial activity from the HV lead signals and measured frequency and amplitude distribution information to discriminate sinus rhythm (SR) and AFib segments. The authors analyzed 186 data segments from 21 patients (six AFib, 14 SR, one AFib and SR). For individual segments in this data set, the sensitivity of the algorithm was 78%, specificity 92.65%, positive and negative predictive values 79.59 and 91.97%, respectively. These results demonstrate that atrial activity is present in the HV lead signals, and AFib detection can be achieved in many, but not all cases, using information currently available to ICDs. Prior work from surface electrocardiograms suggests that this algorithm can function during ventricular tachycardias. However, specificity of the algorithm is not high enough for clinical use     

Extraction and analysis of T waves in electrocardiograms during atrial flutter

Analysis of T waves in the ECG is an essential clinical tool for diagnosis, monitoring, and follow-up of patients with heart dysfunction. During atrial flutter, this analysis has been so far limited by the perturbation of flutter waves superimposed over the T wave. This paper presents a method based on missing data interpolation for eliminating flutter waves from the ECG during atrial flutter. To cope with the correlation between atrial and ventricular electrical activations, the CLEAN deconvolution algorithm was applied to reconstruct the spectrum of the atrial component of the ECG from signal segments corresponding to TQ intervals. The locations of these TQ intervals, where the atrial contribution is presumably dominant, were identified iteratively. The algorithm yields the extracted atrial and ventricular contributions to the ECG. Standard T-wave morphology parameters (T-wave amplitude, T peak-T end duration, QT interval) were measured. This technique was validated using synthetic signals, compared to average beat subtraction in a patient with a pacemaker, and tested on pseudo-orthogonal ECGs from patients in atrial flutter. Results demonstrated improvements in accuracy and robustness of T-wave analysis as compared to current clinical practice.     

Cancellation of ventricular activity in the ECG: evaluation of novel and existing methods

Due to the much higher amplitude of the electrical activity of the ventricles in the surface electrocardiogram (ECG), its cancellation is crucial for the analysis and characterization of atrial fibrillation. In this paper, two different methods are proposed for this cancellation. The first one is an average beat subtraction type of method. Two sets of templates are created: one set for the ventricular depolarization waves and one for the ventricular repolarization waves. Next, spatial optimization (rotation and amplitude scaling) is applied to the QRS templates. The second method is a single beat method that cancels the ventricular involvement in each cardiac cycle in an independent manner. The estimation and cancellation of the ventricular repolarization is based on the concept of dominant T and U waves. Subsequently, the atrial activities during the ventricular depolarization intervals are estimated by a weighted sum of sinusoids observed in the cleaned up segments. ECG signals generated by a biophysical model as well as clinical ECG signals are used to evaluate the performance of the proposed methods in comparison to two standard ABS-based methods.     

CPR artifact removal from human ECG using optimal multichannel filtering

The purpose of this study was to assess whether the artifacts presented by precordial compressions during cardiopulmonary resuscitation could be removed from the human electrocardiogram (ECG) using a filtering approach. This would allow analysis and defibrillator charging during ongoing precordial compressions yielding a very important clinical improvement to the treatment of cardiac arrest patients. In this investigation we started with noise-free human ECGs with ventricular fibrillation (VF) and ventricular tachycardia (VT) records. To simulate a realistic resuscitation situation, we added a weighted artifact signal to the human ECG, where the weight factor was chosen to provide the desired signal-to-noise ratio (SNR) level. As artifact signals we used ECGs recorded from animals in asystole during precordial compressions at rates 60, 90, and 120 compressions/min. The compression depth and the thorax impedance was also recorded. In a real-life situation such reference signals are available and, using an adaptive multichannel Wiener filter, we construct an estimate of the artifact signal, which subsequently can be subtracted from the noisy human ECG signal. The success of the proposed method is demonstrated through graphic examples, SNR, and rhythm classification evaluations.     

Temporal and spatial phase analyses of the electrocardiogram stratify intra-atrial and intra-ventricular organization

We hypothesized that electrocardiogram (ECG) spatial phase analysis would define a spectrum of intracardiac organization from atrial fibrillation (AF), nonisthmus-dependent and isthmus-dependent atrial flutter (AFL) to supraventricular tachycardias (SVT), and similarly for ventricular arrhythmias. We analyzed arrhythmia ECGs of 33 patients with isthmus (n = 9) and nonisthmus (n = 5) dependent AFL and SVT: atrial (n = 3), atrioventricular nodal (n = 3), and orthodromic reciprocating (n = 3) tachycardias, as well as AF (n = 5), ventricular tachycardia (monomorphic, VT-MM; n = 7), and fibrillation (VF; n = 3). ECG spatial phase was considered coherent when the correlation coefficient of an atrial (or ventricular) template to its ECG over time maintained a constant relationship in XY, XZ, and YZ planes. Regularity was quantified spectrally from ECG and correlation series. Spatial coherence occurred in 9/9 cases of isthmus--but only 1/5 of cases of nonisthmus-dependent AFL (p < 0.01; chi2). All showed one dominant spectral peak (temporal coherence). In AF, spatial phase was inconsistent in all planes and spectra were broad band. Temporal and spatial coherence occurred in other SVT. VT-MM maintained spatial phase and a single spectral peak, while VF displayed neither. Our conclusions are that temporal and spatial phase analysis from the ECG stratifies intra-atrial and intra-ventricular organization and reveals subtle variability lost on visual inspection.     

基于希尔伯特黄变换和深度卷积神经网络的房颤检测

房颤是一种常见的心律失常,其发病率会随着年龄增长而升高。因此,从心电(ECG)信号中尽早识别出房颤,有助于降低中风风险和心源性死亡率。为有效提高其检测准确率,该文提出一种基于希尔伯特黄变换(HHT)和深度卷积神经网络的房颤检测方法。1维的时域心电信号通过希尔伯特黄变换,转换为时频域信号,旨在通过时频分析,丰富原始信号的特征。进而,采用DenseNet深度卷积神经网络来处理精细的时频图,并在迭代过程中选出最佳检测模型。该方法获得的最佳检测模型在麻省理工学院-贝斯以色列医院(MIT-BIH)和2017年生理信号竞赛(2017 PhysioNet Challenge)的房颤数据集上分别取得了99.11%和97.25%的检测准确率。此外,该文将希尔伯特黄变换与其他时频分析方法以及稠密网络(DenseNet)与其他卷积神经网络进行了对比。相比于其他检测方法,实验结果表明希尔伯特黄变换和深度卷积神经网络(DCNN)为房颤检测提供了更加准确的识别方式。     

Propagation pattern analysis during atrial fibrillation based on sparse modeling

In this study, sparse modeling is introduced for the estimation of propagation patterns in intracardiac atrial fibrillation (AF) signals. The estimation is based on the partial directed coherence function, derived from fitting a multivariate autoregressive model to the observed signal using least-squares (LS) estimation. The propagation pattern analysis incorporates prior information on sparse coupling as well as the distance between the recording sites. Two optimization methods are employed for estimation of the model parameters, namely, the adaptive group least absolute selection and shrinkage operator (aLASSO), and a novel method named the distance-adaptive group LASSO (dLASSO). Using simulated data, both optimization methods were superior to LS estimation with respect to detection and estimation performance. The normalized error between the true and estimated model parameters dropped from 0.20 ± 0.04 for LS estimation to 0.03 ± 0.01 for both aLASSO and dLASSO when the number of available data samples exceeded the number of model parameters by a factor of 5. For shorter data segments, the error reduction was more pronounced and information on the distance gained in importance. Propagation pattern analysis was also studied on intracardiac AF data, the results showing that the identification of propagation patterns is substantially simplified by the sparsity assumption.     

Detection of Fetal Heart Rate Through 3-D Phase Space Analysis From Multivariate Abdominal Recordings

A novel three-stage methodology for the detection of fetal heart rate (fHR) from multivariate abdominal ECG recordings is introduced. In the first stage, the maternal R-peaks and fiducial points (maternal QRS onset and offset) are detected, using band-pass filtering and phase space analysis. The maternal fiducial points are used to eliminate the maternal QRS complexes from the abdominal ECG recordings. In the second stage, two denoising procedures are applied to enhance the fetal QRS complexes. The phase space characteristics are employed to identify fetal heart beats not overlapping with the maternal QRSs, which are eliminated in the first stage. The extraction of the fHR is accomplished in the third stage, using a histogram-based technique in order to identify the location of the fetal heart beats that overlap with the maternal QRSs. The methodology is evaluated on simulated multichannel ECG signals, generated by a recently proposed model with various SNRs, and on real signals, recorded from pregnant women in various weeks during gestation. In both cases, the obtained results indicate high performance; in the simulated ECGs, the accuracy ranges from 72.78% to 98.61%, depending on the employed SNR, while in the real recordings, the average accuracy is 95.45%. The proposed methodology is advantageous since it copes with the existence of noise from various sources while it is applicable in multichannel abdominal recordings.      

Atrial activity extraction for atrial fibrillation analysis using blind source separation

This contribution addresses the extraction of atrial activity (AA) from real electrocardiogram (ECG) recordings of atrial fibrillation (AF). We show the appropriateness of independent component analysis (ICA) to tackle this biomedical challenge when regarded as a blind source separation (BSS) problem. ICA is a statistical tool able to reconstruct the unobservable independent sources of bioelectric activity which generate, through instantaneous linear mixing, a measurable set of signals. The three key hypothesis that make ICA applicable in the present scenario are discussed and validated: 1) AA and ventricular activity (VA) are generated by sources of independent bioelectric activity; 2) AA and VA present non-Gaussian distributions; and 3) the generation of the surface ECG potentials from the cardioelectric sources can be regarded as a narrow-band linear propagation process. To empirically endorse these claims, an ICA algorithm is applied to recordings from seven patients with persistent AF. We demonstrate that the AA source can be identified using a kurtosis-based reordering of the separated signals followed by spectral analysis of the sub-Gaussian sources. In contrast to traditional methods, the proposed BSS-based approach is able to obtain a unified AA signal by exploiting the atrial information present in every ECG lead, which results in an increased robustness with respect to electrode selection and placement.     

A novel method for beat-to-beat detection of ventricular late potentials

A novel method for beat-to-beat detection of ventricular late potentials (VLP) from high-resolution electrocardiograms (ECGs) is presented. ECG signals from the X lead are first filtered using a bandpass filter, and then a time-sequence adaptive filter, to improve its signal-to-noise ratio. Eight features are extracted using wavelet transform, from the VLP time-frequency distribution of the filtered ECG signals, and used as inputs of specially designed artificial neural network for VLP recognition. The artificial neural network was trained and tested using clinical data, respectively. The results show that the presented method can detect beat-to-beat-based VLP with sensitivity of 80% and specificity of 77%, and the detection accuracy is 78%.     

A new method for analysis of atrial activation during chronicatrial fibrillation in man

To further clarify the mechanisms maintaining chronic atrial fibrillation (CAF), a method identifying preferable activation patterns of the atria during fibrillation, by time averaging of multiple discrete excitation vectors, was developed. Repeated recordings, each of 56 atrial bipolar electrograms simultaneously acquired during 8 s, were made at multiple sites in the right atrial free wall and the left atrial appendage in 16 patients with CAF using a 2.17×3.54 cm electrode array. The local activation times (LAT's) in each recording were estimated as the median activation time at the respective measurement point. By calculating the time difference between the LAT's at adjacent measurement points in two spatial dimensions, a direction vector was created for each activation wave passing each set of measurement points, a total of 42 sets. By time averaging of the individual direction vectors (typically n=55) at each set of measurement points, preferable activation patterns were determined. Three types of activation patterns were found: 1) inconsistent activation (n=5), 2) consistent activation with preferential propagation directions (n=7) and 3) consistent activation with impulses originating from a localizable site within the recording area (n=4). All activation patterns were reproducible and the two latter patterns were proven significant using statistical tests. It is concluded that this new method is useful in further clarification of the mechanisms involved in the maintenance of atrial fibrillation