Removal of cardiopulmonary resuscitation artifacts from human ECG using an efficient matching pursuit-like algorithm

We present a computationally efficient and numerically robust solution to the problem of removing artifacts due to precordial compressions and ventilations from the human electrocardiogram (ECG) in an emergency medicine setting. Incorporated into automated external defibrillators, this would allow for simultaneous ECG signal analysis and administration of precordial compressions and ventilations, resulting in significant clinical improvement to the treatment of cardiac arrest patients. While we have previously demonstrated the feasibility of such artifact removal using a multichannel Wiener filter, we here focus on an efficient matching pursuit-like approach making practical real-time implementations of such a scheme feasible for a wide variety of sampling rates and filter lengths. Using more realistic data than what have been previously available, we present evidence showing the excellent performance of our approach and quantify its computational complexity.     

Removal of CPR artifacts from the ventricular fibrillation ECG by adaptive regression on lagged reference signals

BACKGROUND AND OBJECTIVE: Removing cardiopulmonary resuscitation (CPR)-related artifacts from human ventricular fibrillation (VF) electrocardiogram (ECG) signals provides the possibility to continuously detect rhythm changes and estimate the probability of defibrillation success. This could reduce "hands-off" analysis times which diminish the cardiac perfusion and deteriorate the chance for successful defibrillations. METHODS AND RESULTS: Our approach consists in estimating the CPR part of a corrupted signal by adaptive regression on lagged copies of a reference signal which correlate with the CPR artifact signal. The algorithm is based on a state-space model and the corresponding Kalman recursions. It allows for stochastically changing regression coefficients. The residuals of the Kalman estimation can be identified with the CPR-filtered ECG signal. In comparison with ordinary least-squares regression, the proposed algorithm shows, for low signal-to-noise ratio (SNR) corrupted signals, better SNR improvements and yields better estimates of the mean frequency and mean amplitude of the true VF ECG signal. CONCLUSIONS: The preliminary results from a small pool of human VF and animal asystole CPR data are slightly better than the results of comparable previous studies which, however, not only used different algorithms but also different data pools. The algorithm carries the possibility of further optimization.     

A Least Mean-Square Filter for the Estimation of the Cardiopulmonary Resuscitation Artifact Based on the Frequency of the Compressions

Cardiopulmonary resuscitation (CPR) artifacts caused by chest compressions and ventilations interfere with the rhythm diagnosis of automated external defibrillators (AED). CPR must be interrupted for a reliable diagnosis. However, pauses in chest compressions compromise the defibrillation success rate and reduce perfusion of vital organs. The removal of the CPR artifacts would enable compressions to continue during AED rhythm analysis, thereby increasing the likelihood of resuscitation success. We have estimated the CPR artifact using only the frequency of the compressions as additional information to model it. Our model of the artifact is adaptively estimated using a least mean-square (LMS) filter. It was tested on 89 shockable and 292 nonshockable ECG samples from real out-of-hospital sudden cardiac arrest episodes. We evaluated the results using the shock advice algorithm of a commercial AED. The sensitivity and specificity were above 95% and 85%, respectively, for a wide range of working conditions of the LMS filter. Our results show that the CPR artifact can be accurately modeled using only the frequency of the compressions. These can be easily registered after small changes in the hardware of the CPR compression pads.      

CPR Artifact Removal in Ventricular Fibrillation ECG Signals Using Gabor Multipliers

Background and objective: We present an algorithm for discarding cardiopulmonary resuscitation (CPR) components from ventricular fibrillation ECG (VF ECG) signals and establish a method for comparing CPR attenuation on a common dataset. Removing motion artifacts in ECG allows for uninterrupted rhythm analysis and reduces ldquohands-offrdquo time during resuscitation. Methods and results: The current approach assumes a multichannel setting where the information of the corrupted ECG is combined with an additional pressure signal in order to estimate the motion artifacts. The underlying algorithm relies on a localized time--frequency transformation, the Gabor transform, that reveals the perturbation components, which, in turn, can be attenuated. The performance of the method is evaluated on a small set of test signals in the form of error analysis and compared to two well-established CPR removal algorithms that use an adaptive filtering system and a state--space model, respectively. Conclusion: We primarily point out the potential of the algorithm for successful artifact removal; however, on account of the limited set of human VF and animal asystole CPR signals, we refrain from a statistical analysis of the efficiency of CPR attenuation. The results encourage further investigations in both the theoretical and the clinical setup.     

Noise cancellation signal processing method and computer system for improved real-time electrocardiogram artifact correction during MRI data acquisition

A system was developed for real-time electrocardiogram (ECG) analysis and artifact correction during magnetic resonance (MR) scanning, to improve patient monitoring and triggering of MR data acquisitions. Based on the assumption that artifact production by magnetic field gradient switching represents a linear time invariant process, a noise cancellation (NC) method is applied to ECG artifact linear prediction. This linear prediction is performed using a digital finite impulse response (FIR) matrix, that is computed employing ECG and gradient waveforms recorded during a training scan. The FIR filters are used during further scanning to predict artifacts by convolution of the gradient waveforms. Subtracting the artifacts from the raw ECG signal produces the correction with minimal delay. Validation of the system was performed both off-line, using prerecorded signals, and under actual examination conditions. The method is implemented using a specially designed Signal Analyzer and Event Controller (SAEC) computer and electronics. Real-time operation was demonstrated at 1 kHz with a delay of only 1 ms introduced by the processing. The system opens the possibility of automatic monitoring algorithms for electrophysiological signals in the MR environment.     

An algorithm used for ventricular fibrillation detection without interrupting chest compression

Ventricular fibrillation (VF) is the primary arrhythmic event in the majority of patients suffering from sudden cardiac arrest. Attention has been focused on this particular rhythm since it is recognized that prompt therapy, especially electrical defibrillation, may lead to a successful outcome. However, current versions of automated external defibrillators (AEDs) mandate repetitive interruptions of chest compression for rhythm analyses since artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) preclude reliable electrocardiographic (ECG) rhythm analysis. Yet, repetitive interruptions in chest compression are detrimental to the success of defibrillation. The capability for rhythm analysis without requiring "hands-off" intervals will allow for more effective resuscitation. In this paper, a novel continuous-wavelet-transformation-based morphology consistency evaluation algorithm was developed for the detection of disorganized VF from organized sinus rhythm (SR) without interrupting the ongoing chest compression. The performance of this method was evaluated on both uncorrupted and corrupted ECG signals recorded from AEDs obtained from out-of-hospital victims of cardiac arrest. A total of 232 patients and 31,092 episodes of either VF or SR were accessed, in which 8195 episodes were corrupted by artifacts produced by chest compressions. We also compared the performance of this method with three other established algorithms, including VF filter, spectrum analysis, and complexity measurement. Even though there was a modest decrease in specificity and accuracy when chest compression artifact was present, the performance of this method was still superior to other reported methods for VF detection during uninterrupted CPR.     

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.     

A nonlinear Bayesian filtering framework for ECG denoising

In this paper, a nonlinear Bayesian filtering framework is proposed for the filtering of single channel noisy electrocardiogram (ECG) recordings. The necessary dynamic models of the ECG are based on a modified nonlinear dynamic model, previously suggested for the generation of a highly realistic synthetic ECG. A modified version of this model is used in several Bayesian filters, including the Extended Kalman Filter, Extended Kalman Smoother, and Unscented Kalman Filter. An automatic parameter selection method is also introduced, to facilitate the adaptation of the model parameters to a vast variety of ECGs. This approach is evaluated on several normal ECGs, by artificially adding white and colored Gaussian noises to visually inspected clean ECG recordings, and studying the SNR and morphology of the filter outputs. The results of the study demonstrate superior results compared with conventional ECG denoising approaches such as bandpass filtering, adaptive filtering, and wavelet denoising, over a wide range of ECG SNRs. The method is also successfully evaluated on real nonstationary muscle artifact. This method may therefore serve as an effective framework for the model-based filtering of noisy ECG recordings.     

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.      

可穿戴心电信号监测中运动伪影消除技术研究

心电图(ECG)是心脏疾病诊断最有效的工具。噪声的去除和Q波、R波、S波的提取是心电信号检测中的两大主题。本文使用Savitzky-Golay滤波器对人体在弯腰、走路、坐下-站起等运动状态下采集的心电信号进行分析,去除信号中的基线漂移和运动伪影,并对滤波后信号的Q波、R波和S波进行检测。通过将本文提出的滤波方式与卡尔曼滤波、小波分解就时间复杂度和功率谱密度两个参数进行对比分析,评估Savitzky-Golay滤波器在心电信号中运动伪影去除的优势。实验结果表明,Savitzky-Golay滤波器能更加有效地适应心电信号的变化,有效地去除心电信号中的噪声,并且最大限度保持心电波形的形状和波峰。      

Telemetry of human electrocardiograms in aerial and aquaticenvironments

A technique for human electroencephalogram (ECG) telemetry that is equally useful on land and in water (i.e. amphibious ECG telemetry) with a single transmitter was developed. For the ECG on land, an electromagnetic wave of 79 MHz FM VHF was used, while for the ECG under water, a 77-kHz FM current was used. The VHF was received by an aerial of an FM radio and the current by two underwater antennas along course-marker ropes. When a subject jumped from a diving platform into the water, continuous recording of ECG signals was possible with only a short time disturbance of the signals due to change in posture of the subject before jumping. This indicates rapid switching from electromagnetic to conductive transmission. The ECGs on land and during surface or underwater swimming showed a clear difference in the QRS complex and T wave     

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.     

Extraction of fetal electrocardiogram using adaptive neuro-fuzzy inference systems

In this paper, we investigate the use of adaptive neuro-fuzzy inference systems (ANFIS) for fetal electrocardiogram (FECG) extraction from two ECG signals recorded at the thoracic and abdominal areas of the mother's skin. The thoracic ECG is assumed to be almost completely maternal (MECG) while the abdominal ECG is considered to be composite as it contains both the mother's and the fetus' ECG signals. The maternal component in the abdominal ECG signal is a nonlinearly transformed version of the MECG. We use an ANFIS network to identify this nonlinear relationship, and to align the MECG signal with the maternal component in the abdominal ECG signal. Thus, we extract the FECG component by subtracting the aligned version of the MECG signal from the abdominal ECG signal. We validate our technique on both real and synthetic ECG signals. Our results demonstrate the effectiveness of the proposed technique in extracting the FECG component from abdominal signals of very low maternal to fetal signal-to-noise ratios. The results also show that the technique is capable of extracting the FECG even when it is totally embedded within the maternal QRS complex.     

Spatiotemporal QRST cancellation techniques for analysis of atrial fibrillation

A new method for QRST cancellation is presented for the analysis of atrial fibrillation in the surface electrocardiogram (ECG). The method is based on a spatiotemporal signal model which accounts for dynamic changes in QRS morphology caused, e.g., by variations in the electrical axis of the heart. Using simulated atrial fibrillation signals added to normal ECGs, the results show that the spatiotemporal method performs considerably better than does straightforward average beat subtraction (ABS). In comparison to the ABS method, the average QRST-related error was reduced to 58 percent. The results obtained from ECGs with atrial fibrillation agreed very well with those from simulated fibrillation signals.     

Improved complete ensemble empirical mode decomposition with adaptive noise: quasi-oppositional Jaya hybrid algorithm for ECG denoising

Electrocardiogram (ECG) is an effective, non-invasive, and economical diagnostic equipment, which plays a key role in screening and understanding of heart illnesses. However, the recorded signals are frequently distorted with several types of noises (baseline wander (BW), power-line interference (PLI), etc.) and the distortion creates serious challenges to healthcare providers. Therefore, it is imperative that the ECG signal should be noise-free and tidy as desirable to support correct decisions by physicians. In this paper, a novel hybrid methodology for ECG filtering is proposed, which comprises improved complete ensemble empirical mode decomposition with adaptive noise (ICEEMDAN) algorithm in conjunction with the quasi-oppositional Jaya algorithm (QOJA). The robust ICEEMDAN based decomposition approach is used to decompose the noisy ECG into several intrinsic mode functions (IMFs). Then, the frequency bands arising out of the combined BW and PLI are recognized prudently using the Fourier spectrum to evade any intersection with valuable information in the ECG signals. The QOJA is performed on noisy IMFs to suppress artifacts. The efficiency of our proposed hybrid methodology has been assessed by adding combined BW and PLI at a different signal-to-noise ratio (SNR) to ECG records from MIT/BIH arrhythmia database. The obtained SNR improvement (14.52–30.32 dB) discloses the superiority of the proposed hybrid methodology while comparing it with the ICEEMDAN joint with the least mean square (LMS) adaptive algorithm (11.58–28.21 dB) and ICEEMDAN (9.31–26.97 dB).

     

Estimation of QRS complex power spectra for design of a QRS filter

We present power spectral analysis of ECG waveforms as well as isolated QRS complexes and episodes of noise and artifact. The power spectral analysis shows that the QRS complex could be separated from other interfering signals. A bandpass filter that maximizes the signal (QRS complex)-to-noise (T-waves, 60 Hz, EMG, etc.) ratio would be of use in many ECG monitoring instruments. We calculate the coherence function and, from that, the signal-to-noise ratio. Upon carrying out this analysis on experimentaly obtained ECG data, we observe that a bandpass filter with a center frequency of 17 Hz and a Q of 5 yields the best signal-to-noise ratio.     

脑电信号预处理方法研究综述

脑电信号是一种复杂且重要的生物信号,被广泛应用于类脑智能技术和脑机接口领域的研究。文中介绍了干扰正常脑电信号的常见非生理性伪迹和生理性伪迹的类型及特点,并对生理性伪迹的产生原因进行了详细分析。通过对各种脑电信号去除伪迹方法的回顾以及应用现状的分析,比较并总结了传统去除伪迹方法和新型去除伪迹方法的研究进展,并进一步分析去除伪迹方法的优缺点。部分方法已经成功应用于处理脑电信号中的眼电、心电和肌电等伪迹中。文中还针对目前脑电信号去除伪迹的需求及所面临的问题给出了应对策略,并对未来的研究方向进行了分析和展望。     

Noninvasive measurement of physiological signals on a modified home bathroom scale

A commercial bathroom scale with both handlebar and footpad electrodes was modified to enable measurement of four physiological signals: the ballistocardiogram (BCG), electrocardiogram (ECG), lower body impedance plethysmogram (IPG), and lower body electromyogram (EMG). The BCG, which describes the reaction of the body to cardiac ejection of blood, was measured using the strain gauges in the scale. The ECG was detected using handlebar electrodes with a two-electrode amplifier. For the lower body IPG, the two electrodes under the subject's toes were driven with an ac current stimulus, and the resulting differential voltage across the heels was measured and demodulated synchronously with the source. The voltage signal from the same two footpad electrodes under the heels was passed through a passive low-pass filter network into another amplifier, and the output was the lower body EMG signal. The signals were measured from nine healthy subjects, and the average signal-to-noise ratio (SNR) while the subjects were standing still was estimated for the four signals as follows: BCG, 7.6 dB; ECG, 15.8 dB; IPG, 10.7 dB. During periods of motion, the decrease in SNR for the BCG signal was found to be correlated to the increase in rms power for the lower body EMG (r = 0.89, p <; 0.01). The EMG could, thus, be used to flag noise-corrupted segments of the BCG, increasing the measurement robustness. This setup could be used for monitoring the cardiovascular health of patients at home.     

Canine sternal force-displacement relationship duringcardiopulmonary resuscitation

A viscoelastic model developed to model human sternal response to the cyclic loading of manual cardiopulmonary resuscitation (CPR) [8] was used to evaluate the properties of canine chests during CPR. Sternal compressions with ventilations after every fifth compression were applied to supine canines (n = 7) with a mechanical resuscitation device. The compressions were applied at a nominal rate of 90/min with a peak force near 400 N. From measurements of sternal force, sternal displacement, and tracheal airflow, model parameters were estimated and their dependence on time and lung volume evaluated. The position to which the chest recoiled between compressions changed with time at a mean rate of 1.0 mm/min. Within each ventilation cycle (five compressions) the sternal recoil position decreased by 2.0 cm for each liter of decrease in lung volume. The elastic force and damping decreased with time and decreasing lung volume. Canine and human [8] model parameters were found to be similar despite the notable differences in thoracic anatomy between the species, supporting the continued use of canines as models for human CPR. These parameters may be useful in the development of a model relating sternal compression forces to blood flow during CPR.     

Reducing Motion Artifacts and Interference in Biopotential Recording

The application of engineering principles and techniques to biopotential recording has resulted in a continual improvement both in the type and the quality of recorded signals. Physical placement of electrodes has enabled improved discrimination of the biopotential of interest (such as the ECG) from unwanted biopotentials (such as the EMG). Understanding that the major motion artifact in ECG recording arises from the skin and not the electrode has resulted in techniques that reduce this artifact, such as skin abrasion and mechanical stabilization. However, skin abrasion makes the skin more subject to irritation, so mild gels are required. The development of the floating silver/silver chloride electrode has eliminated motion artifact and noise caused by the electrode. The development of the driven-right-leg circuit has greatly reduced interference due to power lines. Adaptive filters have reduced the difficult-to-eliminate interference due to spark-gap electrosurgical units.