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.     

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.     

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.     

基于EEMD与多重分形的心电信号特征提取与分类

心电信号的快速分类在心脏病医学诊断领域具有至关重要的作用,为了降低人工识别的成本,提高心电信号分类的准确率。文章以正常搏动、房性早搏、室性早搏、左束支传导阻滞及右束支传导阻滞信号为研究对象,用集合经验模态分解分解心电信号,并结合相关系数来选取本征模态函数进行重构心电信号。从心电信号的非线性动力学角度出发,用多重分形理论进行分析,研究其质量指数曲线、广义分形维数和多重分形谱,提取合适的多重分形特征,用于支持向量机的训练。实验结果表明,用该方法训练测试30次得到的分类准确率平均值为96.09%,单次实验对正常搏动、左束支传导阻滞信号的分类精确率可达97%以上,证明该方法在心电信号分类中的有效性。     

Event-synchronous cancellation of the heart interference inbiomedical signals

A two-pass adaptive filtering algorithm is proposed for cancellation of recurrent interferences such as the heart interference in biomedical signals. In the first pass, an average waveform in one period of the interference is estimated by event-synchronous (QRS-synchronous) averaging of the corrupted signal. In a second pass, an adaptive Schur recursive least squares (RLS) lattice filter is used to cancel the interference by using the event synchronously repeated estimated average waveform of the interference as an artificial reference signal. One key feature of this approach is that the ECG is only used for QRS synchronization and not directly as a reference signal for adaptive filtering. Thus the proposed algorithm can be applied to interference problems where ECG and true interference are almost synchronous but show considerably different waveforms. This is usually the case with the heart interference in biomedical signals. Both off-line and real-time implementations of the event synchronous interference canceller are described. The method is applied to the cancellation of the heart interference in magnetoencephalogram (MEG) signals and to the effective isolation of ventricular extrasystoles (VES) in magnetocardiogram (MCG) signals. Experimental results are shown. The new method typically attenuates the amplitudes of R-wave and T-wave interference components by an amplitude factor of 30 without influencing the MEG events of interest     

Variability of the QRS signal in high-resolution electrocardiograms and magnetocardiograms

The variability of electric and magnetic signals from the heart during the depolarization phase is investigated. A signal processing method is developed, which provides estimates for the beat-to-beat variability of the QRS-complex. The method is based on the decomposition of the depolarization signal into bandpass signals by means of the Morlet wavelet transform. The beat variability of the depolarization signal is estimated by normalized variances of the envelope and instantaneous frequency of bandpass signals. Time intervals of the bandpass filtered depolarization signals having a high signal-to-noise ratio are selected applying an analysis based on phase statistics. The method was tested by computer simulation and experimental data taken from electrocardiographic and magnetocardiographic measurements of healthy persons and patients prone to malignant ventricular tachycardia (VT) or ventricular fibrillation (VF). Results suggest that the calculated variance parameters permit the characterization of beat variable depolarization signals and distinguish VT/VF patients from healthy persons.     

Dynamic analysis of ventricular repolarization duration from24-hour Holter recordings

Evaluation of the influence of the autonomic nervous system on the ventricular repolarization duration was carried out using beat-to-beat analysis of the time intervals between the peaks of the R and T waves (RTm). After pre-processing of digitized Holter ECG's, auto and cross spectrum analyses were applied to heart rate and repolarization duration variability signals. Coherence analysis was used to assess the existence of common spectral contributions. The heart rate variability signal was used as reference of the sympatho-vagal balance at the sinus node. It was found that, in normal individuals, the autonomic nervous system directly influences the ventricular repolarization duration and that this influence is qualitatively very similar to the one that modulates the heart rate. Pathological alteration of these parallel autonomic activities to the heart (on the sinus node and on the ventricle) might cause uncoupling between depolarization and repolarization     

A new method for measuring small local vibrations in the heartusing ultrasound

In order to diagnose ventricular dysfunction based on the acoustic characteristics of the heart muscle of the ventricle, it is necessary to detect vibration signals from various parts of the ventricular wall. This is, however, difficult using previously proposed ultrasonic diagnostic methods or systems. The reason is that the amplitude of the cardiac motion is large during one beat period which produces large fluctuations in the transit time required for ultrasonic waves to travel from the transducer to the heart and back. This paper proposes a new method for overcoming this problem and accurately measuring small vibrations of the ventricle wall using ultrasound. In this method, the demodulated ultrasound signal reflected at the heart wall is converted from analogue to digital (A/D) signal at a high sampling frequency; from the resultant digital signal, the velocity of the wall is accurately obtained over a wide dynamic range based on the Doppler effect. The proposed method is preliminarily applied to the detection of small vibrations on the aortic wall and the interventricular septum. The new method offers potential for research in acoustical diagnosis of heart and artery dysfunction     

Atrial activity enhancement by Wiener filtering using an artificial neural network

This paper describes a novel technique for the cancellation of the ventricular activity for applications such as P-wave or atrial fibrillation detection. The procedure was thoroughly tested and compared with a previously published method, using quantitative measures of performance. The novel approach estimates, by means of a dynamic time delay neural network (TDNN), a time-varying, nonlinear transfer function between two ECG leads. Best results were obtained using an Elman TDNN with nine input samples and 20 neurons, employing a sigmoidal tangencial activation in the hidden layer and one linear neuron in the output stage. The method does not require a previous stage of QRS detection. The technique was quantitatively evaluated using the MIT-BIH arrhythmia database and compared with an adaptive cancellation scheme proposed in the literature. Results show the advantages of the proposed approach, and its robustness during noisy episodes and QRS morphology variations.     

A novel extraction method of fetal electrocardiogram from the composite abdominal signal

In contrast to the ultrasonic measurement of fetal heart motion, the fetal electrocardiogram (ECG) provides clinically significant information concerning the electrophysiological state of a fetus. In this paper, a novel method for extracting the fetal ECG from abdominal composite signals is proposed. This method consists of the cancellation of the mother's ECG and blind source separation with the reference signal (BSSR). The cancellation of the mother's ECG component was performed by subtracting the linear combination of mutually orthogonal projections of the heart vector. The BSSR is a fixed-point algorithm, the Lagrange function of which includes the higher order cross-correlation between the extracted signal and the reference signal as the cost term rather than a constraint. This realizes the convexity of the Lagrange function in a simple form, which guarantees the convergence of the algorithm. By practical application, the proposed method has been shown to be able to extract the P and T waves in addition to the R wave. The reliability and accuracy of the proposed method was confirmed by comparing the extracted signals with the directly recorded ECG at the second stage of labor. The gestational age-dependency of the physiological parameters of the extracted fetal ECG also coincided well with that of the magnetocardiogram, which proves the clinical applicability of the proposed method.     

Computer analysis of the electrocardiogram during esophageal pacingcardiac stress

It has been estimated that 15 to 30% of patients with suspected or known coronary artery disease are unable to perform an adequate exercise stress test due to a variety of reasons such as obesity, poor physical condition, claudication, etc. Transesophageal atrial pacing has been proposed as a noninvasive alternative for inducing cardiac stress in patients who cannot exercise. Although computer analysis is commonly employed to analyze the electrocardiogram (ECG) during the conventional exercise stress test, the surface ECG recorded during transesophageal atrial pacing is contaminated with large pacing artifacts which confound beat identification by standard computer software. We report the development of a robust signal processing algorithm for interpretation of the surface ECG during transesophageal atrial pacing stress. The algorithm employs novel schemes using both linear and nonlinear transformations to detect and differentiate between the pacing artifact and QRS complex even in difficult situations where the pacing artifact is in proximity to or superimposed on the QRS complex. The algorithm uses sophisticated logic for automatic recognition of sustained capture. It subsequently calculates beat-by-beat and average (over five beats) ST segment amplitude and slope. The algorithm also reports the instantaneous heart rate, RR interval, pace-to-R interval, R-wave amplitude, and estimated sinus node recovery time upon loss of sustained capture. The limitations of present exercise ECG computer methods in processing the ECG during transesophageal atrial pacing stress are evaluated and significantly improved performance by our algorithm is demonstrated.     

Minimisation of gradient artefacts in cardiac-MRI-gating using adaptive interference cancellation filter with synthesised reference

A simple and successful method for cardiac-MRI-gating is proposed. The adaptive interference cancellation filter (AICF) is used with a synthesised reference signal to reduce the gradient artefacts caused by the magnetic resonance (MR). The reference signals of the AICF were a combination of the noisy, three-channel ECG signals. In particular, the proposed method is based on a simple experimental setup and does not require any information from amplifiers of the MRI machine, such as shape, amplitude and rise time.     

Phase-rectified signal averaging used to estimate the dominant frequencies in ECG signals during atrial fibrillation

Phase-rectified signal averaging (PRSA) is a technique recently introduced to enhance quasi-periodic signal components. An important parameter that can be extracted from surface ECG is the dominant frequency (DF) of atrial fibrillation (AF). AF signal components are always highly contaminated by the ventricular complexes, and the cancellation of these components is never perfect. The remaining artifacts tend to induce erroneous DF estimates. In this paper, we report on the use of PRSA in the context of noninvasive AF classification procedures for improving DF estimation. The potential of PRSA is demonstrated by experiments both on synthetic and clinical ECG signals.     

Applications of adaptive filtering to ECG analysis: noisecancellation and arrhythmia detection

Several adaptive filter structures are proposed for noise cancellation and arrhythmia detection. The adaptive filter essentially minimizes the mean-squared error between a primary input, which is the noisy ECG, and a reference input, which is either noise that is correlated in some way with the noise in the primary input or a signal that is correlated only with ECG in the primary input. Different filter structures are presented to eliminate the diverse forms of noise: baseline wander, 60 Hz power line interference, muscle noise, and motion artifact. An adaptive recurrent filter structure is proposed for acquiring the impulse response of the normal QRS complex. The primary input of the filter is the ECG signal to be analyzed, while the reference input is an impulse train coincident with the QRS complexes. This method is applied to several arrhythmia detection problems: detection of P-waves, premature ventricular complexes, and recognition of conduction block, atrial fibrillation, and paced rhythm.     

Enhanced real-time ECG coder for packetized telecardiology applications.

A new real-time compression method for electrocardiogram (ECG) signals has been developed based on the wavelet transform approach. The method is specifically adaptable for packetized telecardiology applications. The signal is segmented into beats and a beat template is subtracted from them, producing a residual signal. Beat templates and residual signals are coded with a wavelet expansion. Compression is achieved by selecting a subset of wavelet coefficients. The number of selected coefficients depends on a threshold which has different definitions depending on the operational mode of the coder. Compression performance has been tested using a subset of ECG records from MIT-BIH Arrhythmia database. This method has been designed for real-time packetized telecardiology scenarios both in wired and wireless environments.     

How Many Leads Are Necessary for a Reliable Reconstruction of Surface Potentials During Atrial Fibrillation?

In this study, we aimed at determining how many leads are necessary for accurately reconstructing ECG potentials during atrial fibrillation (AF) on the body surface. Although the standard ECG is appropriate for the detection of this arrhythmia, its accuracy for extracting other diagnostic features or constructing surface potential maps may not be optimal. We evaluated the suitability of the standard ECG in AF and proposed a new lead system for improving the information content of AF signals in limited lead systems. We made use of 64-lead body surface potential mapping recordings of 17 patients during AF and 18 healthy subjects. Lead selection was performed by making use of a lead selection algorithm proposed by Lux, and error curves were calculated for increasing number of selected leads for QRS complexes and P waves from healthy subjects and AF signals. From our results, at least 23 leads are needed in order to have the same degree of accuracy in the derivation of AF waves as the 12-lead ECG for a normal QRS complex (25% error). The 12-lead ECG allows a reconstruction of surface potentials with 53% error. If a limited lead set is to be chosen, a repositioning of only four electrodes from the standard ECG reduces reconstruction error in 11%. This repositioning of electrodes may include more right anterior electrodes and one posterior electrode.     

Effect of Multiscale PCA De-noising in ECG Beat Classification for Diagnosis of Cardiovascular Diseases

Current trends in clinical applications demand automation in electrocardiogram (ECG) signal processing and heart beat classification. This paper examines the design of an effective recognition method to diagnose heart diseases. The proposed method consists of three main modules: de-noising module, feature extraction module, and classifier module. In the de-noising module, multiscale principal component analysis (MSPCA) is used for noise reduction of the ECG signals. In the feature extraction module, autoregressive (AR) modeling is used for extracting features. In the classifier module, different classifiers are examined such as simple logistic, k-nearest neighbor, multilayer perceptron, radial basis function networks, and support vector machines. Different experiments are carried out using the MIT-BIH arrhythmia database to classify different ECG heart beats and the performance of the proposed method is evaluated in terms of several standard metrics. The experimental results show that the proposed method is able to reduce noise from the noisy ECG signals more accurately in comparison to previous methods. The numerical results indicated that the proposed algorithm achieved 99.93 % of the classification accuracy using MSPCA de-noising and AR modeling.     

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.      

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.     

A low-complexity data-adaptive approach for premature ventricular contraction recognition

Premature ventricular contraction (PVC) may lead to life-threatening cardiac conditions. Real-time automated PVC recognition approaches provide clinicians the useful tools for timely diagnosis if dangerous conditions surface in their patients. Based on the morphological differences of the PVC beats in the ventricular depolarization phase (QRS complex) and repolarization phase (mainly T-wave), two beat-to-beat template-matching procedures were implemented to identify them. Both templates were obtained by a probability-based approach and hence were fully data-adaptive. A PVC recognizer was then established by analyzing the correlation coefficients from the two template-matching procedures. Our approach was trained on 22 ECG recordings from the MIT-BIH arrhythmia database (MIT-BIH-AR) and then tested on another 22 nonoverlapping recordings from the same database. The PVC recognition accuracy was 98.2 %, with the sensitivity and positive predictivity of 93.1 and 81.4 %, respectively. To evaluate its robustness against noise, our approach was applied again to the above testing set, but this time, the ECGs were not preprocessed. A comparable performance was still obtained. A good generalization capability was also confirmed by validating our approach on an independent St. Petersburg Institute of Cardiological Technics database. In addition, our performance was comparable with these published complex approaches. In conclusion, we have developed a low-complexity data-adaptive PVC recognition approach with good robustness against noise and generalization capability. Its performance is comparable to other state-of-the-art methods, demonstrating a good potential in real-time application.