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Guo RX, Tian X, Bazoukis G, Tse G, Hong S, Chen KY, Liu T. Application of artificial intelligence in the diagnosis and treatment of cardiac arrhythmia. Pacing Clin Electrophysiol 2024; 47:789-801. [PMID: 38712484 DOI: 10.1111/pace.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/29/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
The rapid growth in computational power, sensor technology, and wearable devices has provided a solid foundation for all aspects of cardiac arrhythmia care. Artificial intelligence (AI) has been instrumental in bringing about significant changes in the prevention, risk assessment, diagnosis, and treatment of arrhythmia. This review examines the current state of AI in the diagnosis and treatment of atrial fibrillation, supraventricular arrhythmia, ventricular arrhythmia, hereditary channelopathies, and cardiac pacing. Furthermore, ChatGPT, which has gained attention recently, is addressed in this paper along with its potential applications in the field of arrhythmia. Additionally, the accuracy of arrhythmia diagnosis can be improved by identifying electrode misplacement or erroneous swapping of electrode position using AI. Remote monitoring has expanded greatly due to the emergence of contactless monitoring technology as wearable devices continue to develop and flourish. Parallel advances in AI computing power, ChatGPT, availability of large data sets, and more have greatly expanded applications in arrhythmia diagnosis, risk assessment, and treatment. More precise algorithms based on big data, personalized risk assessment, telemedicine and mobile health, smart hardware and wearables, and the exploration of rare or complex types of arrhythmia are the future direction.
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Affiliation(s)
- Rong-Xin Guo
- Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xu Tian
- Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Inomenon Polition Amerikis, Larnaca, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Gary Tse
- Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Shenda Hong
- National Institute of Health Data Science, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Kang-Yin Chen
- Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of lonic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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2
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Rahm AK, Lugenbiel P. [Digital precision medicine in rhythmology : Risk prediction of recurrences, sudden cardiac death, and outcome]. Herzschrittmacherther Elektrophysiol 2024; 35:97-103. [PMID: 38639777 DOI: 10.1007/s00399-024-01015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Digital precision medicine is gaining increasing importance in rhythmology, especially in the treatment of cardiac arrhythmias. This trend is driven by the advancing digitization in healthcare and the availability of large amounts of data from various sources such as electrocardiograms (ECGs), implants like pacemakers and implantable cardioverter-defibrillators (ICDs), as well as wearables like smartwatches and fitness trackers. Through the analysis of this data, physicians can develop more precise and individualized diagnoses and treatment strategies for patients with cardiac arrhythmias. For example, subtle changes in ECGs can be identified, indicating potentially dangerous arrhythmias. Genetic analyses and resulting large datasets also play an increasingly significant role, especially in hereditary ion channel disorders such as long QT syndrome (LQTS) and Brugada syndrome (BrS), as well as in lone atrial fibrillation (AF). Precision medicine enables the development of individualized treatment approaches tailored to the specific needs and risk factors of each patient. This can help improve screening strategies, reduce adverse events, and ultimately enhance the quality of life for patients. Technological advancements such as big data, artificial intelligence, machine learning, and predictive analytics play a crucial role in predicting the risk of arrhythmias and sudden cardiac death. These concepts enable more precise and personalized predictions and support physicians in the treatment and monitoring of their patients.
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Affiliation(s)
- Ann-Kathrin Rahm
- Klinik für Kardiologie, Angiologie und Pulmologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
- HCR - Heidelberger Zentrum für Herzrhythmusstörungen, Heidelberg, Deutschland.
- InformaticsForLife Institute, Heidelberg, Deutschland.
| | - Patrick Lugenbiel
- Klinik für Kardiologie, Angiologie und Pulmologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
- HCR - Heidelberger Zentrum für Herzrhythmusstörungen, Heidelberg, Deutschland.
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3
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Raileanu G, de Jong JSSG. Electrocardiogram Interpretation Using Artificial Intelligence: Diagnosis of Cardiac and Extracardiac Pathologic Conditions. How Far Has Machine Learning Reached? Curr Probl Cardiol 2024; 49:102097. [PMID: 37739276 DOI: 10.1016/j.cpcardiol.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
Artificial intelligence (AI) is already widely used in different fields of medicine, making possible the integration of the paraclinical exams with the clinical findings in patients, for a more accurate and rapid diagnosis and treatment decision. The electrocardiogram remains one of the most important, fastest, cheapest, and noninvasive methods of diagnosis in cardiology, despite the rapid development and progression of the technology. Even if studied a long time ago, it still has a lot of less understood features that, with a better understanding, can give more clues to a correct and prompt diagnosis in a short time. The use of AI in the interpretation of the ECG improved the accuracy and the time to diagnosis in different cardiovascular diseases, and more than this, explaining the decision to make AI diagnosis improved the human understanding of the different features of the ECG that might be considered for a more accurate diagnosis. The purpose of this article is to provide an overview of the most recently published articles about the use of AI in ECG interpretation.
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Affiliation(s)
- Gabriela Raileanu
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Mjahad A, Saban M, Azarmdel H, Rosado-Muñoz A. Efficient Extraction of Deep Image Features Using a Convolutional Neural Network (CNN) for Detecting Ventricular Fibrillation and Tachycardia. J Imaging 2023; 9:190. [PMID: 37754954 PMCID: PMC10532022 DOI: 10.3390/jimaging9090190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
To safely select the proper therapy for ventricular fibrillation (VF), it is essential to distinguish it correctly from ventricular tachycardia (VT) and other rhythms. Provided that the required therapy is not the same, an erroneous detection might lead to serious injuries to the patient or even cause ventricular fibrillation (VF). The primary innovation of this study lies in employing a CNN to create new features. These features exhibit the capacity and precision to detect and classify cardiac arrhythmias, including VF and VT. The electrocardiographic (ECG) signals utilized for this assessment were sourced from the established MIT-BIH and AHA databases. The input data to be classified are time-frequency (tf) representation images, specifically, Pseudo Wigner-Ville (PWV). Previous to Pseudo Wigner-Ville (PWV) calculation, preprocessing for denoising, signal alignment, and segmentation is necessary. In order to check the validity of the method independently of the classifier, four different CNNs are used: InceptionV3, MobilNet, VGGNet and AlexNet. The classification results reveal the following values: for VF detection, there is a sensitivity (Sens) of 98.16%, a specificity (Spe) of 99.07%, and an accuracy (Acc) of 98.91%; for ventricular tachycardia (VT), the sensitivity is 90.45%, the specificity is 99.73%, and the accuracy is 99.09%; for normal sinus rhythms, sensitivity stands at 99.34%, specificity is 98.35%, and accuracy is 98.89%; finally, for other rhythms, the sensitivity is 96.98%, the specificity is 99.68%, and the accuracy is 99.11%. Furthermore, distinguishing between shockable (VF/VT) and non-shockable rhythms yielded a sensitivity of 99.23%, a specificity of 99.74%, and an accuracy of 99.61%. The results show that using tf representations as a form of image, combined in this case with a CNN classifier, raises the classification performance above the results in previous works. Considering that these results were achieved without the preselection of ECG episodes, it can be concluded that these features may be successfully introduced in Automated External Defibrillation (AED) and Implantable Cardioverter Defibrillation (ICD) therapies, also opening the door to their use in other ECG rhythm detection applications.
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Affiliation(s)
| | | | | | - Alfredo Rosado-Muñoz
- GDDP, Department Electronic Engineering, School of Engineering, University of Valencia, 46100 Burjassot, Valencia, Spain; (A.M.); (M.S.); (H.A.)
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Fayyazifar N, Dwivedi G, Suter D, Ahderom S, Maiorana A, Clarkin O, Balamane S, Saha N, King B, Green MS, Golian M, Chow BJ. A novel convolutional neural network structure for differential diagnosis of wide QRS complex tachycardia. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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de Lepper AGW, Buck CMA, van 't Veer M, Huberts W, van de Vosse FN, Dekker LRC. From evidence-based medicine to digital twin technology for predicting ventricular tachycardia in ischaemic cardiomyopathy. JOURNAL OF THE ROYAL SOCIETY, INTERFACE 2022; 19:20220317. [PMID: 36128708 DOI: 10.1098/rsif.2022.0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Survivors of myocardial infarction are at risk of life-threatening ventricular tachycardias (VTs) later in their lives. Current guidelines for implantable cardioverter defibrillators (ICDs) implantation to prevent VT-related sudden cardiac death is solely based on symptoms and left ventricular ejection fraction. Catheter ablation of scar-related VTs is performed following ICD therapy, reducing VTs, painful shocks, anxiety, depression and worsening heart failure. We postulate that better prediction of the occurrence and circuit of VT, will improve identification of patients at risk for VT and boost preventive ablation, reducing mortality and morbidity. For this purpose, multiple time-evolving aspects of the underlying pathophysiology, including the anatomical substrate, triggers and modulators, should be part of VT prediction models. We envision digital twins as a solution combining clinical expertise with three prediction approaches: evidence-based medicine (clinical practice), data-driven models (data science) and mechanistic models (biomedical engineering). This paper aims to create a mutual understanding between experts in the different fields by providing a comprehensive description of the clinical problem and the three approaches in an understandable manner, leveraging future collaborations and technological innovations for clinical decision support. Moreover, it defines open challenges and gains for digital twin solutions and discusses the potential of hybrid modelling.
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Affiliation(s)
| | - Carlijn M A Buck
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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7
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Ventricular Fibrillation and Tachycardia Detection Using Features Derived from Topological Data Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rapid and accurate detection of ventricular arrhythmias is essential to take appropriate therapeutic actions when cardiac arrhythmias occur. Furthermore, the accurate discrimination between arrhythmias is also important, provided that the required shocking therapy would not be the same. In this work, the main novelty is the use of the mathematical method known as Topological Data Analysis (TDA) to generate new types of features which can contribute to the improvement of the detection and classification performance of cardiac arrhythmias such as Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT). The electrocardiographic (ECG) signals used for this evaluation were obtained from the standard MIT-BIH and AHA databases. Two input data to the classify are evaluated: TDA features, and Persistence Diagram Image (PDI). Using the reduced TDA-obtained features, a high average accuracy near 99% was observed when discriminating four types of rhythms (98.68% to VF; 99.05% to VT; 98.76% to normal sinus; and 99.09% to Other rhythms) with specificity values higher than 97.16% in all cases. In addition, a higher accuracy of 99.51% was obtained when discriminating between shockable (VT/VF) and non-shockable rhythms (99.03% sensitivity and 99.67% specificity). These results show that the use of TDA-derived geometric features, combined in this case this the k-Nearest Neighbor (kNN) classifier, raises the classification performance above results in previous works. Considering that these results have been achieved without preselection of ECG episodes, it can be concluded that these features may be successfully introduced in Automated External Defibrillation (AED) and Implantable Cardioverter Defibrillation (ICD) therapies.
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Abstract
In this digital era, artificial intelligence (AI) is establishing a strong foothold in commercial industry and the field of technology. These effects are trickling into the healthcare industry, especially in the clinical arena of cardiology. Machine learning (ML) algorithms are making substantial progress in various subspecialties of cardiology. This will have a positive impact on patient care and move the field towards precision medicine. In this review article, we explore the progress of ML in cardiovascular imaging, electrophysiology, heart failure, and interventional cardiology.
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Nguyen MT, Nguyen THT, Le HC. A review of progress and an advanced method for shock advice algorithms in automated external defibrillators. Biomed Eng Online 2022; 21:22. [PMID: 35366906 PMCID: PMC8976411 DOI: 10.1186/s12938-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractShock advice algorithm plays a vital role in the detection of sudden cardiac arrests on electrocardiogram signals and hence, brings about survival improvement by delivering prompt defibrillation. The last decade has witnessed a surge of research efforts in racing for efficient shock advice algorithms, in this context. On one hand, it has been reported that the classification performance of traditional threshold-based methods has not complied with the American Heart Association recommendations. On the other hand, the rise of machine learning and deep learning-based counterparts is paving the new ways for the development of intelligent shock advice algorithms. In this paper, we firstly provide a comprehensive survey on the development of shock advice algorithms for rhythm analysis in automated external defibrillators. Shock advice algorithms are categorized into three groups based on the classification methods in which the detection performance is significantly improved by the use of machine learning and/or deep learning techniques instead of threshold-based approaches. Indeed, in threshold-based shock advice algorithms, a parameter is calculated as a threshold to distinguish shockable rhythms from non-shockable ones. In contrast, machine learning-based methods combine multiple parameters of conventional threshold-based approaches as a set of features to recognize sudden cardiac arrest. Noticeably, those features are possibly extracted from stand-alone ECGs, alternative signals using various decomposition techniques, or fully augmented ECG segments. Moreover, these signals can be also used directly as the input channels of deep learning-based shock advice algorithm designs. Then, we propose an advanced shock advice algorithm using a support vector machine classifier and a feature set extracted from a fully augmented ECG segment with its shockable and non-shockable signals. The relatively high detection performance of the proposed shock advice algorithm implies a potential application for the automated external defibrillator in the practical clinic environment. Finally, we outline several interesting yet challenging research problems for further investigation.
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Nedios S, Iliodromitis K, Kowalewski C, Bollmann A, Hindricks G, Dagres N, Bogossian H. Big Data in electrophysiology. Herzschrittmacherther Elektrophysiol 2022; 33:26-33. [PMID: 35137276 DOI: 10.1007/s00399-022-00837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
The quantity of data produced and captured in medicine today is unprecedented. Technological improvements and automation have expanded the traditional statistical methods and enabled the analysis of Big Data. This has permitted the discovery of new associations with a granularity that was previously hidden to human eyes. In the first part of this review, the authors would like to provide an overview of basic Machine Learning (ML) principles and techniques in order to better understand their application in recent publications about cardiac arrhythmias. In the second part, ML-enabled advances in disease detection and diagnosis, outcome prediction, and novel disease characterization in topics like electrocardiography, atrial fibrillation, ventricular arrhythmias, and cardiac devices are presented. Finally, the limitations and challenges of applying ML in clinical practice, such as validation, replication, generalizability, and regulatory issues, are discussed. More carefully designed studies and collaborations are needed for ML to become feasible, trustworthy, accurate, and reproducible and to reach its full potential for patient-oriented precision medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany.
- Rhythmologie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Konstantinos Iliodromitis
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
| | - Christopher Kowalewski
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Harilaos Bogossian
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
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11
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Automatic cardiac arrhythmia classification based on hybrid 1-D CNN and Bi-LSTM model. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Wan R, Huang Y, Wu X. Detection of Ventricular Fibrillation Based on Ballistocardiography by Constructing an Effective Feature Set. SENSORS (BASEL, SWITZERLAND) 2021; 21:3524. [PMID: 34069374 PMCID: PMC8158750 DOI: 10.3390/s21103524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Ventricular fibrillation (VF) is a type of fatal arrhythmia that can cause sudden death within minutes. The study of a VF detection algorithm has important clinical significance. This study aimed to develop an algorithm for the automatic detection of VF based on the acquisition of cardiac mechanical activity-related signals, namely ballistocardiography (BCG), by non-contact sensors. BCG signals, including VF, sinus rhythm, and motion artifacts, were collected through electric defibrillation experiments in pigs. Through autocorrelation and S transform, the time-frequency graph with obvious information of cardiac rhythmic activity was obtained, and a feature set of 13 elements was constructed for each 7 s segment after statistical analysis and hierarchical clustering. Then, the random forest classifier was used to classify VF and non-VF, and two paradigms of intra-patient and inter-patient were used to evaluate the performance. The results showed that the sensitivity and specificity were 0.965 and 0.958 under 10-fold cross-validation, and they were 0.947 and 0.946 under leave-one-subject-out cross-validation. In conclusion, the proposed algorithm combining feature extraction and machine learning can effectively detect VF in BCG, laying a foundation for the development of long-term self-cardiac monitoring at home and a VF real-time detection and alarm system.
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Affiliation(s)
- Rongru Wan
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (R.W.); (Y.H.)
| | - Yanqi Huang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (R.W.); (Y.H.)
| | - Xiaomei Wu
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (R.W.); (Y.H.)
- Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai 200032, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai 200093, China
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Degirmenci M, Ozdemir M, Izci E, Akan A. Arrhythmic Heartbeat Classification Using 2D Convolutional Neural Networks. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Chang KC, Hsieh PH, Wu MY, Wang YC, Chen JY, Tsai FJ, Shih ES, Hwang MJ, Huang TC. Usefulness of Machine Learning-Based Detection and Classification of Cardiac Arrhythmias With 12-Lead Electrocardiograms. Can J Cardiol 2021; 37:94-104. [DOI: 10.1016/j.cjca.2020.02.096] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022] Open
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Abstract
Artificial intelligence through machine learning (ML) methods is becoming prevalent throughout the world, with increasing adoption in healthcare. Improvements in technology have allowed early applications of machine learning to assist physician efficiency and diagnostic accuracy. In electrophysiology, ML has applications for use in every stage of patient care. However, its use is still in infancy. This article will introduce the potential of ML, before discussing the concept of big data and its pitfalls. The authors review some common ML methods including supervised and unsupervised learning, then examine applications in cardiac electrophysiology. This will focus on surface electrocardiography, intracardiac mapping and cardiac implantable electronic devices. Finally, the article concludes with an overview of how ML may impact on electrophysiology in the future.
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Krasteva V, Ménétré S, Didon JP, Jekova I. Fully Convolutional Deep Neural Networks with Optimized Hyperparameters for Detection of Shockable and Non-Shockable Rhythms. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2875. [PMID: 32438582 PMCID: PMC7285174 DOI: 10.3390/s20102875] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022]
Abstract
Deep neural networks (DNN) are state-of-the-art machine learning algorithms that can be learned to self-extract significant features of the electrocardiogram (ECG) and can generally provide high-output diagnostic accuracy if subjected to robust training and optimization on large datasets at high computational cost. So far, limited research and optimization of DNNs in shock advisory systems is found on large ECG arrhythmia databases from out-of-hospital cardiac arrests (OHCA). The objective of this study is to optimize the hyperparameters (HPs) of deep convolutional neural networks (CNN) for detection of shockable (Sh) and nonshockable (NSh) rhythms, and to validate the best HP settings for short and long analysis durations (2-10 s). Large numbers of (Sh + NSh) ECG samples were used for training (720 + 3170) and validation (739 + 5921) from Holters and defibrillators in OHCA. An end-to-end deep CNN architecture was implemented with one-lead raw ECG input layer (5 s, 125 Hz, 2.5 uV/LSB), configurable number of 5 to 23 hidden layers and output layer with diagnostic probability p ∈ [0: Sh,1: NSh]. The hidden layers contain N convolutional blocks × 3 layers (Conv1D (filters = Fi, kernel size = Ki), max-pooling (pool size = 2), dropout (rate = 0.3)), one global max-pooling and one dense layer. Random search optimization of HPs = {N, Fi, Ki}, i = 1, … N in a large grid of N = [1, 2, … 7], Fi = [5;50], Ki = [5;100] was performed. During training, the model with maximal balanced accuracy BAC = (Sensitivity + Specificity)/2 over 400 epochs was stored. The optimization principle is based on finding the common HPs space of a few top-ranked models and prediction of a robust HP setting by their median value. The optimal models for 1-7 CNN layers were trained with different learning rates LR = [10-5; 10-2] and the best model was finally validated on 2-10 s analysis durations. A number of 4216 random search models were trained. The optimal models with more than three convolutional layers did not exhibit substantial differences in performance BAC = (99.31-99.5%). Among them, the best model was found with {N = 5, Fi = {20, 15, 15, 10, 5}, Ki = {10, 10, 10, 10, 10}, 7521 trainable parameters} with maximal validation performance for 5-s analysis (BAC = 99.5%, Se = 99.6%, Sp = 99.4%) and tolerable drop in performance (<2% points) for very short 2-s analysis (BAC = 98.2%, Se = 97.6%, Sp = 98.7%). DNN application in future-generation shock advisory systems can improve the detection performance of Sh and NSh rhythms and can considerably shorten the analysis duration complying with resuscitation guidelines for minimal hands-off pauses.
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Affiliation(s)
- Vessela Krasteva
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria;
| | - Sarah Ménétré
- Schiller Médical, 4 Rue Louis Pasteur, 67160 Wissembourg, France; (S.M.); (J.-P.D.)
| | - Jean-Philippe Didon
- Schiller Médical, 4 Rue Louis Pasteur, 67160 Wissembourg, France; (S.M.); (J.-P.D.)
| | - Irena Jekova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria;
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Gajowniczek K, Grzegorczyk I, Ząbkowski T, Bajaj C. Weighted Random Forests to Improve Arrhythmia Classification. ELECTRONICS 2020; 9. [PMID: 32051761 PMCID: PMC7015067 DOI: 10.3390/electronics9010099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Construction of an ensemble model is a process of combining many diverse base predictive learners. It arises questions of how to weight each model and how to tune the parameters of the weighting process. The most straightforward approach is simply to average the base models. However, numerous studies have shown that a weighted ensemble can provide superior prediction results to a simple average of models. The main goals of this article are to propose a new weighting algorithm applicable for each tree in the Random Forest model and the comprehensive examination of the optimal parameter tuning. Importantly, the approach is motivated by its flexibility, good performance, stability, and resistance to overfitting. The proposed scheme is examined and evaluated on the Physionet/Computing in Cardiology Challenge 2015 data set. It consists of signals (electrocardiograms and pulsatory waveforms) from intensive care patients which triggered an alarm for five cardiac arrhythmia types (Asystole, Bradycardia, Tachycardia, Ventricular Tachycardia, and Ventricular Fultter/Fibrillation). The classification problem regards whether the alarm should or should not have been generated. It was proved that the proposed weighting approach improved classification accuracy for the three most challenging out of the five investigated arrhythmias comparing to the standard Random Forest model.
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Affiliation(s)
- Krzysztof Gajowniczek
- Department of Artificial Intelligence, Institute of Information Technology, Warsaw University of Life Sciences - SGGW, 02-776 Warsaw, Poland
- Correspondence: ; Tel.: +48-506-746-850
| | - Iga Grzegorczyk
- Department of Physics of Complex Systems, Faculty of Physics, Warsaw University of Technology, 00-662 Warsaw, Poland
| | - Tomasz Ząbkowski
- Department of Artificial Intelligence, Institute of Information Technology, Warsaw University of Life Sciences - SGGW, 02-776 Warsaw, Poland
| | - Chandrajit Bajaj
- Department of Computer Science, Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX 78712
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18
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Real-Time Localization of Epileptogenic Foci EEG Signals: An FPGA-Based Implementation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The epileptogenic focus is a brain area that may be surgically removed to control of epileptic seizures. Locating it is an essential and crucial step prior to the surgical treatment. However, given the difficulty of determining the localization of this brain region responsible of the initial seizure discharge, many works have proposed machine learning methods for the automatic classification of focal and non-focal electroencephalographic (EEG) signals. These works use automatic classification as an analysis tool for helping neurosurgeons to identify focal areas off-line, out of surgery, during the processing of the huge amount of information collected during several days of patient monitoring. In turn, this paper proposes an automatic classification procedure capable of assisting neurosurgeons online, during the resective epilepsy surgery, to refine the localization of the epileptogenic area to be resected, if they have doubts. This goal requires a real-time implementation with as low a computational cost as possible. For that reason, this work proposes both a feature set and a classifier model that minimizes the computational load while preserving the classification accuracy at 95.5%, a level similar to previous works. In addition, the classification procedure has been implemented on a FPGA device to determine its resource needs and throughput. Thus, it can be concluded that such a device can embed the whole classification process, from accepting raw signals to the delivery of the classification results in a cost-effective Xilinx Spartan-6 FPGA device. This real-time implementation begins providing results after a 5 s latency, and later, can deliver floating-point classification results at 3.5 Hz rate, using overlapped time-windows.
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Zhang K, Aleexenko V, Jeevaratnam K. Computational approaches for detection of cardiac rhythm abnormalities: Are we there yet? J Electrocardiol 2020; 59:28-34. [PMID: 31954954 DOI: 10.1016/j.jelectrocard.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022]
Abstract
The analysis of an electrocardiogram (ECG) is able to provide vital information on the electrical activity of the heart and is crucial for the accurate diagnosis of cardiac arrhythmias. Due to the nature of some arrhythmias, this might be a time-consuming and difficult to accomplish process. The advent of novel machine learning technologies in this field has a potential to revolutionise the use of the ECG. In this review, we outline key advances in ECG analysis for atrial, ventricular and complex multiform arrhythmias, as well as discuss the current limitations of the technology and the barriers that must be overcome before clinical integration is feasible.
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Affiliation(s)
- Kevin Zhang
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom; School of Medicine, Imperial College London, United Kingdom
| | - Vadim Aleexenko
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom.
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20
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Picon A, Irusta U, Álvarez-Gila A, Aramendi E, Alonso-Atienza F, Figuera C, Ayala U, Garrote E, Wik L, Kramer-Johansen J, Eftestøl T. Mixed convolutional and long short-term memory network for the detection of lethal ventricular arrhythmia. PLoS One 2019; 14:e0216756. [PMID: 31107876 PMCID: PMC6527215 DOI: 10.1371/journal.pone.0216756] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022] Open
Abstract
Early defibrillation by an automated external defibrillator (AED) is key for the survival of out-of-hospital cardiac arrest (OHCA) patients. ECG feature extraction and machine learning have been successfully used to detect ventricular fibrillation (VF) in AED shock decision algorithms. Recently, deep learning architectures based on 1D Convolutional Neural Networks (CNN) have been proposed for this task. This study introduces a deep learning architecture based on 1D-CNN layers and a Long Short-Term Memory (LSTM) network for the detection of VF. Two datasets were used, one from public repositories of Holter recordings captured at the onset of the arrhythmia, and a second from OHCA patients obtained minutes after the onset of the arrest. Data was partitioned patient-wise into training (80%) to design the classifiers, and test (20%) to report the results. The proposed architecture was compared to 1D-CNN only deep learners, and to a classical approach based on VF-detection features and a support vector machine (SVM) classifier. The algorithms were evaluated in terms of balanced accuracy (BAC), the unweighted mean of the sensitivity (Se) and specificity (Sp). The BAC, Se, and Sp of the architecture for 4-s ECG segments was 99.3%, 99.7%, and 98.9% for the public data, and 98.0%, 99.2%, and 96.7% for OHCA data. The proposed architecture outperformed all other classifiers by at least 0.3-points in BAC in the public data, and by 2.2-points in the OHCA data. The architecture met the 95% Sp and 90% Se requirements of the American Heart Association in both datasets for segment lengths as short as 3-s. This is, to the best of our knowledge, the most accurate VF detection algorithm to date, especially on OHCA data, and it would enable an accurate shock no shock diagnosis in a very short time.
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Affiliation(s)
- Artzai Picon
- Computer Vision Group, Tecnalia Research & Innovation, Derio, Spain
| | - Unai Irusta
- Department of Communications Engineering, University of the Basque Country UPV/EHU, Bilbao, Spain
| | | | - Elisabete Aramendi
- Department of Communications Engineering, University of the Basque Country UPV/EHU, Bilbao, Spain
| | - Felipe Alonso-Atienza
- Department of Signal Theory and Communications, Rey Juan Carlos University, Madrid, Spain
- Client Solutions Advanced Analytics, BBVA, Madrid, Spain
| | - Carlos Figuera
- Department of Signal Theory and Communications, Rey Juan Carlos University, Madrid, Spain
- Client Solutions Advanced Analytics, BBVA, Madrid, Spain
| | - Unai Ayala
- Electronics and Computing Department, Mondragon Unibertsitatea, Faculty of Engineering (MU-ENG), Mondragón, Spain
| | | | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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MOHANTY MONALISA, BISWAL PRADYUT, SABUT SUKANTA. VENTRICULAR TACHYCARDIA AND FIBRILLATION DETECTION USING DWT AND DECISION TREE CLASSIFIER. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the life-threatening ventricular arrhythmias that require treatment in an emergency. Detection of VT and VF at an early stage is crucial for achieving the success of the defibrillation treatment. Hence an automatic system using computer-aided diagnosis tool is helpful in detecting the ventricular arrhythmias in electrocardiogram (ECG) signal. In this paper, a discrete wavelet transform (DWT) was used to denoise and decompose the ECG signals into different consecutive frequency bands to reduce noise. The methodology was tested using ECG data from standard CU ventricular tachyarrhythmia database (CUDB) and MIT-BIH malignant ventricular ectopy database (VFDB) datasets of PhysioNet databases. A set of time-frequency features consists of temporal, spectral, and statistical were extracted and ranked by the correlation attribute evaluation with ranker search method in order to improve the accuracy of detection. The ranked features were classified for VT and VF conditions using support vector machine (SVM) and decision tree (C4.5) classifier. The proposed DWT based features yielded the average sensitivity of 98%, specificity of 99.32%, and accuracy of 99.23% using a decision tree (C4.5) classifier. These results were better than the SVM classifier having an average accuracy of 92.43%. The obtained results prove that using DWT based time-frequency features with decision tree (C4.5) classifier can be one of the best choices for clinicians for precise detection of ventricular arrhythmias.
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Affiliation(s)
- MONALISA MOHANTY
- Department of Electronics & Communication Engineering, ITER, SOA Deemed to be University, Odisha, India
| | - PRADYUT BISWAL
- Department of Electronics and Telecommunication Engineering, IIIT Bhubaneswar, Odisha, India
| | - SUKANTA SABUT
- School of Electronics Engineering, KIIT Deemed to be University, Odisha, India
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Reducing False Arrhythmia Alarms Using Different Methods of Probability and Class Assignment in Random Forest Learning Methods. SENSORS 2019; 19:s19071588. [PMID: 30986930 PMCID: PMC6479538 DOI: 10.3390/s19071588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/16/2022]
Abstract
The literature indicates that 90% of clinical alarms in intensive care units might be false. This high percentage negatively impacts both patients and clinical staff. In patients, false alarms significantly increase stress levels, which is especially dangerous for cardiac patients. In clinical staff, alarm overload might lead to desensitization and could result in true alarms being ignored. In this work, we applied the random forest method to reduce false arrhythmia alarms and specifically explored different methods of probability and class assignment, as these affect the classification accuracy of the ensemble classifiers. Due to the complex nature of the problem, i.e., five types of arrhythmia and several methods to determine probability and the alarm class, a synthetic measure based on the ranks was proposed. The novelty of this contribution is the design of a synthetic measure that helps to leverage classification results in an ensemble model that indicates a decision path leading to the best result in terms of the area under the curve (AUC) measure or the global accuracy (score). The results of the research are promising. The best performance in terms of the AUC was 100% accuracy for extreme tachycardia, whereas the poorest results were for ventricular tachycardia at 87%. Similarly, in terms of the accuracy, the best results were observed for extreme tachycardia (91%), whereas ventricular tachycardia alarms were the most difficult to detect, with an accuracy of only 51%.
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Detection of Ventricular Fibrillation Using the Image from Time-Frequency Representation and Combined Classifiers without Feature Extraction. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due the fact that the required therapy to treat Ventricular Fibrillation (V F) is aggressive (electric shock), the lack of a proper detection and recovering therapy could cause serious injuries to the patient or trigger a ventricular fibrillation, or even death. This work describes the development of an automatic diagnostic system for the detection of the occurrence of V F in real time by means of the time-frequency representation (T F R) image of the ECG. The main novelties are the use of the T F R image as input for a classification process, as well as the use of combined classifiers. The feature extraction stage is eliminated and, together with the use of specialized binary classifiers, this method improves the results of the classification. To verify the validity of the method, four different classifiers in different combinations are used: Regression Logistic with L2 Regularization (L 2 R L R), adaptive neural network (A N N C), Bagging (B A G G), and K-nearest neighbor (K N N). The Hierarchical Method (HM) and Voting Majority Method (VMM) combinations are used. ECG signals used for evaluation were obtained from the standard MIT-BIH and AHA databases. When the classifiers were combined, it was observed that the combination of B A G G , K N N , and A N N C using the Hierarchical Method (HM) gave the best results, with a sensitivity of 95.58 ± 0.41%, a 99.31 ± 0.08% specificity, a 98.6 ± 0.04% of overall accuracy, and a precision of 98.25 ± 0.29% for V F . Whereas a sensitivity of 94.02 ± 0.58%, a specificity of 99.31 ± 0.08%, an overall accuracy of 99.14 ± 0.43%, and a precision of 98.59 ± 0.09% was obtained for V T with a run time between 0.07 s and 0.12 s. Results show that the use of T F R image data to feed the combined classifiers yields a reduction in execution time with performance values above to those obtained by individual classifiers. This is of special utility for V F detection in real time.
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Abawajy J, Kelarev A, Yi X, Jelinek HF. Minimal ensemble based on subset selection using ECG to diagnose categories of CAN. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 160:85-94. [PMID: 29728250 DOI: 10.1016/j.cmpb.2018.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/06/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Early diagnosis of cardiac autonomic neuropathy (CAN) is critical for reversing or decreasing its progression and prevent complications. Diagnostic accuracy or precision is one of the core requirements of CAN detection. As the standard Ewing battery tests suffer from a number of shortcomings, research in automating and improving the early detection of CAN has recently received serious attention in identifying additional clinical variables and designing advanced ensembles of classifiers to improve the accuracy or precision of CAN diagnostics. Although large ensembles are commonly proposed for the automated diagnosis of CAN, large ensembles are characterized by slow processing speed and computational complexity. This paper applies ECG features and proposes a new ensemble-based approach for diagnosis of CAN progression. METHODS We introduce a Minimal Ensemble Based On Subset Selection (MEBOSS) for the diagnosis of all categories of CAN including early, definite and atypical CAN. MEBOSS is based on a novel multi-tier architecture applying classifier subset selection as well as the training subset selection during several steps of its operation. Our experiments determined the diagnostic accuracy or precision obtained in 5 × 2 cross-validation for various options employed in MEBOSS and other classification systems. RESULTS The experiments demonstrate the operation of the MEBOSS procedure invoking the most effective classifiers available in the open source software environment SageMath. The results of our experiments show that for the large DiabHealth database of CAN related parameters MEBOSS outperformed other classification systems available in SageMath and achieved 94% to 97% precision in 5 × 2 cross-validation correctly distinguishing any two CAN categories to a maximum of five categorizations including control, early, definite, severe and atypical CAN. CONCLUSIONS These results show that MEBOSS architecture is effective and can be recommended for practical implementations in systems for the diagnosis of CAN progression.
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Affiliation(s)
- Jemal Abawajy
- School of Information Technology, Deakin University, 221 Burwood Hwy, Victoria 3125, Australia.
| | - Andrei Kelarev
- School of Information Technology, Deakin University, 221 Burwood Hwy, Victoria 3125, Australia; School of Science, RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia.
| | - Xun Yi
- School of Science, RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia.
| | - Herbert F Jelinek
- School of Community Health, Charles Sturt University, PO Box 789, Albury, NSW 2640, Australia.
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Efficient classification of ventricular arrhythmias using feature selection and C4.5 classifier. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Rajeswari J, Jagannath M. Advances in biomedical signal and image processing – A systematic review. INFORMATICS IN MEDICINE UNLOCKED 2017. [DOI: 10.1016/j.imu.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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