Diagnostic decision support systems for atrial fibrillation based on a novel electrocardiogram approach

Intelligent Algorithm-Based Electrocardiography to Predict Atrial Fibrillation after Coronary Artery Bypass Grafting in the Elderly

The objective of this study was to explore the predictive value of electrocardiogram (ECG) based on intelligent analysis algorithm for atrial fibrillation (AF) in elderly patients undergoing coronary artery bypass grafting (CABG). Specifically, 106 elderly patients with coronary heart disease who underwent CABG in the hospital were selected, including 52 patients with postoperative AF (AF group) and 54 patients without arrhythmia (control group). Within 1-3 weeks after operation, the dynamic ECG monitoring system based on Gentle AdaBoost algorithm constructed in this study was adopted. After the measurement of the 12-lead P wave duration, the maximum P wave duration (Pmax) and minimum P wave duration (Pmin) were recorded. As for simulation experiments, the same data was used as the back-propagation algorithm. The results showed that for the detection accuracy of the test samples, the Gentle AdaBoost algorithm showed 93.7% accuracy after the first iteration, and the Gentle AdaBoost algorithm was 16.1% higher than the back-propagation algorithm. Compared with the control group, the detection rate of arrhythmia in patients after CABG was significantly lower ( $P<0.05$ ). Bivariate logistic regression analysis on Pmax and Pmin showed as follows: Pmax: 95% confidential interval (CI): 1.024-1.081, $P<0.05$ ; Pmin: 95% CI: 1.036-1.117, $P<0.05$ . The sensitivity of Pmax and Pmin in predicting paroxysmal AF was 78.2% and 73.4%, respectively; the specificity of them was 80.1% and 85.6%, respectively; the positive predictive value was 81.2% and 83.4%, respectively; and the negative predictive value was 79.5% and 75.3%, respectively. In conclusion, the generalization ability of Gentle AdaBoost algorithm was better than that of back-propagation algorithm, and it can identify arrhythmia better. Pmax and Pmin were important indicators of AF after CABG.

Digital biomarkers and algorithms for detection of atrial fibrillation using surface electrocardiograms: A systematic review

AIMS

Automated detection of atrial fibrillation (AF) in continuous rhythm registrations is essential in order to prevent complications and optimize treatment of AF. Many algorithms have been developed to detect AF in surface electrocardiograms (ECGs) during the past few years. The aim of this systematic review is to gain more insight into these available classification methods by discussing previously used digital biomarkers and algorithms and make recommendations for future research.

METHODS

On the 14^th of September 2020, the PubMed database was searched for articles focusing on algorithms for AF detection in ECGs using the MeSH terms Atrial Fibrillation, Electrocardiography and Algorithms. Articles which solely focused on differentiation of types of rhythm disorders or prediction of AF termination were excluded.

RESULTS

The search resulted in 451 articles, of which 130 remained after full-text screening. Not only did the amount of research on methods for AF detection increase over the past years, but a trend towards more complex classification methods is observed. Furthermore, three different types of features can be distinguished: atrial features, ventricular features, and signal features. Although AF is an atrial disease, only 22% of the described methods use atrial features.

CONCLUSION

More and more studies focus on improving accuracy of classification methods for AF in ECGs. As a result, algorithms become increasingly complex and less well interpretable. Only a few studies focus on detecting atrial activity in the ECG. Developing innovative methods focusing on detection of atrial activity might provide accurate classifiers without compromising on transparency.