A Real-Time Arrhythmia Heartbeats Classification Algorithm Using Parallel Delta Modulations and Rotated Linear-Kernel Support Vector Machines

A novel method of swin transformer with time-frequency characteristics for ECG-based arrhythmia detection

Introduction

Arrhythmia is an important indication of underlying cardiovascular diseases (CVD) and is prevalent worldwide. Accurate diagnosis of arrhythmia is crucial for timely and effective treatment. Electrocardiogram (ECG) plays a key role in the diagnosis of arrhythmia. With the continuous development of deep learning and machine learning processes in the clinical field, ECG processing algorithms have significantly advanced the field with timely and accurate diagnosis of arrhythmia.

Methods

In this study, we combined the wavelet time-frequency maps with the novel Swin Transformer deep learning model for the automatic detection of cardiac arrhythmias. In specific practice, we used the MIT-BIH arrhythmia dataset, and to improve the signal quality, we removed the high-frequency noise, artifacts, electromyographic noise and respiratory motion effects in the ECG signals by the wavelet thresholding method; we used the complex Morlet wavelet for the feature extraction, and plotted wavelet time-frequency maps to visualise the time-frequency information of the ECG; we introduced the Swin Transformer model for classification and achieve high classification accuracy of ECG signals through hierarchical construction and self attention mechanism, and combines windowed multi-head self-attention (W-MSA) and shifted window-based multi-head self-attention (SW-MSA) to comprehensively utilise the local and global information.

Results

To enhance the confidence of the experimental results, we evaluated the performance using intra-patient and inter-patient paradigm analyses, and the model classification accuracies reached 99.34% and 98.37%, respectively, which are better than the currently available detection methods.

Discussion

The results reveal that our proposed method is superior to currently available methods for detecting arrhythmia ECG. This provides a new idea for ECG based arrhythmia diagnosis.

Automated cardiac arrhythmia detection techniques: a comprehensive review for prospective approach

Abnormal cardiac functionality produces irregular heart rhythms which are commonly known as arrhythmias. In some conditions, arrhythmias are treated as very dangerous which may lead to sudden cardiac arrest. The incidence and prevalence of cardiac anomalies seeks early detection of arrhythmias using automated classification techniques. In the past, numerous automated arrhythmia detection techniques have been developed that are based on electrocardiogram (ECG) signal analysis. Focusing on the prospective research in this field, this article reports a comprehensive review of existing techniques that are obtained using search engines such as IEEE explore, Google scholar and science direct. Based on the review, the existing techniques are broadly categorized into two types: machine-learning and deep-learning-based techniques. In this study, it is noticed that the performance of the machine-learning-based arrhythmia detection techniques depend on pre-processing of ECG signal, R-peaks detection, features extraction and classification tools while the deep-learning-based techniques do not require the features extraction step. Generally, the existing techniques utilize Massachusetts Institute of Technology-Beth Israel Hospital arrhythmia database to evaluate the classification performance. The classification performance of automated techniques also depends on ECG data used for training and testing of the classifier. It is expected that the performance should be evaluated using a variety of ECG signals including the cases of inter-patient and intra-patient paradigm. The existing techniques also require to deal with the class-imbalance problem. In addition to this, a specific partition-ratio between training and testing datasets should be maintained for fair comparison of performance of different techniques.

ECG-based data-driven solutions for diagnosis and prognosis of cardiovascular diseases: A systematic review

Cardiovascular diseases (CVD) are a leading cause of death globally, and result in significant morbidity and reduced quality of life. The electrocardiogram (ECG) plays a crucial role in CVD diagnosis, prognosis, and prevention; however, different challenges still remain, such as an increasing unmet demand for skilled cardiologists capable of accurately interpreting ECG. This leads to higher workload and potential diagnostic inaccuracies. Data-driven approaches, such as machine learning (ML) and deep learning (DL) have emerged to improve existing computer-assisted solutions and enhance physicians' ECG interpretation of the complex mechanisms underlying CVD. However, many ML and DL models used to detect ECG-based CVD suffer from a lack of explainability, bias, as well as ethical, legal, and societal implications (ELSI). Despite the critical importance of these Trustworthy Artificial Intelligence (AI) aspects, there is a lack of comprehensive literature reviews that examine the current trends in ECG-based solutions for CVD diagnosis or prognosis that use ML and DL models and address the Trustworthy AI requirements. This review aims to bridge this knowledge gap by providing a systematic review to undertake a holistic analysis across multiple dimensions of these data-driven models such as type of CVD addressed, dataset characteristics, data input modalities, ML and DL algorithms (with a focus on DL), and aspects of Trustworthy AI like explainability, bias and ethical considerations. Additionally, within the analyzed dimensions, various challenges are identified. To these, we provide concrete recommendations, equipping other researchers with valuable insights to understand the current state of the field comprehensively.

Second-Order Level-Crossing Sampling Analog to Digital Converter for Electrocardiogram Delineation and Premature Ventricular Contraction Detection

This article presents an electrocardiogram (ECG) delineation and arrhythmia heartbeat detection system using a novel second-order level-crossing sampling analog to digital converter (ADC) for real-time data compression and feature extraction. The proposed system consists of the front-end integrated circuit of the data converter, the delineation algorithm, and the arrhythmia detection algorithm. Compared with conventional level-sampling ADCs, the proposed circuit updates tracking thresholds using linear extrapolation, which forms a second-order level-crossing sampling ADC that has sloped sampling levels. The computing is done digitally and is implemented by modifying the digital control logic of a conventional Successive-approximation-register (SAR) ADC. The system separates the sampling and quantization processes and only selects the turning points in the input waveform for quantization. The output of the proposed data converter consists of both the digital value of the selected sampling points and the timestamp between the selected sampling points. The main advantages are data savings for the data converter and the following digital signal processing or communication circuits, which are ideal for low-power sensors. The test chip was fabricated using a 180 nm CMOS process. When sensing sparse signals such as ECG signals the proposed ADC achieves a compression factor of 8.33. The delineation algorithm uses a triangle filter method to locate the fiducial points and measures the intervals, slopes, and morphology of the QRS complex and the P/T waves. Those extracted features are then used in the arrhythmia heartbeat detection algorithm to identify Premature Ventricular Contraction (PVC). The overall performance of the system is evaluated using the MIT-BIH database and the QT database, which is also compared with the recently reported systems. The accuracy, sensitivity, specificity, PPV, and F1 score are 97.3%, 89.6%, 97.8%, 73.3%, and 0.81 for detecting PVC.

A Systematic Review of Machine Learning and IoT Applied to the Prediction and Monitoring of Cardiovascular Diseases

According to the Pan American Health Organization, cardiovascular disease is the leading cause of death worldwide, claiming an estimated 17.9 million lives each year. This paper presents a systematic review to highlight the use of IoT, IoMT, and machine learning to detect, predict, or monitor cardiovascular disease. We had a final sample of 164 high-impact journal papers, focusing on two categories: cardiovascular disease detection using IoT/IoMT technologies and cardiovascular disease using machine learning techniques. For the first category, we found 82 proposals, while for the second, we found 85 proposals. The research highlights list of IoT/IoMT technologies, machine learning techniques, datasets, and the most discussed cardiovascular diseases. Neural networks have been popularly used, achieving an accuracy of over 90%, followed by random forest, XGBoost, k-NN, and SVM. Based on the results, we conclude that IoT/IoMT technologies can predict cardiovascular diseases in real time, ensemble techniques obtained one of the best performances in the accuracy metric, and hypertension and arrhythmia were the most discussed diseases. Finally, we identified the lack of public data as one of the main obstacles for machine learning approaches for cardiovascular disease prediction.

Automatic classification of arrhythmias using multi-branch convolutional neural networks based on channel-based attention and bidirectional LSTM

Cardiac arrhythmia is an abnormal rhythm of the heartbeat and can be life-threatening Electrocardiogram (ECG) is a technology that uses an electrocardiograph machine to record a graph of the changes in electrical activity produced by the heart at each cardiac cycle. ECG can generally be used to check whether the examinee has arrhythmia, ion channel disease, cardiomyopathy, electrolyte disorder and other diseases. To reduce the workload of doctors and improve the accuracy of ECG signal recognition, a novel and lightweight automatic ECG classification method based on Convolutional Neural Network (CNN) is proposed. The multi-branch network with different receptive fields is used to extract the multi-spatial deep features of heartbeats. The Channel Attention Module (CAM) and Bidirectional Long Short-Term Memory neural network (BLSTM) module are used to filter redundant ECG features. CAM and BLSTM are beneficial for distinguishing different categories of heartbeats. In the experiments, a four-fold cross-validation technique is used to improve the generalization capability of the network, and it shows good performance on the testing set. This method divides heartbeats into five categories according to the American Advancement of Medical Instrumentation (AAMI) criteria, which is validated in the MIT-BIH arrhythmia database. The sensitivity of this method to Ventricular Ectopic Beat (VEB) is 98.5% and the F1 score is 98.2%. The precision of the Supraventricular Ectopic Beat (SVEB) is 91.1%, and the corresponding F1 score is 90.8%. The proposed method has high classification performance and a lightweight feature. In a word, it has broad application prospects in clinical medicine and health testing.

Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review

Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data.

A Review of Embedded Machine Learning Based on Hardware, Application, and Sensing Scheme

Machine learning is an expanding field with an ever-increasing role in everyday life, with its utility in the industrial, agricultural, and medical sectors being undeniable. Recently, this utility has come in the form of machine learning implementation on embedded system devices. While there have been steady advances in the performance, memory, and power consumption of embedded devices, most machine learning algorithms still have a very high power consumption and computational demand, making the implementation of embedded machine learning somewhat difficult. However, different devices can be implemented for different applications based on their overall processing power and performance. This paper presents an overview of several different implementations of machine learning on embedded systems divided by their specific device, application, specific machine learning algorithm, and sensors. We will mainly focus on NVIDIA Jetson and Raspberry Pi devices with a few different less utilized embedded computers, as well as which of these devices were more commonly used for specific applications in different fields. We will also briefly analyze the specific ML models most commonly implemented on the devices and the specific sensors that were used to gather input from the field. All of the papers included in this review were selected using Google Scholar and published papers in the IEEExplore database. The selection criterion for these papers was the usage of embedded computing systems in either a theoretical study or practical implementation of machine learning models. The papers needed to have provided either one or, preferably, all of the following results in their studies-the overall accuracy of the models on the system, the overall power consumption of the embedded machine learning system, and the inference time of their models on the embedded system. Embedded machine learning is experiencing an explosion in both scale and scope, both due to advances in system performance and machine learning models, as well as greater affordability and accessibility of both. Improvements are noted in quality, power usage, and effectiveness.

A 2.66 µW Clinician-Like Cardiac Arrhythmia Watchdog Based on P-QRS-T for Wearable Applications

A wearable electrocardiogram (ECG) device is an effective tool for managing cardiovascular diseases. This paper presents a low power clinician-like cardiac arrhythmia watchdog (CAW) for wearable ECG devices. The CAW is based on a novel P-QRS-T detection algorithm that makes use of clinical features to identify abnormalities. Implemented in 0.18 μm CMOS process, the CAW consumes 2.66 µW for 80 bpm heart rate at 1.2 V supply with an area of 0.578 mm². Verified on QT database, the average sensitivity/positive predictivity for P-wave, QRS complex and T-wave are over 93.39%/88.55%, 99.69%/99.48%, and 97.13%/93.18% respectively, across over 190000 beats. It shows over 99.8% arrhythmia detection accuracy for 43 subjects evaluated on MIT-BIH database.

Machine Learning for Cardiovascular Outcomes From Wearable Data: Systematic Review From a Technology Readiness Level Point of View

BACKGROUND

Wearable technology has the potential to improve cardiovascular health monitoring by using machine learning. Such technology enables remote health monitoring and allows for the diagnosis and prevention of cardiovascular diseases. In addition to the detection of cardiovascular disease, it can exclude this diagnosis in symptomatic patients, thereby preventing unnecessary hospital visits. In addition, early warning systems can aid cardiologists in timely treatment and prevention.

OBJECTIVE

This study aims to systematically assess the literature on detecting and predicting outcomes of patients with cardiovascular diseases by using machine learning with data obtained from wearables to gain insights into the current state, challenges, and limitations of this technology.

METHODS

We searched PubMed, Scopus, and IEEE Xplore on September 26, 2020, with no restrictions on the publication date and by using keywords such as "wearables," "machine learning," and "cardiovascular disease." Methodologies were categorized and analyzed according to machine learning-based technology readiness levels (TRLs), which score studies on their potential to be deployed in an operational setting from 1 to 9 (most ready).

RESULTS

After the removal of duplicates, application of exclusion criteria, and full-text screening, 55 eligible studies were included in the analysis, covering a variety of cardiovascular diseases. We assessed the quality of the included studies and found that none of the studies were integrated into a health care system (TRL<6), prospective phase 2 and phase 3 trials were absent (TRL<7 and 8), and group cross-validation was rarely used. These issues limited these studies' ability to demonstrate the effectiveness of their methodologies. Furthermore, there seemed to be no agreement on the sample size needed to train these studies' models, the size of the observation window used to make predictions, how long participants should be observed, and the type of machine learning model that is suitable for predicting cardiovascular outcomes.

CONCLUSIONS

Although current studies show the potential of wearables to monitor cardiovascular events, their deployment as a diagnostic or prognostic cardiovascular clinical tool is hampered by the lack of a realistic data set and proper systematic and prospective evaluation.

A Binary PSO-based Model Selection for Novel Smooth Twin Support Vector Regression

The recently proposed smooth twin support vector regression, denoted by STSVR, gains better training speed compared with twin support vector regression (TSVR). In the STSVR, sigmoid function is used for the smooth function, however, its approximation precision is relatively low, leading to the generalization performance of STSVR is not good enough. Moreover, STSVR has at least three parameters that need regulating, which affects its practical applications. In this paper, we increase the regression performance of STSVR from two aspects. First, by introducing Chen-Harker-Kanzow-Smale (CHKS) function, a new smooth version for TSVR, termed as smooth CHKS twin support vector regression (SCTSVR) is proposed. Second, a binary particle swarm optimization (PSO)-based model selection for SCTSVR is suggested. Computational results on one synthetic as well as several benchmark datasets confirm the great improvements on the training process of proposed algorithm.

Visual saliency detection approach for long-term ECG analysis

BACKGROUND AND OBJECTIVE

Detection and analysis of QRS-complex as well as the processing of electrocardiogram (ECG) signal using computers are being practiced for over the last fifty-eight years, approximately, and yet the thirst of designing superior ECG processing and recognition algorithms still captures researchers' attention around the globe. A saliency detection-based technique for the processing of one-dimensional biomedical signals such as ECG is proposed here for the first time, to the best or our knowledge.

METHODS AND RESULTS

In this proposed research work, first, a trigonometric threshold-based technique is used to identify the QRS-complexes from the ECG signal. Motion-artifact (MA) and sudden-change-in-baseline (SCB) types of noises are considered to be the toughest among others to filter out from the ECG signals as the bandwidths of these two types of noises overlap with that of the ECG. Only one feature is extracted from each of the QRS-complex-intervals, and the normalised values of this feature are arranged in the form of a gray-scale image. Then, a saliency detection-based technique is applied iteratively on the gray-scale image to detect those regions of the ECG signals, which are highly corrupted with MA and (or) SCB noises. Next, three unique geometric-features are extracted from the rest of the QRS-complexes, which are not corrupted with MA or SCB noises, and the normalised values of these three features are arranged in the form of an Red-Green-Blue (RGB) image. Again, the saliency detection-based technique is applied to identify the abnormal QRS-complexes from the RGB image.

CONCLUSIONS

The technique is tested on long-term ECG signals; totaling a duration of 17.54 days, and its performance is evaluated through both quantitative and qualitative measures. The applicability, scope of implement in real-time scenarios, advantage of the proposed technique over the existing ones are discussed with a group of clinicians and cardiologists, and very affirmative and encouraging responses are received from them.

Robust wave-feature adaptive heartbeat classification based on self-attention mechanism using a transformer model

Objective. Electrocardiography is a common method for screening cardiovascular diseases. Accurate heartbeat classification assists in diagnosis and has attracted great attention. In this paper, we proposed an automatic heartbeat classification method based on a transformer neural network using a self-attention mechanism.Approach.An adaptive heartbeat segmentation method was designed to selectively focus on the time-dependent representation of heartbeats. A one-dimensional convolution layer was used to embed wave characteristics into symbolic representations, and then, a transformer block using multi-head attention was applied to deal with the dependence of wave-embedding. The model was trained and evaluated using the MIT-BIH arrhythmia database (MIT-DB). To improve the model performance, the model pre-trained on MIT-BIH supraventricular arrhythmia database (MIT-SVDB) was used and fine-tuned on MIT-DB.Main results.The proposed method was verified using the MIT-DB for two groups. In the first group, our method attained F1 scores of 0.86 and 0.96 for the supraventricular ectopic beat class and ventricular ectopic beat class, respectively. In the second group, our method achieved an average F1 value of 99.83% and better results than other state-of-the-art methods.Significance.We proposed a novel heartbeat classification method based on a transformer model. This method provides a new solution for real-time electrocardiogram heartbeat classification, which can be applied to wearable devices.

An ECG Delineation and Arrhythmia Classification System Using Slope Variation Measurement by Ternary Second-Order Delta Modulators for Wearable ECG Sensors

This paper presents a system for electrocardiogram (ECG) delineation and arrhythmia classification. The proposed system consists of a front-end integrated circuit, a delineation algorithm implemented on an FPGA board, and an arrhythmia classification algorithm. The front-end circuit applies a ternary second-order Delta modulator to measure the slope variation of the input analog ECG signal. The circuit converts the analog inputs into a pulse density modulated bitstream, whose pulse density is proportional to the slope variation of the input analog signal regardless of the instantaneous amplitude. The front-end chip can detect the minimum slope variation of 3.2 mV/ms ² within a 3 ms timing error. The front-end integrated circuit was fabricated with a 180 nm CMOS process occupying a 0.25 mm ² area with a 151 nW power consumption at the sampling rate of 1 kS/s. Based on the slope variation obtained from the front-end circuit, a delineation algorithm is designed to detect fiducial points in the ECG waveform. The delineation algorithm was tested on a Spartan-6 FPGA. The delineation system can detect the intervals, slopes, and morphology of the QRS/PT waves and form a feature set that contains 22 features. Based on these features, a rotate linear kernel support vector machine (SVM) is applied for patient-specific arrhythmia classification of the ventricular ectopic beat (VEB), supraventricular ectopic beat (SVEB), and heartbeats originating in sinus node. The performance of the proposed system is comparable to the recently published methods while providing a promising solution for the low-complexity implementation of future wearable ECG monitoring systems.

An Efficient ECG Classification System Using Resource-Saving Architecture and Random Forest

This paper presents a resource-saving system to extract a few important features of electrocardiogram (ECG) signals. In addition, real-time classifiers are proposed as well to classify different types of arrhythmias via these features. The proposed feature extraction system is based on two delta-sigma modulators adopting 250 Hz sampling rate and three wave detection algorithms to analyze outputs of the modulators. It extracts essential details of each heartbeat, and the details are encoded into 68 bits data that is only 1.48% of the other comparable methods. To evaluate our classification, we use a novel patient-specific training protocol in conjunction with the MIT-BIH database and the recommendation of the AAMI to train the classifiers. The classifiers are random forests that are designed to recognize two major types of arrhythmias. They are supraventricular ectopic beats (SVEB) and ventricular ectopic beats (VEB). The performance of the arrhythmia classification reaches to the F1 scores of 81.05% for SVEB and 97.07% for VEB, which are also comparable to the state-of-the-art methods. The method provides a reliable and accurate approach to analyze ECG signals. Additionally, it also possesses time-efficient, low-complexity, and low-memory-usage advantages. Benefiting from these advantages, the method can be applied to practical ECG applications, especially wearable healthcare devices and implanted medical devices, for wave detection and arrhythmia classification.

A Smart Sensing System of Water Quality and Intake Monitoring for Livestock and Wild Animals

This paper presents a water intake monitoring system for animal agriculture that tracks individual animal watering behavior, water quality, and water consumption. The system is deployed in an outdoor environment to reach remote areas. The proposed system integrates motion detectors, cameras, water level sensors, flow meters, Radio-Frequency Identification (RFID) systems, and water temperature sensors. The data collection and control are performed using Arduino microcontrollers with custom-designed circuit boards. The data associated with each drinking event are water consumption, water temperature, drinking duration, animal identification, and pictures. The data and pictures are automatically stored on Secure Digital (SD) cards. The prototypes are deployed in a remote grazing site located in Tucumcari, New Mexico, USA. The system can be used to perform water consumption and watering behavior studies of both domestic animals and wild animals. The current system automatically records the drinking behavior of 29 cows in a two-week duration in the remote ranch.

A review of wearable and unobtrusive sensing technologies for chronic disease management

With the rapidly increasing number of patients with chronic disease, numerous recent studies have put great efforts into achieving long-term health monitoring and patient management. Specifically, chronic diseases including cardiovascular disease, chronic respiratory disease and brain disease can threaten patients' health conditions over a long period of time, thus effecting their daily lives. Vital health parameters, such as heart rate, respiratory rate, SpO2 and blood pressure, are closely associated with patients’ conditions. Wearable devices and unobtrusive sensing technologies can detect such parameters in a convenient way and provide timely predictions on health condition deterioration by tracking these biomedical signals and health parameters. In this paper, we review current advancements in wearable devices and unobtrusive sensing technologies that can provides possible tools and technological supports for chronic disease management. Current challenges and future directions of related techniques are addressed accordingly.

Proposing feature engineering method based on deep learning and K-NNs for ECG beat classification and arrhythmia detection

Arrhythmia is slow, fast or irregular heartbeat. Manual ECG assessment and disease classification is an error-prone task because of vast differences in ECG morphology and difficulty in accurate identifying ECG components. Moreover, proposing a computer-aided diagnosis system for heartbeat classification can be useful when access to medical care centers is difficult or impossible. Therefore, the main aim of this study is classifying ECG beats for arrhythmia detection (four beat classes are considered). Previous studies have proposed different methods based on traditional machine learning and/or deep learning. In this paper, a novel feature engineering method is proposed based on deep learning and K-NNs. The features extracted by our proposed method are classified with different classifiers such as decision trees, SVMs with different kernels and random forests. Our proposed method has reasonably good performance for beat classification and achieves the average Accuracy of 99.77%, AUC of 99.99%, Precision of 99.75% and Recall of 99.30% using fivefold Cross Validation strategy. The main advantage of the proposed method is its low computational time compared to training deep learning models from scratch and its high accuracy compared to the traditional machine learning models. The strength and suitability of the proposed method for feature extraction is shown by the high balance between sensitivity and specificity.