Extraction of the fetal ECG in noninvasive recordings by signal decompositions

No signal processing technique has been able to reliably deliver an undistorted fetal electrocardiographic (fECG) signal from electrodes placed on the maternal abdomen because of the low signal-to-noise ratio of the fECG recorded from the maternal body surface. As a result, this led to increased rates of Caesarean deliveries of healthy infants. In an attempt to solve the problem, Physionet/Computing in Cardiology announced the 2013 Challenge: noninvasive fetal ECG.We are suggesting a method for cancellation of the maternal ECG consisting of: maternal QRS detection, heart rate dependant P-QRS-T interval selection, location of the fiducial points inside this interval for best matching by cross correlation, superimposition of the intervals, calculation of the mean signal of the P-QRS-T interval, and sequential subtraction of the mean signal from the whole fECG recording. Three signal decomposition methods were further applied in order to enhance the fetal QRSs (fQRS): principal component analysis, root-mean-square and Hotelling's T-squared. A combined lead of all decompositions was synthesized and fQRS detection was performed on it.The current research differs from the Challenge in that it uses three signal decomposition methods to enhance the fECG. The new results for 97 recordings of test set B are: 305.657 for Event 4: Fetal heart rate (FHR) and 23.062 for Event 5: Fetal RR interval (FRR).

An optimized lead system for long-term esophageal electrocardiography

Long-term electrocardiography (ECG) featuring adequate atrial and ventricular signal quality is highly desirable. Routinely used surface leads are limited in atrial signal sensitivity and recording capability impeding complete ECG delineation, i.e. in the presence of supraventricular arrhythmias. Long-term esophageal ECG might overcome these limitations but requires a dedicated lead system and recorder design. To this end, we analysed multiple-lead esophageal ECGs with respect to signal quality by describing the ECG waves as a function of the insertion level, interelectrode distance, electrode shape and amplifier's input range. The results derived from clinical data show that two bipolar esophageal leads, an atrial lead with short (15 mm) interelectrode distance and a ventricular lead with long (80 mm) interelectrode distance provide non-inferior ventricular signal strength and superior atrial signal strength compared to standard surface lead II. High atrial signal slope in particular is observed with the atrial esophageal lead. The proposed esophageal lead system in combination with an increased recorder input range of ±20 mV minimizes signal loss due to excessive electrode motion typically observed in esophageal ECGs. The design proposal might help to standardize long-term esophageal ECG registrations and facilitate novel ECG classification systems based on the independent detection of ventricular and atrial electrical activity.

Suppression of MR gradient artefacts on electrophysiological signals based on an adaptive real-time filter with LMS coefficient updates

Electrocardiogram (ECG) acquisition is still a challenge as gradient artefacts superimposed on the electrophysiological signal can only be partially removed. The signal shape of theses artefacts can be similar to the QRS-complex, causing possible misinterpretation during patient monitoring and false triggering/gating of the MRI. For their real-time suppression, an adaptive filter is proposed. The adaptive filter is based on the noise-canceller configuration with LMS coefficient updates. The references of the noise canceller are the three gradient signals that are acquired simultaneously with the noisy ECG. Tests were done on patients, on volunteers and using an MR-safe ECG simulator. The noise canceller's performance was measured offline, simulating real-time processing by point-by-point operations. To create worst-case scenarios, clinical sequences with strong- and fast-switching gradients have been chosen. The noise-cancelling filter reduces the gradient artefacts' peak amplitudes by 80-99% after adaptation, without changing the desired ECG signal shape. The estimated reduction of total average power of the MR gradient artefacts is 62-98%. The proposed filter is capable of reducing artefacts due to strong- and fast-switching gradients in real-time applications and worst-case situations. The quality of the ECG is sufficiently high that a standard one-lead QRS-detector can be used for gating/triggering the MRI. For permanent patient monitoring, further improvements are needed.