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The causes of ventricular fibrillation (VF) are not yet elucidated, and it has been proposed that different mechanisms might exist. Moreover, conventional analysis methods do not seem to provide time or frequency domain features that allow for recognition of different VF patterns in electrode-recorded biopotentials. The present work aims to determine whether low-dimensional latent spaces could exhibit discriminative features for different mechanisms or conditions during VF episodes. For this purpose, manifold learning using autoencoder neural networks was analyzed based on surface ECG recordings. The recordings covered the onset of the VF episode as well as the next 6 min, and comprised an experimental database based on an animal model with five situations, including control, drug intervention (amiodarone, diltiazem, and flecainide), and autonomic nervous system blockade. The results show that latent spaces from unsupervised and supervised learning schemes yielded moderate though quite noticeable separability among the different types of VF according to their type or intervention. In particular, unsupervised schemes reached a multi-class classification accuracy of 66%, while supervised schemes improved the separability of the generated latent spaces, providing a classification accuracy of up to 74%. Thus, we conclude that manifold learning schemes can provide a valuable tool for studying different types of VF while working in low-dimensional latent spaces, as the machine-learning generated features exhibit separability among different VF types. This study confirms that latent variables are better VF descriptors than conventional time or domain features, making this technique useful in current VF research on elucidation of the underlying VF mechanisms.

During the last decades there has been a rapidly growing elderly population and the number of patients with chronic heart-related diseases has exploded. Many of them (such as those with congestive heart failure or some types of arrhythmias) require close medical supervision, thus imposing a big burden on healthcare costs in most western economies. Specifically, continuous or frequent Arterial Blood Pressure (ABP) and electrocardiogram (ECG) monitoring are important tools in the follow-up of many of these patients. In this work, we present a novel remote non-ambulatory and clinically validated heart self-monitoring system, which allows ABP and ECG monitoring to effectively identify clinically relevant arrhythmias. The system integrates digital transmission of the ECG and tensiometer measurements, within a patient-comfortable support, easy to recharge and with a multi-function software, all of them aiming to adapt for elderly people. The main novelty is that both physiological variables (ABP and ECG) are simultaneously measured in an ambulatory environment, which to our best knowledge is not readily available in the clinical market. Different processing techniques were implemented to analyze the heart rhythm, including pause detection, rhythm alterations and atrial fibrillation, hence allowing early detection of these diseases. Our results achieved clinical quality both for in-lab hardware testing and for ambulatory scenario validations. The proposed active assisted living (AAL) Sensor-based system is an end-to-end multidisciplinary system, fully connected to a platform and tested by the clinical team from beginning to end.

Recent research has proven the existence of statistical relation among fragmented QRS and several highly prevalence diseases, such as cardiac sarcoidosis, acute coronary syndrome, arrythmogenic cardiomyopathies, Brugada syndrome, and hypertrophic cardiomyopathy. One out of five hundred people suffer from hypertrophic cardiomyopathies. The relation among the fragmentation and arrhythmias drives the objective of this work, which is to propose a valid method for QRS fragmentation detection. With that aim, we followed a two-stage approach. First, we identified the features that better characterize the fragmentation by analyzing the physiological interpretation of multivariate approaches, such as principal component analysis (PCA) and independent component analysis (ICA). Second, we created an invariant transformation method for the multilead electrocardiogram (ECG), by scrutinizing the statistical distributions of the PCA eigenvectors and of the ICA transformation arrays, in order to anchor the desired elements in the suitable leads in the feature space. A complete database was compounded incorporating real fragmented ECGs, surrogate registers by synthetically adding fragmented activity to real non-fragmented ECG registers, and standard clean ECGs. Results showed that the creation of beat templates together with the application of PCA over eight independent leads achieves 0.995 fragmentation enhancement ratio and 0.07 dispersion coefficient. In the case of ICA over twelve leads, the results were 0.995 fragmentation enhancement ratio and 0.70 dispersion coefficient. We conclude that the algorithm presented in this work constructs a new paradigm, by creating a systematic and powerful tool for clinical anamnesis and evaluation based on multilead ECG. This approach consistently consolidates the inconspicuous elements present in multiple leads onto designated variables in the output space, hence offering additional and valid visual and non-visual information to standard clinical review, and opening the door to a more accurate automatic detection and statistically valid systematic approach for a wide number of applications. In this direction and within the companion paper, further developments are presented applying this technique to fragmentation detection.

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder that affects 0.2% of the population and it is genetically transmitted. Several ECG findings have been related to the presence of fibrosis in other cardiac diseases, but data for HCM in this setting are lacking. Our hypothesis is that fibrosis affects the electrical cardiac propagation in patients with HCM in a relatively specific way and that this effect may be detected with suitable postprocessing applied to the ECG signals. We used 43 standard 12-lead ECGs from patients with previous clinical diagnosis of HCM. Principal Component Analysis (PCA) was applied by combining the ECG-leads oriented to different anatomic regions, hence assessing the potential fibrosis effects in the resulting leads for postprocessing convenience. Linear classifier of Support Vector Machine type were used with several statistics extracted from the resulting PCA-components, including normalized power, standard deviation, kurtosis, skewness, and local maxima. Results reached 75.0% sensitivity, 80.0% specificity, 85.7% positive predictive value, 66.7% negative predictive value, and 76.9% accuracy in our database. There is evidence that myocardial fibrosis can be detected in patients with HCM by postprocessing their ECG signals.

T Wave Alternans (TWA) is a cardiac risk indicator which measures the functional cardioelectric instability substrate. Traditional estimation of TWA has been made on the surface ECG, hence providing the researcher with an anatomically non-specific marker. We addressed the assessment of TWA in ECG Imaging (ECGI) recordings to characterize the test with regionalization and spatial specificity, hence identifying those cardiac regions with functional cardiac instability according to this marker. ECGI potentials were obtained from 7 patients with Long QT syndrome by recording signals in the patient torso during about 60 seconds. Epicardium registers were estimated through inverse problem algorithms and the whole set of signals were analyzed by means of the Temporal Method to find the alternans amplitude and waveform. TWA amplitudes were in general spatially scattered in the torso, whereas high amplitude regions trended to be spatially grouped in the epicardium. Our results point out that TWA could be spatially grouped in the epicardial signals, and that ECGI could yield a clinically useful representation on TWA spatio-temporal distribution.

OBJECTIVE: Changes in ECG-derived parameters are studied in atrial fibrillation (AF) patients undergoing cryoballoon catheter ablation.APPROACH: Parameters characterizing f-wave frequency, morphology by phase dispersion, and amplitude are estimated using a model-based statistical approach. These parameters are studied before, during, and after ablation, as well as for AF type (paroxysmal/persistent). Seventy-seven (49/28 paroxysmal/persistent) AF patients undergoing de novo catheter ablation are included in the study, out of which 31 (16/15 paroxysmal/persistent) were in AF during the whole procedure. A signal quality index (SQI) is used to identify analyzable segments.MAIN RESULTS: f-wave frequency decreased significantly during ablation (p = 0.001), in particular after ablation of the inferior right pulmonary vein (p

Despite the wide literature on R-wave detection algorithms for ECG Holter recordings, the long-term monitoring applications are bringing new requirements, and it is not clear that the existing methods can be straightforwardly used in those scenarios. Our aim in this work was twofold: First, we scrutinized the scope and limitations of existing methods for Holter monitoring when moving to long-term monitoring; Second, we proposed and benchmarked a beat detection method with adequate accuracy and usefulness in long-term scenarios. A longitudinal study was made with the most widely used waveform analysis algorithms, which allowed us to tune the free parameters of the required blocks, and a transversal study analyzed how these parameters change when moving to different databases. With all the above, the extension to long-term monitoring in a database of 7-day Holter monitoring was proposed and analyzed, by using an optimized simultaneous-multilead processing. We considered both own and public databases. In this new scenario, the noise-avoid mechanisms are more important due to the amount of noise that exists in these recordings, moreover, the computational efficiency is a key parameter in order to export the algorithm to the clinical practice. The method based on a Polling function outperformed the others in terms of accuracy and computational efficiency, yielding 99.48% sensitivity, 99.54% specificity, 99.69% positive predictive value, 99.46% accuracy, and 0.85% error for MIT-BIH arrhythmia database. We conclude that the method can be used in long-term Holter monitoring systems.

This article belongs to the Special Issue Sensors for Health Monitoring and Disease Diagnosis., Noise and artifacts are inherent contaminating components and are particularly present in Holter electrocardiogram (ECG) monitoring. The presence of noise is even more significant in long-term monitoring (LTM) recordings, as these are collected for several days in patients following their daily activities; hence, strong artifact components can temporarily impair the clinical measurements from the LTM recordings. Traditionally, the noise presence has been dealt with as a problem of non-desirable component removal by means of several quantitative signal metrics such as the signal-to-noise ratio (SNR), but current systems do not provide any information about the true impact of noise on the ECG clinical evaluation. As a first step towards an alternative to classical approaches, this work assesses the ECG quality under the assumption that an ECG has good quality when it is clinically interpretable. Therefore, our hypotheses are that it is possible (a) to create a clinical severity score for the effect of the noise on the ECG, (b) to characterize its consistency in terms of its temporal and statistical distribution, and (c) to use it for signal quality evaluation in LTM scenarios. For this purpose, a database of external event recorder (EER) signals is assembled and labeled from a clinical point of view for its use as the gold standard of noise severity categorization. These devices are assumed to capture those signal segments more prone to be corrupted with noise during long-term periods. Then, the ECG noise is characterized through the comparison of these clinical severity criteria with conventional quantitative metrics taken from traditional noise-removal approaches, and noise maps are proposed as a novel representation tool to achieve this comparison. Our results showed that neither of the benchmarked quantitative noise measurement criteria represent an accurate enough estimation of the clinical severity of the noise. A case study of long-term ECG is reported, showing the statistical and temporal correspondences and properties with respect to EER signals used to create the gold standard for clinical noise. The proposed noise maps, together with the statistical consistency of the characterization of the noise clinical severity, paves the way towards forthcoming systems providing us with noise maps of the noise clinical severity, allowing the user to process different ECG segments with different techniques and in terms of different measured clinical parameters., This work was supported by the PRINCIPIAS project (TEC2013-48439-C4-1-R and TEC2013-48439-C4-2-R), FINALE project (TEC2016-75161-C2-1-R and TEC2016-75161-C2-2-R), KERMES project (TEC2016-81900-REDT), and project TEC2015-64835-C3-1-R with FEDER fundings. These grants allow to cover open access costs for publication.

In the past few years, the presence of fragmentation in the QRS complex has been demonstrated to be related to diseases such as myocardial fibrosis, cardiac sarcoidosis, arrythmogenic cardiopathies, acute coronary syndrome, and Brugada syndrome, among others. The detection of fragmentation in the QRS is usually carried out manually, which represents a subjective pattern recognition task that demands an effort by the clinician, increasing with the number of patients. These problems have made the process of fragmentation detection a good candidate to its automatization. In this work, we used a database with over six-thousand 12-lead ECG from Hospital Virgen de la Arrixaca de Murcia (Spain), which where digitally recorded with GE MAC5000. Affected and non-affected patients records were extracted for computerized analysis. Clinical supervision was performed for gold-standard development and for signal classification. Fragmentation detection algorithms were developed using first and second derivatives calculation in the pre-qualified segments of the signal, after fiducial point detection. The obtained results were 96.88% sensitivity, 72.92% specificity, and 82.50% accuracy. These results confirm that it is possible to automatically detect fragmentation, constituting a relevant tool to pre-qualify patients for further diagnostic-tests, and it also opens new opportunities for computerized diagnosis.

Hypertrophic cardiomyopathy, according to its prevalence, is a comparatively common disease related to the risk of suffering sudden cardiac death, heart failure and stroke. This illness is characterized by the excessive deposition of collagen among healthy myocardium cells. This situation, which is medically known as fibrosis, constitutes effective conduction obstacles in the myocardium electrical path, and when severe enough, it can be outlined as additional peaks or notches in the QRS, clinically entitled as fragmentation. Nowadays, the fragmentation detection is performed by visual inspection, but the fragmented QRS can be confused with the noise present in the electrocardiogram (ECG). On the other hand, fibrosis detection is performed by magnetic resonance imaging with late gadolinium enhancement, the main drawback of this technique being its cost in terms of time and money. In this work, we propose two automatic algorithms, one for fragmented QRS detection and another for fibrosis detection. For this purpose, we used four different databases, including the subrogated database described in the companion paper and incorporating three additional ones, one compounded by more accurate subrogated ECG signals and two compounded by real and affected subjects as labeled by expert clinicians. The first real-world database contains QRS fragmented records and the second one contains records with fibrosis and both were recorded in Hospital Cl&iacute, nico Universitario Virgen de la Arrixaca (Spain). To deeply analyze the scope of these datasets, we benchmarked several classifiers such as Neural Networks, Support Vector Machines (SVM), Decision Trees and Gaussian Na&iuml, ve Bayes (NB). For the fragmentation dataset, the best results were 0.94 sensitivity, 0.88 specificity, 0.89 positive predictive value, 0.93 negative predictive value and 0.91 accuracy when using SVM with Gaussian kernel. For the fibrosis databases, more limited accuracy was reached, with 0.47 sensitivity, 0.91 specificity, 0.82 predictive positive value, 0.66 negative predictive value and 0.70 accuracy when using Gaussian NB. Nevertheless, this is the first time that fibrosis detection is attempted automatically from ECG postprocessing, paving the way towards improved algorithms and methods for it. Therefore, we can conclude that the proposed techniques could offer a valuable tool to clinicians for both fragmentation and fibrosis diagnoses support.

A number of relevant clinical measurements are derived from QRS detection. As a consequence, the fast and accurate calculation becomes a key factor to meet this target, which is especially relevant for the huge amount of beats recorded in the increasingly used long term monitoring. In this paper, we propose several algorithms that present high efficiency and accuracy for the QRS detetion in long term, and we benchmark them with some of the most relevant published QRS detection algorithms. All the implemented algorithms were applied to a specifically created gold-standard database. This gold-standard was labelled by expert clinicians, who evaluated manually every beat within 120 records of 48h multilead Holter from Hospital Virgen de la Arrixaca of Murcia (Spain). One of our new methods outperformed the others in terms of accuracy and computational efficiency, by using a multilead processing combining OR-function with a new Pan-Tompkins detector. It presented 99.2% sensitivity, 95.6% specificity, 97.1% accuracy, and 77-s processing time for our database. The QRS detection methods used in short term ECG records or traditional 24h Holter can be limited in long term, whereas the proposed multilead processing can provide with better performance in these monitoring scenarios.