Feasibility of atrial fibrillation detection from a novel wearable armband device.

Background: Atrial fibrillation (AF) is the world's most common heart rhythm disorder and even several minutes of AF episodes can contribute to risk for complications, including stroke. However, AF often goes undiagnosed owing to the fact that it can be paroxysmal, brief, and asymptomatic. Objective: To facilitate better AF monitoring, we studied the feasibility of AF detection using a continuous electrocardiogram (ECG) signal recorded from a novel wearable armband device. Methods: In our 2-step algorithm, we first calculate the R-R interval variability-based features to capture randomness that can indicate a segment of data possibly containing AF, and subsequently discriminate normal sinus rhythm from the possible AF episodes. Next, we use density Poincaré plot-derived image domain features along with a support vector machine to separate premature atrial/ventricular contraction episodes from any AF episodes. We trained and validated our model using the ECG data obtained from a subset of the MIMIC-III (Medical Information Mart for Intensive Care III) database containing 30 subjects. Results: When we tested our model using the novel wearable armband ECG dataset containing 12 subjects, the proposed method achieved sensitivity, specificity, accuracy, and F1 score of 99.89%, 99.99%, 99.98%, and 0.9989, respectively. Moreover, when compared with several existing methods with the armband data, our proposed method outperformed the others, which shows its efficacy. Conclusion: Our study suggests that the novel wearable armband device and our algorithm can be used as a potential tool for continuous AF monitoring with high accuracy.

Using the Redundant Convolutional Encoder-Decoder to Denoise QRS Complexes in ECG Signals Recorded with an Armband Wearable Device.

Long-term electrocardiogram (ECG) recordings while performing normal daily routines are often corrupted with motion artifacts, which in turn, can result in the incorrect calculation of heart rates. Heart rates are important clinical information, as they can be used for analysis of heart-rate variability and detection of cardiac arrhythmias. In this study, we present an algorithm for denoising ECG signals acquired with a wearable armband device. The armband was worn on the upper left arm by one male participant, and we simultaneously recorded three ECG channels for 24 h. We extracted 10-s sequences from armband recordings corrupted with added noise and motion artifacts. Denoising was performed using the redundant convolutional encoder-decoder (R-CED), a fully convolutional network. We measured the performance by detecting R-peaks in clean, noisy, and denoised sequences and by calculating signal quality indices: signal-to-noise ratio (SNR), ratio of power, and cross-correlation with respect to the clean sequences. The percent of correctly detected R-peaks in denoised sequences was higher than in sequences corrupted with either added noise (70-100% vs. 34-97%) or motion artifacts (91.86% vs. 61.16%). There was notable improvement in SNR values after denoising for signals with noise added (7-19 dB), and when sequences were corrupted with motion artifacts (0.39 dB). The ratio of power for noisy sequences was significantly lower when compared to both clean and denoised sequences. Similarly, cross-correlation between noisy and clean sequences was significantly lower than between denoised and clean sequences. Moreover, we tested our denoising algorithm on 60-s sequences extracted from recordings from the Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH) arrhythmia database and obtained improvement in SNR values of 7.08 ± 0.25 dB (mean ± standard deviation (sd)). These results from a diverse set of data suggest that the proposed denoising algorithm improves the quality of the signal and can potentially be applied to most ECG measurement devices.

Motion and Noise Artifact-Resilient Atrial Fibrillation Detection using a Smartphone.

We have recently found that our previously-developed atrial fibrillation (AF) detection algorithm for smartphones can give false positives when subjects' fingers or hands move, as we rely on proper finger placement over the smartphone camera to collect the signal of interest. Specifically, smartphone camera pulsatile signals that are obtained from normal sinus rhythm (NSR) subjects but are corrupted by motion and noise artifacts (MNAs) are frequently detected as AF. AF and motion-corrupted episodes have the similar characteristic that pulse-to-pulse intervals (PPIs) are irregular. We have developed an MNA-resilient smartphone-based AF detection algorithm that first discriminates and eliminates MNA-corrupted episodes in smartphone camera recordings, and then detects AF in MNA-free recordings. We found that MNA-corrupted episodes have highly-varying pulse slope, large turning point ratio, or large kurtosis values in smartphone signals compared to MNA-free AF and NSR episodes. We first use these three metrics for MNA discrimination and exclusion. Then, AF is detected in MNA-free signals using our previous algorithm. The capability to discriminate MNAs and AFs separately in smartphone signals increases the specificity of AF detection. To evaluate the performance of the proposed MNA-resilient AF algorithm, 99 subjects, including 88 study participants with AF at baseline and in NSR after electrical cardioversion as well as 11 participants with MNA-corrupted NSR, were recruited. Using iPhone 4S, 5S, and 6S models, we collected 2-minute pulsatile time series from each subject. The clinical results show that the accuracy, sensitivity and specificity of the proposed AF algorithm are 0.97, 0.98, 0.97, respectively, which are higher than those of the previous AF algorithm.

Novel Fingertip Image-Based Heart Rate Detection Methods for a Smartphone.

We hypothesize that our smartphone-based fingertip image-based heart rate detection methods reliably detect the heart rhythm and rate of subjects. We propose fingertip curve line movement-based and fingertip image intensity-based detection methods, which both use the movement of successive fingertip images obtained from smartphone cameras. To investigate the performance of the proposed methods, heart rhythm and rate of the proposed methods are compared to those of the conventional method, which is based on average image pixel intensity. Using a smartphone, we collected 120 s pulsatile time series from each recruited subject. The results show that the proposed fingertip curve line movement-based method detects heart rate with a maximum deviation of 0.0832 Hz and 0.124 Hz using time- and frequency-domain based estimation, respectively, compared to the conventional method. Moreover, another proposed fingertip image intensity-based method detects heart rate with a maximum deviation of 0.125 Hz and 0.03 Hz using time- and frequency-based estimation, respectively.

A Robust Motion Artifact Detection Algorithm for Accurate Detection of Heart Rates From Photoplethysmographic Signals Using Time-Frequency Spectral Features.

Motion and noise artifacts (MNAs) impose limits on the usability of the photoplethysmogram (PPG), particularly in the context of ambulatory monitoring. MNAs can distort PPG, causing erroneous estimation of physiological parameters such as heart rate (HR) and arterial oxygen saturation (SpO2). In this study, we present a novel approach, "TifMA," based on using the time-frequency spectrum of PPG to first detect the MNA-corrupted data and next discard the nonusable part of the corrupted data. The term "nonusable" refers to segments of PPG data from which the HR signal cannot be recovered accurately. Two sequential classification procedures were included in the TifMA algorithm. The first classifier distinguishes between MNA-corrupted and MNA-free PPG data. Once a segment of data is deemed MNA-corrupted, the next classifier determines whether the HR can be recovered from the corrupted segment or not. A support vector machine (SVM) classifier was used to build a decision boundary for the first classification task using data segments from a training dataset. Features from time-frequency spectra of PPG were extracted to build the detection model. Five datasets were considered for evaluating TifMA performance: (1) and (2) were laboratory-controlled PPG recordings from forehead and finger pulse oximeter sensors with subjects making random movements, (3) and (4) were actual patient PPG recordings from UMass Memorial Medical Center with random free movements and (5) was a laboratory-controlled PPG recording dataset measured at the forehead while the subjects ran on a treadmill. The first dataset was used to analyze the noise sensitivity of the algorithm. Datasets 2-4 were used to evaluate the MNA detection phase of the algorithm. The results from the first phase of the algorithm (MNA detection) were compared to results from three existing MNA detection algorithms: the Hjorth, kurtosis-Shannon entropy, and time-domain variability-SVM approaches. This last is an approach recently developed in our laboratory. The proposed TifMA algorithm consistently provided higher detection rates than the other three methods, with accuracies greater than 95% for all data. Moreover, our algorithm was able to pinpoint the start and end times of the MNA with an error of less than 1 s in duration, whereas the next-best algorithm had a detection error of more than 2.2 s. The final, most challenging, dataset was collected to verify the performance of the algorithm in discriminating between corrupted data that were usable for accurate HR estimations and data that were nonusable. It was found that on average 48% of the data segments were found to have MNA, and of these, 38% could be used to provide reliable HR estimation.