Coronary Artery Occlusion Detection Using 3-Lead ECG System Suitable for Credit Card-Size Personal Device Integration.

Background: Early coronary occlusion detection by portable personal device with limited number of electrocardiographic (ECG) leads might shorten symptom-to-balloon time in acute coronary syndromes. Objectives: The purpose of this study was to compare the accuracy of coronary occlusion detection using vectorcardgiographic analysis of a near-orthogonal 3-lead ECG configuration suitable for credit card-size personal device integration with automated and human 12 lead ECG interpretation. Methods: The 12-lead ECGs with 3 additional leads ("abc") using 2 arm and 2 left parasternal electrodes were recorded in 66 patients undergoing percutaneous coronary intervention prior to ("baseline", n = 66), immediately before ("preinflation", n = 66), and after 90-second balloon coronary occlusion ("inflation", n = 120). Performance of computer-measured ST-segment shift on vectorcardgiographic loops constructed from "abc" and 12 leads, standard 12-lead ECG, and consensus human interpretation in coronary occlusion detection were compared in "comparative" and "spot" modes (with/without reference to "baseline") using areas under ROC curves (AUC), reliability, and sensitivity/specificity analysis. Results: Comparative "abc"-derived ST-segment shift was similar to two 12-lead methods (vector/traditional) in detecting balloon coronary occlusion (AUC = 0.95, 0.96, and 0.97, respectively, P = NS). Spot "abc" and 12-lead measurements (AUC = 0.72, 0.77, 0.68, respectively, P = NS) demonstrated poorer performance (P < 0.01 vs comparative measurements). Reliability analysis demonstrated comparative automated measurements in "good" agreement with reference (preinflation/inflation), while comparative human interpretation was in "moderate" range. Spot automated and human reading showed "poor" agreement. Conclusions: Vectorcardiographic ST-segment analysis using baseline comparison of 3-lead ECG system suitable for credit card-size personal device integration is similar to established 12-lead ECG methods in detecting balloon coronary occlusion.

ECG waveform dataset for predicting defibrillation outcome in out-of-hospital cardiac arrested patients.

The provided database of 260 ECG signals was collected from patients with out-of-hospital cardiac arrest while treated by the emergency medical services. Each ECG signal contains a 9 second waveform showing ventricular fibrillation, followed by 1 min of post-shock waveform. Patients' ECGs are made available in multiple formats. All ECGs recorded during the prehospital treatment are provided in PFD files, after being anonymized, printed in paper, and scanned. For each ECG, the dataset also includes the whole digitized waveform (9 s pre- and 1 min post-shock each) and numerous features in temporal and frequency domain extracted from the 9 s episode immediately prior to the first defibrillation shock. Based on the shock outcome, each ECG file has been annotated by three expert cardiologists, - using majority decision -, as successful (56 cases), unsuccessful (195 cases), or indeterminable (9 cases). The code for preprocessing, for feature extraction, and for limiting the investigation to different temporal intervals before the shock is also provided. These data could be reused to design algorithms to predict shock outcome based on ventricular fibrillation analysis, with the goal to optimize the defibrillation strategy (immediate defibrillation versus cardiopulmonary resuscitation and/or drug administration) for enhancing resuscitation.

Predicting defibrillation success in out-of-hospital cardiac arrested patients: Moving beyond feature design.

OBJECTIVE: Optimizing timing of defibrillation by evaluating the likelihood of a successful outcome could significantly enhance resuscitation. Previous studies employed conventional machine learning approaches and hand-crafted features to address this issue, but none have achieved superior performance to be widely accepted. This study proposes a novel approach in which predictive features are automatically learned. METHODS: A raw 4s VF episode immediately prior to first defibrillation shock was feed to a 3-stage CNN feature extractor. Each stage was composed of 4 components: convolution, rectified linear unit activation, dropout and max-pooling. At the end of feature extractor, the feature map was flattened and connected to a fully connected multi-layer perceptron for classification. For model evaluation, a 10 fold cross-validation was employed. To balance classes, SMOTE oversampling method has been applied to minority class. RESULTS: The obtained results show that the proposed model is highly accurate in predicting defibrillation outcome (Acc = 93.6 %). Since recommendations on classifiers suggest at least 50 % specificity and 95 % sensitivity as safe and useful predictors for defibrillation decision, the reported sensitivity of 98.8 % and specificity of 88.2 %, with the analysis speed of 3 ms/input signal, indicate that the proposed model possesses a good prospective to be implemented in automated external defibrillators. CONCLUSIONS: The learned features demonstrate superiority over hand-crafted ones when performed on the same dataset. This approach benefits from being fully automatic by fusing feature extraction, selection and classification into a single learning model. It provides a superior strategy that can be used as a tool to guide treatment of OHCA patients in bringing optimal decision of precedence treatment. Furthermore, for encouraging replicability, the dataset has been made publicly available to the research community.

Properties of different types of dry electrodes for wearable smart monitoring devices.

Wearable smart monitors (WSMs) applied for the estimation of electrophysiological signals are of utmost interest for a non-stressed life. WSM which records heart muscle activities could signalize timely a life-threatening event. The heart muscle activities are typically recorded across the heart at the surface of the body; hence, a WSM monitor requires high-quality surface electrodes. The electrodes used in the clinical settings [i.e. silver/silver chloride (Ag/AgCl) with the gel] are not practical for the daily out of clinic usage. A practical WSM requires the application of a dry electrode with stable and reproducible electrical characteristics. We compared the characteristics of six types of dry electrodes and one gelled electrode during short-term recordings sessions (≈30 s) in real-life conditions: Orbital, monolithic polymer plated with Ag/AgCl, and five rectangular shaped 10 × 6 × 2 mm electrodes (Orbital, Ag electrode, Ag/AgCl electrode, gold electrode and stainless-steel AISI304). The results of a well-controlled analysis which considered motion artifacts, line noise and junction potentials suggest that among the dry electrodes Ag/AgCl performs the best. The Ag/AgCl electrode is in average three times better compared with the stainless-steel electrode often used in WSMs.

Deep Learning Approach for Highly Specific Atrial Fibrillation and Flutter Detection based on RR Intervals.

Atrial fibrillation (AF) and atrial flutter (AFL) represent atrial arrhythmias closely related to increasing risk for embolic stroke, and therefore being in the focus of cardiologists. While the reported methods for AF detection exhibit high performances, little attention has been given to distinguishing these two arrhythmias. In this study, we propose a deep neural network architecture, which combines convolutional and recurrent neural networks, for extracting features from sequence of RR intervals. The learned features were used to classify a long term ECG signals as AF, AFL or sinus rhythm (SR). A 10-fold cross-validation strategy was used for choosing an architecture design and tuning model hyperparameters. Accuracy of 88.28 %, with the sensitivities of 93.83%, 83.60% and 83.83% for SR, AF and AFL, respectively, was achieved. After choosing optimal network structure, the model was trained on the entire training set and finally evaluated on the blindfold test set which resulted in 89.67% accuracy, and 97.20%, 94.20%, and 77.78% sensitivity for SR, AF and AFL, respectively. Promising performances of the proposed model encourage continuing development of highly specific AF and AFL detection procedure based on deep learning. Distinction between these two arrhythmias can make therapy more efficient and decrease the recovery time to normal heart rhythm.

Cardiac-induced localized thoracic motion detected by a fiber optic sensing scheme.

The cardiovascular health of the human population is a major concern for medical clinicians, with cardiovascular diseases responsible for 48% of all deaths worldwide, according to the World Health Organization. The development of new diagnostic tools that are practicable and economical to scrutinize the cardiovascular health of humans is a major driver for clinicians. We offer a new technique to obtain seismocardiographic signals up to 54 Hz covering both ballistocardiography (below 20 Hz) and audible heart sounds (20 Hz upward), using a system based on curvature sensors formed from fiber optic long period gratings. This system can visualize the real-time three-dimensional (3-D) mechanical motion of the heart by using the data from the sensing array in conjunction with a bespoke 3-D shape reconstruction algorithm. Visualization is demonstrated by adhering three to four sensors on the outside of the thorax and in close proximity to the apex of the heart; the sensing scheme revealed a complex motion of the heart wall next to the apex region of the heart. The detection scheme is low-cost, portable, easily operated and has the potential for ambulatory applications.

Localized modes in mini-gaps opened by periodically modulated intersite coupling in two-dimensional nonlinear lattices.

Spatially periodic modulation of the intersite coupling in two-dimensional (2D) nonlinear lattices modifies the eigenvalue spectrum by opening mini-gaps in it. This work aims to build stable localized modes in the new bandgaps. Numerical analysis shows that single-peak and composite two- and four-peak discrete static solitons and breathers emerge as such modes in certain parameter areas inside the mini-gaps of the 2D superlattice induced by the periodic modulation of the intersite coupling along both directions. The single-peak solitons and four-peak discrete solitons are stable in a part of their existence domain, while unstable stationary states (in particular, two-soliton complexes) may readily transform into robust localized breathers.

Discrete localized modes supported by an inhomogeneous defocusing nonlinearity.

We report that infinite and semi-infinite lattices with spatially inhomogeneous self-defocusing (SDF) onsite nonlinearity, whose strength increases rapidly enough toward the lattice periphery, support stable unstaggered (UnST) discrete bright solitons, which do not exist in lattices with the spatially uniform SDF nonlinearity. The UnST solitons coexist with stable staggered (ST) localized modes, which are always possible under the defocusing onsite nonlinearity. The results are obtained in a numerical form and also by means of variational approximation (VA). In the semi-infinite (truncated) system, some solutions for the UnST surface solitons are produced in an exact form. On the contrary to surface discrete solitons in uniform truncated lattices, the threshold value of the norm vanishes for the UnST solitons in the present system. Stability regions for the novel UnST solitons are identified. The same results imply the existence of ST discrete solitons in lattices with the spatially growing self-focusing nonlinearity, where such solitons cannot exist either if the nonlinearity is homogeneous. In addition, a lattice with the uniform onsite SDF nonlinearity and exponentially decaying intersite coupling is introduced and briefly considered. Via a similar mechanism, it may also support UnST discrete solitons. The results may be realized in arrayed optical waveguides and collisionally inhomogeneous Bose-Einstein condensates trapped in deep optical lattices. A generalization for a two-dimensional system is briefly considered.

A new method for respiratory-volume monitoring based on long-period fibre gratings.

Respiratory-volume monitoring is an indispensable part of mechanical ventilation. Here we present a new method of the respiratory-volume measurement based on a single fibre-optical long-period sensor of bending and the correlation between torso curvature and lung volume. Unlike the commonly used air-flow based measurement methods the proposed sensor is drift-free and immune to air-leaks. In the paper, we explain the working principle of sensors, a two-step calibration-test measurement procedure and present results that establish a linear correlation between the change in the local thorax curvature and the change of the lung volume. We also discuss the advantages and limitations of these sensors with respect to the current standards.

Stable periodic density waves in dipolar Bose-Einstein condensates trapped in optical lattices.

Density-wave patterns in discrete media with local interactions are known to be unstable. We demonstrate that stable double- and triple-period patterns (DPPs and TPPs), with respect to the period of the underlying lattice, exist in media with nonlocal nonlinearity. This is shown in detail for dipolar Bose-Einstein condensates, loaded into a deep one-dimensional optical lattice. The DPP and TPP emerge via phase transitions of the second and first kind, respectively. The emerging patterns may be stable if the dipole-dipole interactions are repulsive and sufficiently strong, in comparison with the local repulsive nonlinearity. Within the set of the considered states, the TPPs realize a minimum of the free energy. A vast stability region for the TPPs is found in the parameter space, while the DPP stability region is relatively narrow. The same mechanism may create stable density-wave patterns in other physical media featuring nonlocal interactions.

Wireless remote monitoring of reconstructed 12-lead ECGs after ablation for atrial fibrillation using a hand-held device.

OBJECTIVE: Atrial fibrillation (AF) surveillance using a wireless handheld monitor capable of 12-lead electrocardiogram reconstruction was performed, and arrhythmia detection rate was compared with serial Holter monitoring. METHODS: Twenty-five patients were monitored after an AF ablation procedure using the hand-held monitor for 2 months immediately after and then for 1 month approximately 6 months postablation. All patients underwent 12-lead 24-hour Holter monitoring at 1, 2, and 6 months postablation. RESULTS: During months 1-2, 425 of 2942 hand-held monitor transmissions from 21 of 25 patients showed AF/atrial flutter (Afl). The frequency of detected arrhythmias decreased by month 6 to 85/1128 (P < .01) in 15 of 23 patients. Holter monitoring diagnosed AF/Afl in 8 of 25 and 7 of 23 patients at months 1-2 and month 6, respectively (P < .01 compared with wireless hand-held monitor). Af/Afl diagnosis by wireless monitoring preceded Holter detection by an average of 24 days. CONCLUSIONS: Wireless monitoring with 12-lead electrocardiogram reconstruction demonstrated reliable AF/Afl detection that was more sensitive than serial 12-lead 24-hour Holter monitoring.

Algorithm for quantitative 3 dimensional analysis of ECG signals improves myocardial diagnosis over cardiologists in diabetic patients.

UNLABELLED: Acute myocardial infarction (AMI) diagnosis in type II diabetes (DM2) patients is difficult and ECG findings are often non-diagnostic or inconclusive. We developed computer algorithms to process standard 12-lead ECG input data for quantitative 3-dimensional (3D) analysis (my3KGTM), and hypothesized that use of the my3KGTM's array of over 100 3D-based AMI diagnostic markers may improve diagnostic accuracy for AMI in DM2 patients. METHODS: We identified 155 consecutive DM2 patients age >25 yrs with chest discomfort or shortness of breath who were evaluated at an urban emergency department (130 patients (pts)) or the cardiac catheterization laboratory (25 pts) for possible AMI. The first digital 12-lead ECG for each patient, obtained within 30 min of presentation, was evaluated by (1) 2 blinded expert cardiologists, and (2) my3KGTM. In each case, the ECG was classified as either likely AMI or likely non-AMI. "Gold standard" was the final clinical diagnosis. Statistical analysis was McNemar's test with continuity correction. RESULTS: The 155 DM2 patients were 50% male, mean age 56.8 ± 12.0 yrs; 44 pts had a final clinical diagnosis of AMI (17 ST Elevation Myocardial Infarctions (STEMI), 27 Non-ST Elevation Myocardial Infarctions (NSTEMI)) and 111 had no AMI. CONCLUSIONS: Relative to standard 12L ECG read by cardiologists, quantitative 3D ECG analysis showed significant and substantial gains in sensitivity for AMI diagnosis in DM2 patients, without loss in specificity. Sensitivity gains were particularly high in patients exhibiting NSTEMI, the most common form of AMI in DM2.

Wireless monitoring of reconstructed 12-lead ECG in atrial fibrillation patients enables differential diagnosis of recurrent arrhythmias.

UNLABELLED: Differential diagnosis of symptomatic events in post-ablation atrial fibrillation (AF) patients (pts) is important; in particular, accurate, reliable detection of AF or atrial flutter (AFL) is essential. However, existing remote monitoring devices usually require attached leads and are not suitable for prolonged monitoring; moreover, most do not provide sufficient information to assess atrial activity, since they generally monitor only 1-3 ECG leads and rely on RR interval variability for AF diagnosis. A new hand-held, wireless, symptom-activated event monitor (CardioBip; CB) does not require attached leads and hence can be conveniently used for extended periods. Moreover, CB provides data that enables remote reconstruction of full 12-lead ECG data including atrial signal information. We hypothesized that these CB features would enable accurate remote differential diagnosis of symptomatic arrhythmias in post-ablation AF pts. METHODS: 21 pts who underwent catheter ablation for AF were instructed to make a CB transmission (TX) whenever palpitations, lightheadedness, or similar symptoms occurred, and at multiple times daily when asymptomatic, during a 60 day post-ablation time period. CB transmissions (TXs) were analyzed blindly by 2 expert readers, with differences adjudicated by consensus. RESULTS: 7 pts had no symptomatic episodes during the monitoring period. 14 of 21 pts had symptomatic events and made a total of 1699 TX, 164 of which were during symptoms. TX quality was acceptable for rhythm diagnosis and atrial activity in 96%. 118 TX from 10 symptomatic pts showed AF (96 TX from 10 pts) or AFL (22 TX from 3 pts), and 46 TX from 9 pts showed frequent PACs or PVCs. No other arrhythmias were detected. Five pts made symptomatic TX during AF/AFL and also during PACs/PVCs. CONCLUSIONS: Use of CB during symptomatic episodes enabled detection and differential diagnosis of symptomatic arrhythmias. The ability of CB to provide accurate reconstruction of 12 L ECGs including atrial activity, combined with its ease of use, makes it suitable for long-term surveillance for recurrent AF in post-ablation patients.

Wireless remote monitoring of atrial fibrillation using reconstructed 12-lead ECGs.

UNLABELLED: Remote surveillance is important for patients with atrial fibrillation (AF). Atrial signal recognition with conventional monitoring devices is difficult; remote AF detection is predominantly accomplished by R-R interval analysis. Twelve lead ECG (12L) displays atrial activity and remains the gold standard for AF diagnosis. CardioBip is a portable wireless patient-activated event monitor providing signal reconstruction of a 12L waveform (12CB) using 5 leads and patient-specific transformation matrices. We hypothesized that atrial signal analysis with 12CB can detect atrial activity and improve AF detection. METHODS: 18 patients with AF undergoing DC cardioversion (CV) were studied. Separate 12-lead P and QRS patient-specific transformation matrices were created at baseline AF. Multiple wireless 12CB transmissions were performed 3-7 days before and up to 2 weeks after CV. Rhythm was confirmed with 12-lead ECGs (12L). In SR the number of leads with visible P waves (atrial signal > 0.05 mV), and P wave polarity were analyzed. In AF, the number of leads with AF signal were compared (fibrillatory [f] waves >0.025 mV). RESULTS: Fourteen of 18 patients successfully cardioverted to SR and 4 failed; thus, 14 SR and 22 AF transmissions were analyzed. SR P wave was visible on 141/168 leads on 12L and 137/168 on 12CB (126 true pos [TP] and 11 false pos [FP] relative to 12L; p=0.26). In 126 leads with P waves in both 12L and 12CB, the methods agreed on P wave polarity in 125. In AF, F waves were visible in 178/264 leads on 12L and 189/264 leads on 12CB (144 TP, 45 FP; p=0.27). All 5 AF relapses were successfully detected by 12CB based on atrial activity. CONCLUSION: 12CB is not inferior to 12L in detecting atrial signal in SR and AF, and shows excellent potential for remote wireless monitoring of AF patients.

DNA-RNA transcription as an impact of viscosity.

The impact of viscosity on DNA dynamics is studied both analytically and numerically. It is assumed that the viscosity exists at the segments where DNA molecule is surrounded by RNA polymerase. We demonstrate that the frictional forces destroy the modulation of the incoming solitonic wave. We show that viscosity, crucial for demodulation, is essential for DNA-RNA transcription.

Visual 3Dx: algorithms for quantitative 3-dimensional analysis of ECG signals.

INTRODUCTION: The 12-lead ECG is useful for cardiac diagnosis but has limited sensitivity and specificity. To address this, we developed the Visual3Dx, a comprehensive method for describing cardiac electrical activity in time and space. The Visual3Dx transforms the ECG input into a time-variable heart vector, and normalizes each lead input to assure equal representation from all cardiac regions. METHODS: We compared the Visual3Dx to the standard 12-lead ECG for detection of acute myocardial ischemia (AMI) in 2 clinical models. Model 1 was AMI after 90 s of balloon coronary occlusion in 117 cases. Model 2 was 122 consecutive patients who: (1) presented to an urban emergency department with chest pain; (2) were admitted to coronary care and developed elevated cardiac troponin levels; and (3) had coronary arteriography within 6 hrs. RESULTS: In Model 1, the 12 lead ECG developed ST segment deviation diagnostic of AMI in 78/117 occlusions (67%), whereas using the same input ECG data, the Visual3Dx was diagnostic of AMI in 105/117 occlusions (90%; p<0.001). In Model 2, the first 12 lead ECG was diagnostic of AMI in 80/122 (66%), whereas the Visual3Dx was diagnostic in 103/122 (84%). In both Models, the largest sensitivity gains were seen in left circumflex and right coronary artery occlusions. CONCLUSIONS: The Visual3Dx is a promising tool for 3D quantitative analysis of cardiac electrical activity that may improve diagnosis of AMI, especially in electrically remote regions of the heart. Additional studies will define diagnostic specificity and further improve 3D biomarkers of AMI.

Comparison of QTinno, a fully automated electrocardiographic analysis program, to semiautomated electrocardiographic analysis methods in a drug safety study in healthy subjects.

BACKGROUND: Improved automated methods for electrocardiographic (ECG) analysis are needed, particularly for drug development purposes. OBJECTIVES: This study compared a novel fully automated method for ECG analysis (QTinno; NewCardio, Santa Clara, CA) to 2 semiautomated digital methods: global measurement from the earliest QRS onset to the latest T-wave offset on representative superimposed beats (global) and tangent measurement on 3 consecutive beats in one lead (tangent). METHODS: All 3 methods were used to determine uncorrected and rate-corrected QT interval duration (QT and QTcF) and related metrics in 1422 digital 12-lead ECGs from a phase 1 drug study. Global and tangent annotations were manually adjusted by the same 3 cardiologists wherever necessary. No adjustments were made in QTinno determinations. RESULTS: QTinno returned QTcF change from time-matched baseline (DeltaQTcF) that differed minimally from both global and tangent methods (mean pairwise difference: 0.1 millisecond between QTinno and global, 1.1 milliseconds between QTinno and tangent). The average absolute QT and QTcF intervals by QTinno were approximately 5 milliseconds longer than global and 25 milliseconds longer than by tangent. QTinno had lower intrinsic variability for DeltaQTcF than either global or tangent (between-subject SD: QTinno 4.0 milliseconds, global 5.6 milliseconds, tangent 6.4 milliseconds; within-subject SD: QTinno 4.8 milliseconds, global 7.4 milliseconds, tangent 10.6 milliseconds). All methods were robust in detecting the largest placebo-adjusted mean time-matched DeltaQTcF (15-25 milliseconds) induced by study drug. CONCLUSIONS: The methods show good agreement for drug-induced QTc prolongation. Lower intrinsic variability of DeltaQTcF by QTinno could facilitate smaller sample sizes or increase study power in thorough QTc studies.

Properties of the moving Holstein large polaron in one-dimensional molecular crystals.

The features of the moving large polaron are investigated within Holstein's molecular crystal model. The necessity to account for the phonon dispersion is emphasized and its impact on polaron properties is examined in detail. It was found that the large polaron dynamics is described by the nonlocal nonlinear Schrödinger equation. The character of its solutions is determined by the degree of nonlocality, which is specified by the polaron velocity and group velocity of the lattice modes. An analytic solution for the polaron wavefunction is obtained in the weakly nonlocal limit. It was found that the polaron velocity and phonon dispersion have a significant impact on the parameters and dynamics of large polarons. The polaron amplitude and effective mass increase while its spatial extent decreases with a rise in the degree of nonlocality. The criterion for the stability of large polaron is formulated in terms of the values of the degree of nonlocality, the magnitude of the basic energy parameters of the system and the polaron velocity. It turns out that the large polaron velocity cannot exceed a relatively small limiting value. A similar limitation on large polaron velocity has not been found in previous studies. The consequences of these results on polaron dynamics in realistic conditions are discussed.

High-speed kinks in a generalized discrete phi4 model.

We consider a generalized discrete phi4 model and demonstrate that it can support exact moving kink solutions in the form of tanh with an arbitrarily large velocity. The constructed exact moving solutions are dependent on the specific value of the propagation velocity. We demonstrate that in this class of models, given a specific velocity, the problem of finding the exact moving solution is integrable. Namely, this problem originally expressed as a three-point map can be reduced to a two-point map, from which the exact moving solutions can be derived iteratively. It was also found that these high-speed kinks can be stable and robust against perturbations introduced in the initial conditions.

Staggered and moving localized modes in dynamical lattices with the cubic-quintic nonlinearity.

Results of a comprehensive dynamical analysis are reported for several fundamental species of bright solitons in the one-dimensional lattice modeled by the discrete nonlinear Schrödinger equation with the cubic-quintic nonlinearity. Staggered solitons, which were not previously considered in this model, are studied numerically, through the computation of the eigenvalue spectrum for modes of small perturbations, and analytically, by means of the variational approximation. The numerical results confirm the analytical predictions. The mobility of discrete solitons is studied by means of direct simulations, and semianalytically, in the framework of the Peierls-Nabarro barrier, which is introduced in terms of two different concepts, free energy and mapping analysis. It is found that persistently moving localized modes may only be of the unstaggered type.