Towards Interpretable Arrhythmia Classification With Human-Machine Collaborative Knowledge Representation

Artificial intelligence-driven intelligent learning models for identification and prediction of cardioneurological disorders: A comprehensive study

The integration of Artificial Intelligence (AI) and Intelligent Learning Models (ILMs) in healthcare has transformed the field, offering precise diagnostics, remote monitoring, personalized treatment, and more. Cardioneurological disorders (CD), affecting the cardiovascular and neurological systems, present significant diagnostic and management challenges. Traditional testing methods often lack sensitivity and specificity, leading to delayed or inaccurate diagnoses. AI-driven ILMs trained on large datasets offer promise for accurate identification and prediction of CD by analyzing complex data patterns. However, there is a lack of comprehensive studies reviewing AI applications for the diagnosis of CD and inter related disorders. This paper comprehensively reviews existing integrated solutions involving AI and ILMs in CD, examining their clinical manifestations, epidemiology, diagnostic challenges, and therapeutic considerations. The study examines recent research on CD, reviews AI-driven models' landscape, evaluates existing models, addresses practical considerations, and outlines future research directions. Through this work, we aim to provide insights into the transformative potential of AI-driven ILMs in improving clinical practice and patient outcomes for CD.

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.

State-of-the-art Deep Learning Methods on Electrocardiogram Data: A Systematic Review (Preprint)

Background

Electrocardiogram (ECG) is one of the most common noninvasive diagnostic tools that can provide useful information regarding a patient’s health status. Deep learning (DL) is an area of intense exploration that leads the way in most attempts to create powerful diagnostic models based on physiological signals.

Objective

This study aimed to provide a systematic review of DL methods applied to ECG data for various clinical applications.

Methods

The PubMed search engine was systematically searched by combining “deep learning” and keywords such as “ecg,” “ekg,” “electrocardiogram,” “electrocardiography,” and “electrocardiology.” Irrelevant articles were excluded from the study after screening titles and abstracts, and the remaining articles were further reviewed. The reasons for article exclusion were manuscripts written in any language other than English, absence of ECG data or DL methods involved in the study, and absence of a quantitative evaluation of the proposed approaches.

Results

We identified 230 relevant articles published between January 2020 and December 2021 and grouped them into 6 distinct medical applications, namely, blood pressure estimation, cardiovascular disease diagnosis, ECG analysis, biometric recognition, sleep analysis, and other clinical analyses. We provide a complete account of the state-of-the-art DL strategies per the field of application, as well as major ECG data sources. We also present open research problems, such as the lack of attempts to address the issue of blood pressure variability in training data sets, and point out potential gaps in the design and implementation of DL models.

Conclusions

We expect that this review will provide insights into state-of-the-art DL methods applied to ECG data and point to future directions for research on DL to create robust models that can assist medical experts in clinical decision-making.

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.

ULECGNet: An Ultra-Lightweight End-to-End ECG Classification Neural Network

ECG classification is a key technology in intelligent ECG monitoring. In the past, traditional machine learning methods such as SVM and KNN have been used for ECG classification, but with limited classification accuracy. Recently, the end-to-end neural network has been used for the ECG classification and shows high classification accuracy. However, the end-to-end neural network has large computational complexity including a large number of parameters and operations. Although dedicated hardware such as FPGA and ASIC can be developed to accelerate the neural network, they result in large power consumption, large design cost, or limited flexibility. In this work, we have proposed an ultra-lightweight end-to-end ECG classification neural network which has extremely low computational complexity (~8.2k parameters & ~227k MUL/ADD operations) and can be squeezed into a low-cost MCU (i.e. microcontroller) while achieving 99.1% overall classification accuracy. This outperforms the state-of-the-art ECG classification neural network. Implemented on a low-cost MCU (i.e. MSP432), the proposed design consumes only 0.4 mJ and 3.1 mJ per heartbeat classification for normal and abnormal heartbeats respectively for real-time ECG classification.