Background: Intracardiac electrograms are an indispensable part during diagnosis of supraventriculararrhythmias, but atrial activity (AA) can be obscured by ventricular far-fields (VFF). Concepts based onstatistical independence like principal component analysis (PCA) cannot be applied for VFF removalduring atrial tachycardia with stable conduction.Methods: A database of realistic electrograms containing AAand VFF was generated. Both PCA and thenew technique periodic component analysis (πCA) were implemented, benchmarked, and applied toclinical data.Results: The concept of πCA was successfully verified to retain compromised AA morphology,showing high correlation (cc = 0.98 ± 0.01) for stable atrial cycle length (ACL). Performance ofPCA failed during temporal coupling (cc = 0.03 ± 0.08) but improved for increasing conductionvariability (cc = 0.77 ± 0.14). Stability of ACL was identified as a critical parameter for πCAapplication. Analysis of clinical data confirmed these findings.Conclusion: πCA is introduced as a powerful new technique for artifact removal in periodic signals.Its concept and performance were benchmarked against PCA using simulated data and demonstratedon measured electrograms.
BACKGROUND: Considering the rates of sudden cardiac death (SCD) and pump failure death (PFD) in chronic heart failure (CHF) patients and the cost-effectiveness of their preventing treatments, identification of CHF patients at risk is an important challenge. In this work, we studied the prognostic performance of the combination of an index potentially related to dispersion of repolarization restitution (Deltaalpha), an index quantifying T-wave alternans (IAA) and the slope of heart rate turbulence (TS) for classification of SCD and PFD. METHODS: Holter ECG recordings of 597 CHF patients with sinus rhythm enrolled in the MUSIC study were analyzed and Deltaalpha, IAA and TS were obtained. A strategy was implemented using support vector machines (SVM) to classify patients in three groups: SCD victims, PFD victims and other patients (the latter including survivors and victims of non-cardiac causes). Cross-validation was used to evaluate the performance of the implemented classifier. RESULTS: Deltaalpha and IAA, dichotomized at 0.035 (dimensionless) and 3.73 muV, respectively, were the ECG markers most strongly associated with SCD, while TS, dichotomized at 2.5 ms/RR, was the index most strongly related to PFD. When separating SCD victims from the rest of patients, the individual marker with best performance was Deltaalpha>/=0.035, which, for a fixed specificity (Sp) of 90%, showed a sensitivity (Se) value of 10%, while the combination of Deltaalpha and IAA increased Se to 18%. For separation of PFD victims from the rest of patients, the best individual marker was TS </= 2.5 ms/RR, which, for Sp=90%, showed a Se of 26%, this value being lower than Se=34%, produced by the combination of Deltaalpha and TS. Furthermore, when performing SVM classification into the three reported groups, the optimal combination of risk markers led to a maximum Sp of 79% (Se=18%) for SCD and Sp of 81% (Se=14%) for PFD. CONCLUSIONS: The results shown in this work suggest that it is possible to efficiently discriminate SCD and PFD in a population of CHF patients using ECG-derived risk markers like Deltaalpha, TS and IAA.
Conference Contributions (5)
G. Lenis, F. Conz, and O. Dössel. Combining different ECG derived respiration tracking methods to create an optimal reconstruction of the breathing pattern. In Current Directions in Biomedical Engineering, vol. 1(1) , pp. 54-57, 2015
ECG derived respiration (EDR) is a technique applied to estimate the respiration signal using only the electrocardiogram (ECG). Different approaches have been proposed in the past on how respiration could be gained from the ECG. However, in many applications only one of them is used while the others are not considered at all. In this paper, we propose a new algorithm for the optimal linear combination of different EDR methods in order to create a more accurate estimation. Using two well known databases, it was statistically shown that an optimally chosen fixed set of coefficients for the linear combination delivers a better estimation than each of the methods used solely.
G. Lenis, T. Oesterlein, and O. Dössel. Orthogonal component analysis to remove ventricular far field in non periodic sustained atrial flutter. In Computing in Cardiology, vol. 42, pp. 669-672, 2015
Automatic signal processing of intracardiac electrograms plays a decisive role in the diagnosis and treatment of supraventricular arrhythmias. During sustained atrial flutter, a repetitive signal is measured in the atrium. However, the ventricular far field may overlap with the atrial activity and compromises the automatic signal processing tools during the intervention. Recently, a new method based on periodic component analysis was proposed as an artifact removal technique. The method works satisfactorily with highly periodic atrial activities but fails to reconstruct not regularly repeating signals .In order to account for that case, we developed a new method based on orthogonal component analysis to reconstruct the corrupted atrial electrocardiograms obscured by ventricular far field. We tested the method on synthetic signals and proved it to be successful. The reconstructed signals were of higher quality and the computation time was drastically shorter than the already existing periodic component analysis. We conclude that the new method can be used in realistic scenarios in the future.
M. Kircher, G. Lenis, and O. Dössel. Separating the effect of respiration from the Heart Rate Variability for cases of constant harmonic breathing. In Current Directions in Biomedical Engineering, vol. 1(1) , pp. 46-49, 2015
Heart Rate Variability studies are a known measure for the autonomous control of the heart rate. In special situations, its interpretation can be ambiguous, since the respiration has a major influence on the heart rate variability. For this reason it has often been proposed to measure Heart Rate Variability, while the subjects are breathing at a constant respiration rate. That way the spectral influence of the respiration is known. In this work we propose to remove this constant respiratory influence from the heart rate and the Heart Rate Variability parameters to gain respiration free autonomous controlled heart rate signal. The spectral respiratory component in the heart rate signal is detected and characterized. Subsequently the respiratory effect on Heart Rate Variability is removed using spectral filtering approaches, such as the Notch filter or the Raised Cosine filter. As a result new decoupled Heart Variability parameters are gained, which could lead to new additional interpretations of the autonomous control of the heart rate.
T. Oesterlein, G. Lenis, A. Luik, C. Schmitt, and O. Dössel. Optimized Approach for the Detection of Active Segments in Intracardiac Electrograms Measured during Atrial Flutter. In 42nd International Congress on Electrocardiology Conference Book of Abstracts, 2015
Baseline wander removal is one important part of electrocardiogram (ECG) filtering. This can be achieved by many different approaches. This work investigates the influence of three different baseline wander removal techniques on ST changes. The chosen filters were phase-free Butterworth filtering, median filtering and baseline correction with cubic spline interpolation. 289 simulated ECGs containing ischemia were used to determine the influence of these filtering processes on the ST segment. Synthetic baseline wander and offsets were added to the simulated signals. All methods proved to be good approaches by removing most of the baseline wander in all signals. Correlation coefficients between the original signals and the filtered signals were greater than 0.93 for all ECGs. Cubic spline interpolation performed best regarding the preservation of the ST segment amplitude change when compared to the original signal. The approach modified the ST segment by 0.10mV±0.06mV at elevated K points. Median filtering introduced a variation of 0.33mV±0.29mV, Butterworth filtering reached 0.16mV±0.14mV at elevated K points. Thus, all methods manipulate the ST segment.