Deciphering Heartbeat Signatures: A Vision Transformer Approach to Explainable Atrial Fibrillation Detection from ECG Signals
Walkky（沃基公司）；Chobanian & Avedisian School of Medicine, Boston University（波士顿大学乔巴尼亚与阿夫迪西安医学院）；Clemson University（克莱姆森大学）；Northwell Health Physician Partners（诺斯韦尔健康医师伙伴）；Lenox Hill Hospital（莱诺克斯山医院）
Aruna Mohan, Danne Elbers, Or Zilbershot, Fatemeh Afghah, David Vorchheimer
备注：
Accepted for publication at the 46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, IEEE EMBC 2024
基于可穿戴单导联心电图（ECG）设备的远程患者监测在实现心脏病早期检测方面具有巨大潜力，特别是与用于自动化心脏病检测的人工智能（AI）方法相结合时。此前已有研究将基于深度学习的 AI 方法应用于心脏病检测。然而，这些模型尚未被广泛接受为临床诊断的可靠辅助工具，部分原因在于当前许多 AI 算法存在黑盒认知。特别是，需要识别 ECG 信号中有助于做出准确诊断的关键特征，从而增强模型的可解释性。在本研究中，我们开发了一种 Vision Transformer 方法，基于单导联 ECG 数据识别心房颤动。同时还开发了一种残差网络（ResNet）方法，以便与 Vision Transformer 方法进行比较。这些模型被应用于 Chapman-Shaoxing 数据集，以分类心房颤动，以及另一种常见心律失常（窦性心动过缓）和正常窦性心律心跳。这些模型能够识别决定最终分类结果的心跳关键区域，并突出了 P 波和 T 波，以及心跳持续时间和信号振幅在区分正常窦性心律与心房颤动和窦性心动过缓中的重要性。
英文摘要：
Remote patient monitoring based on wearable single-lead electrocardiogram (ECG) devices has significant potential for enabling the early detection of heart disease, especially in combination with artificial intelligence (AI) approaches for automated heart disease detection. There have been prior studies applying AI approaches based on deep learning for heart disease detection. However, these models are yet to be widely accepted as a reliable aid for clinical diagnostics, in part due to the current black-box perception surrounding many AI algorithms. In particular, there is a need to identify the key features of the ECG signal that contribute toward making an accurate diagnosis, thereby enhancing the interpretability of the model. In the present study, we develop a vision transformer approach to identify atrial fibrillation based on single-lead ECG data. A residual network (ResNet) approach is also developed for comparison with the vision transformer approach. These models are applied to the Chapman-Shaoxing dataset to classify atrial fibrillation, as well as another common arrhythmia, sinus bradycardia, and normal sinus rhythm heartbeats. The models enable the identification of the key regions of the heartbeat that determine the resulting classification, and highlight the importance of P-waves and T-waves, as well as heartbeat duration and signal amplitude, in distinguishing normal sinus rhythm from atrial fibrillation and sinus bradycardia.
Atrial fibrillation is a clinical arrhythmia with multifactorial mechanisms still unresolved. Time-frequency analysis of epicardial electrograms has been investigated to study atrial fibrillation. However, deeper understanding of atrial fibrillation can be achieved if the spatial dimension can be incorporated. Unfortunately, the physical models describing the spatial relations of atrial fibrillation signals are complex and non-linear; hence, the conventional signal processing techniques to study electrograms in the joint space, time, and frequency domain are less suitable. In this study, we wi…
Self-supervised inter-intra period-aware ECG representation learning for detecting atrial fibrillation
Shenzhen International Graduate School（深圳国际研究生院）；Tsinghua University（清华大学）；Beijing National Research Center for Information Science and Technology (BNRist)（北京信息科学与技术国家研究中心）；Beijing Tsinghua Changgung Hospital（北京清华长庚医院）；School of Medicine（医学院）
针对 ECG 标注昂贵及房颤特征捕获不足的问题，提出融合 RR 间期与 P 波知识的周期间-周期内自监督表示学习方法，并在多个数据集取得优异房颤检测性能。
Atrial Fibrillation (AF) is the most common type of arrhythmia (Greek a-, loss + rhythmos, rhythm = loss of rhythm) leading to hospitalization in the United States. Though sometimes AF is asymptomatic, it increases the risk of stroke and heart failure in patients, in addition to lowering the health-related quality of life (HRQOL). AF-related care costs the healthcare system between $6.0 to $26 billion each year. Early detection of AF and clinical attention can help improve symptoms and HRQOL of the patient, as well as bring down the cost of care. However, the prevalent paradigm of AF detection…
Atrial fibrillation(termed as AF/Afib henceforth) is a discrete and often rapid heart rhythm that can lead to clots near the heart. We can detect Afib by ECG signal by the absence of p and inconsistent intervals between R waves as shown in fig(1). Existing methods revolve around CNN that are used to detect afib but most of them work with 12 point lead ECG data where in our case the health gauge watch deals with single-point ECG data. Twelve-point lead ECG data is more accurate than a single point. Furthermore, the health gauge watch data is much noisier. Implementing a model to detect Afib for…
It is challenging to visually detect heart disease from the electrocardiographic (ECG) signals. Implementing an automated ECG signal detection system can help diagnosis arrhythmia in order to improve the accuracy of diagnosis. In this paper, we proposed, implemented, and compared an automated system using two different frameworks of the combination of convolutional neural network (CNN) and long-short term memory (LSTM) for classifying normal sinus signals, atrial fibrillation, and other noisy signals. The dataset we used is from the MIT-BIT Arrhythmia Physionet. Our approach demonstrated that …
National University of Singapore（新加坡国立大学）；University College Dublin（都柏林大学学院）
Deep neural networks (DNN) are a promising tool in medical applications. However, the implementation of complex DNNs on battery-powered devices is challenging due to high energy costs for communication. In this work, a convolutional neural network model is developed for detecting atrial fibrillation from electrocardiogram (ECG) signals. The model demonstrates high performance despite being trained on limited, variable-length input data. Weight pruning and logarithmic quantisation are combined to introduce sparsity and reduce model size, which can be exploited for reduced data movement and lowe…
Combination of frequency-and time-domain characteristics of the fibrillatory waves for enhanced prediction of persistent atrial fibrillation recurrence after catheter ablation
Università della Svizzera italiana（瑞士意大利语大学）；UiT the Arctic University of Norway（挪威北极大学）；TU Wien（维也纳技术大学）；University of Exeter（埃克塞特大学）
We tackle the problem of classifying Electrocardiography (ECG) signals with the aim of predicting the onset of Paroxysmal Atrial Fibrillation (PAF). Atrial fibrillation is the most common type of arrhythmia, but in many cases PAF episodes are asymptomatic. Therefore, in order to help diagnosing PAF, it is important to design procedures for detecting and, more importantly, predicting PAF episodes. We propose a method for predicting PAF events whose first step consists of a feature extraction procedure that represents each ECG as a multi-variate time series. Successively, we design a classificat…
The complexity of the patterns associated with Atrial Fibrillation (AF) and the high level of noise affecting these patterns have significantly limited the current signal processing and shallow machine learning approaches to get accurate AF detection results. Deep neural networks have shown to be very powerful to learn the non-linear patterns in the data. While a deep learning approach attempts to learn complex pattern related to the presence of AF in the ECG, they can benefit from knowing which parts of the signal is more important to focus during learning. In this paper, we introduce a two-c…
Contrastive Self-Supervised Learning Based Approach for Patient Similarity: A Case Study on Atrial Fibrillation Detection from PPG Signal
Bangladesh University of Engineering and Technology（孟加拉国工程技术大学）；United International University（联合国际大学）；University of Maryland（马里兰大学）；United Arab Emirates University（阿联酋大学）
Tarbiat Modares University（塔比亚特·莫达雷斯大学）；Shiraz University of Medical Science（设拉子医科大学）；Mälardalen University（梅拉达伦大学）；Halmstad University（哈尔姆斯塔德大学）
This paper presents a novel machine learning framework for detecting Paroxysmal Atrial Fibrillation (PxAF), a pathological characteristic of Electrocardiogram (ECG) that can lead to fatal conditions such as heart attack. To enhance the learning process, the framework involves a Generative Adversarial Network (GAN) along with a Neural Architecture Search (NAS) in the data preparation and classifier optimization phases. The GAN is innovatively invoked to overcome the class imbalance of the training data by producing the synthetic ECG for PxAF class in a certified manner. The effect of the certif…
Left atrial voltage maps are routinely acquired during electroanatomic mapping in patients undergoing catheter ablation for atrial fibrillation. For patients, who have prior catheter ablation when they are in sinus rhythm, the voltage map can be used to identify low voltage areas using a threshold of 0.2 - 0.45 mV. However, such a voltage threshold for maps acquired during atrial fibrillation has not been well established. A prerequisite for defining a voltage threshold is to maximize the topologically matched low voltage areas between the electroanatomic mapping acquired during atrial fibrill…
In this article, we propose a novel ECG classification framework for atrial fibrillation (AF) detection using spectro-temporal representation (i.e., time varying spectrum) and deep convolutional networks. In the first step we use a Bayesian spectro-temporal representation based on the estimation of time-varying coefficients of Fourier series using Kalman filter and smoother. Next, we derive an alternative model based on a stochastic oscillator differential equation to accelerate the estimation of the spectro-temporal representation in lengthy signals. Finally, after comparative evaluations of …
Philips Research North America（飞利浦北美研究院）；Advanced Algorithm Research Center, Philips Healthcare（飞利浦医疗先进算法研究中心）
The development of new technology such as wearables that record high-quality single channel ECG, provides an opportunity for ECG screening in a larger population, especially for atrial fibrillation screening. The main goal of this study is to develop an automatic classification algorithm for normal sinus rhythm (NSR), atrial fibrillation (AF), other rhythms (O), and noise from a single channel short ECG segment (9-60 seconds). For this purpose, signal quality index (SQI) along with dense convolutional neural networks was used. Two convolutional neural network (CNN) models (main model that acce…
Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI)（朱利亚诺·伊松蒂纳大学卫生机构（ASUGI））；University of Trieste（的里雅斯特大学）；Karolinska Institutet（卡罗林斯卡学院）；Area Science Park, Research and Technology Institute（区域科学园研究技术研究所）
Atrial Fibrillation (AF) is a heart's arrhythmia which, despite being often asymptomatic, represents an important risk factor for stroke, therefore being able to predict AF at the electrocardiogram exam, would be of great impact on actively targeting patients at high risk. In the present work we use Convolution Neural Networks to analyze ECG and predict Atrial Fibrillation starting from realistic datasets, i.e. considering fewer ECG than other studies and extending the maximal distance between ECG and AF diagnosis. We achieved 75.5% (0.75) AUC firstly increasing our dataset size by a shifting …
Bangladesh University of Engineering and Technology（孟加拉国工程技术大学）；Pennsylvania State University（宾夕法尼亚州立大学）；United International University（联合国际大学）；University of Rochester（罗切斯特大学）；United Arab Emirates University（阿联酋大学）
Smartwatches or fitness trackers have garnered a lot of popularity as potential health tracking devices due to their affordable and longitudinal monitoring capabilities. To further widen their health tracking capabilities, in recent years researchers have started to look into the possibility of Atrial Fibrillation (AF) detection in real-time leveraging photoplethysmography (PPG) data, an inexpensive sensor widely available in almost all smartwatches. A significant challenge in AF detection from PPG signals comes from the inherent noise in the smartwatch PPG signals. In this paper, we propose a…
Texas Cardiac Arrhythmia Institute（德克萨斯心律失常研究所）；St David’s Medical Center（圣大卫医疗中心）；BioSig Technologies Inc（BioSig科技公司）
Introduction: 12-lead electrocardiogram (ECG) is recorded during atrial fibrillation (AF) catheter ablation procedure (CAP). It is not easy to determine if CAP was successful without a long follow-up assessing for AF recurrence (AFR). Therefore, an AFR risk prediction algorithm could enable a better management of CAP patients. In this research, we extracted features from 12-lead ECG recorded before and after CAP and train an AFR risk prediction machine learning model. Methods: Pre- and post-CAP segments were extracted from 112 patients. The analysis included a signal quality criterion, heart r…
Memorial Antalya Hospital（安塔利亚纪念医院）；Notrino Research（Notrino研究）；Akdeniz University（阿克deniz大学）；Şanlıurfa Education And Research（尚勒乌尔法教育与研究中心）；Bolu Abant Izzet Baysal University（博卢阿邦特·伊兹·巴伊萨尔大学）
Electrocardiogram recognition of cardiac arrhythmias is critical for cardiac abnormality diagnosis. Because of their strong prediction characteristics, artificial neural networks are the preferred method in medical diagnosis systems. This study presents a method to detect atrial fibrillation with lead-I ECGs using artificial intelligence. The aim of the study is to compare the accuracy of the diagnoses estimated by cardiologists and artificial intelligence over lead-I ECGs using 12-lead ECGs as references. To evaluate the performance of the proposed model, dataset were collected from China Phy…
In the time-series analysis, the time series motifs and the order patterns in time series can reveal general temporal patterns and dynamic features. Triadic Motif Field (TMF) is a simple and effective time-series image encoding method based on triadic time series motifs. Electrocardiography (ECG) signals are time-series data widely used to diagnose various cardiac anomalies. The TMF images contain the features characterizing the normal and Atrial Fibrillation (AF) ECG signals. Considering the quasi-periodic characteristics of ECG signals, the dynamic features can be extracted from the TMF imag…
Institute of Data Science, National University of Singapore（新加坡国立大学数据科学研究所）；School of Computing, National University of Singapore（新加坡国立大学计算学院）；National University of Singapore（新加坡国立大学）
Atrial Fibrillation (AF) is a common cardiac arrhythmia affecting a large number of people around the world. If left undetected, it will develop into chronic disability or even early mortality. However, patients who have this problem can barely feel its presence, especially in its early stage. A non-invasive, automatic, and effective detection method is therefore needed to help early detection so that medical intervention can be implemented in time to prevent its progression. Electrocardiogram (ECG), which records the electrical activities of the heart, has been widely used for detecting the p…
Atrial fibrillation (AF) is the most prevalent heart arrhythmia. AF manifests on the electrocardiogram (ECG) though irregular beat-to-beat time interval variation, the absence of P-wave and the presence of fibrillatory waves (f-wave). We hypothesize that a deep learning (DL) approach trained on the raw ECG will enable robust detection of AF events and the estimation of the AF burden (AFB). We further hypothesize that the performance reached leveraging the raw ECG will be superior to previously developed methods using the beat-to-beat interval variation time series. Consequently, we develop a n…
Learning to Predict Global Atrial Fibrillation Dynamics from Sparse Measurements
Imperial College London（帝国理工学院）；National Heart and Lung Institute（国家心肺研究所）；The Swiss AI Lab IDSIA USI-SUPSI（瑞士IDSIA USI-SUPSI人工智能实验室）；Università della Svizzera italiana（瑞士意大利语大学）；University of Oxford（牛津大学）；Oxford University Hospitals NHS Foundation Trust（牛津大学医院NHS基金会）；Politecnico di Milano（米兰理工大学）
Fraunhofer Institute for Integrated Circuits IIS（弗劳恩霍夫集成电路研究所）；Friedrich-Alexander University Erlangen-Nürnberg（埃尔朗根-纽伦堡弗里德里希-亚历山大大学）；University of Leeds（利兹大学）
Cardiovascular diseases are the most common cause of mortality worldwide. Detection of atrial fibrillation (AF) in the asymptomatic stage can help prevent strokes. It also improves clinical decision making through the delivery of suitable treatment such as, anticoagulant therapy, in a timely manner. The clinical significance of such early detection of AF in electrocardiogram (ECG) signals has inspired numerous studies in recent years, of which many aim to solve this task by leveraging machine learning algorithms. ECG datasets containing AF samples, however, usually suffer from severe class imb…
Indian Institute of Technology, Roorkee（鲁尔基印度理工学院）；Leicester Royal Infirmary（莱斯特皇家医院）；Glenfield Hospital（格伦菲尔德医院）
The incidences of atrial fibrillation (AFib) are increasing at a daunting rate worldwide. For the early detection of the risk of AFib, we have developed an automatic detection system based on deep neural networks. For achieving better classification, it is mandatory to have good pre-processing of physiological signals. Keeping this in mind, we have proposed a two-fold study. First, an end-to-end model is proposed to denoise the electrocardiogram signals using denoising autoencoders (DAE). To achieve denoising, we have used three networks including, convolutional neural network (CNN), dense neu…
Atrial Fibrillation (AF) is an abnormal heart rhythm which can trigger cardiac arrest and sudden death. Nevertheless, its interpretation is mostly done by medical experts due to high error rates of computerized interpretation. One study found that only about 66% of AF were correctly recognized from noisy ECGs. This is in part due to insufficient training data, class skewness, as well as semantical ambiguities caused by noisy segments in an ECG record. In this paper, we propose a K-margin-based Residual-Convolution-Recurrent neural network (K-margin-based RCR-net) for AF detection from noisy EC…
Atrial Fibrillation (AF) is among one of the most common types of heart arrhythmia afflicting more than 3 million people in the U.S. alone. AF is estimated to be the cause of death of 1 in 4 individuals. Recent advancements in Artificial Intelligence (AI) algorithms have led to the capability of reliably detecting AF from ECG signals. While these algorithms can accurately detect AF with high precision, the discrete and deterministic classifications mean that these networks are likely to erroneously classify the given ECG signal. This paper proposes a variational autoencoder classifier network …
The atrial fibrillation burden (AFB) is defined as the percentage of time spend in atrial fibrillation (AF) over a long enough monitoring period. Recent research has demonstrated the added prognosis value that becomes available by using the AFB as compared with the binary diagnosis. We evaluate, for the first time, the ability to estimate the AFB over long-term continuous recordings, using a deep recurrent neutral network (DRNN) approach. Methods: The models were developed and evaluated on a large database of p=2,891 patients, totaling t=68,800 hours of continuous electrocardiography (ECG) rec…
Photoplethysmography (PPG) is a ubiquitous physiological measurement that detects beat-to-beat pulsatile blood volume changes and hence has a potential for monitoring cardiovascular conditions, particularly in ambulatory settings. A PPG dataset that is created for a particular use case is often imbalanced, due to a low prevalence of the pathological condition it targets to predict and the paroxysmal nature of the condition as well. To tackle this problem, we propose log-spectral matching GAN (LSM-GAN), a generative model that can be used as a data augmentation technique to alleviate the class …
Wrist photoplethysmography (PPG) allows unobtrusive monitoring of the heart rate (HR). PPG is affected by the capillary blood perfusion and the pumping function of the heart, which generally deteriorate with age and due to presence of cardiac arrhythmia. The performance of wrist PPG in monitoring beat-to-beat HR in older patients with arrhythmia has not been reported earlier. We monitored PPG from wrist in 18 patients recovering from surgery in the post anesthesia care unit, and evaluated the inter-beat interval (IBI) detection accuracy against ECG based R-to-R intervals (RRI). Nine subjects h…
Technion-IIT（以色列理工学院）；Centre hospitalier Universitaire de Nancy（南锡大学医院中心）；Rambam Medical Center（兰巴姆医疗中心）；Technion The Ruth and Bruce Rappaport Faculty of Medicine（以色列理工学院露丝和布鲁斯·拉帕波特医学院）；Saitama Medical University International Medical Center（埼玉医科大学国际医疗中心）；Mines Paris, PSL Research University（巴黎矿业学院，巴黎文理研究大学）；INSERM（法国国家健康与医学研究院）；Universite de Lorraine（洛林大学）
To drive health innovation that meets the needs of all and democratize healthcare, there is a need to assess the generalization performance of deep learning (DL) algorithms across various distribution shifts to ensure that these algorithms are robust. This retrospective study is, to the best of our knowledge, the first to develop and assess the generalization performance of a deep learning (DL) model for AF events detection from long term beat-to-beat intervals across ethnicities, ages and sexes. The new recurrent DL model, denoted ArNet2, was developed on a large retrospective dataset of 2,14…
Northern Arizona University（北亚利桑那大学）；Ngee Ann Polytechnic（义安理工学院）
Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias that affects the lives of more than 3 million people in the U.S. and over 33 million people around the world and is associated with a five-fold increased risk of stroke and mortality. like other problems in healthcare domain, artificial intelligence (AI)-based algorithms have been used to reliably detect AF from patients' physiological signals. The cardiologist level performance in detecting this arrhythmia is often achieved by deep learning-based methods, however, they suffer from the lack of interpretability. In other …
Preoperative Prediction of Catheter Ablation Outcome in Persistent Atrial Fibrillation Patients through Spectral Organization Analysis of the Surface Fibrillatory Waves
Learning From Alarms: A Robust Learning Approach for Accurate Photoplethysmography-Based Atrial Fibrillation Detection using Eight Million Samples Labeled with Imprecise Arrhythmia Alarms
Personalized Deep Learning for Short-Term Forecasting of Impending Atrial Fibrillation from Continuous Wearable ECG Signals
Seoul National University（首尔大学）；CHA Bundang Medical Center and CHA University School of Medicine（CHA板桥医疗中心和CHA大学医学院）；SEERS Technology Co., Ltd（SEERS科技有限公司）；Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital（首尔大学医学院内科学系和首尔大学医院）
Atrial fibrillation (AF) is the most prevalent arrhythmia and is associated with a five-fold increase in stroke risk. Many individuals with AF go undetected. These individuals are often asymptomatic. There are ongoing debates on whether mass screening for AF is to be recommended. However, there is incentive in performing screening for specific at risk groups such as individuals suspected of sleep-disordered breathing where an important association between AF and obstructive sleep apnea (OSA) has been demonstrated. We introduce a new methodology leveraging digital biomarkers and recent advances…
Many types of ventricular and atrial cardiac arrhythmias have been discovered in clinical practice in the past 100 years, and these arrhythmias are a major contributor to sudden cardiac death. Ventricular tachycardia, ventricular fibrillation, and paroxysmal atrial fibrillation are the most commonly-occurring and dangerous arrhythmias, therefore early detection is crucial to prevent any further complications and reduce fatalities. Implantable devices such as pacemakers are commonly used in patients at high risk of sudden cardiac death. While great advances have been made in medical technology,…
