The electrocardiogram (ECG) remains a fundamental tool in cardiac diagnostics, yet its interpretation traditionally reliant on the expertise of cardiologists. The emergence of deep learning has heralded a revolutionary era in medical data analysis, particularly in the domain of ECG diagnostics. However, inter-patient variability prohibit the generalibility of ECG-AI model trained on a population dataset, hence degrade the performance of ECG-AI on specific patient or patient group. Many studies have address this challenge using different deep learning technologies. This comprehensive review systematically synthesizes research from a wide range of studies to provide an in-depth examination of cutting-edge deep-learning techniques in personalized ECG diagnosis. The review outlines a rigorous methodology for the selection of pertinent scholarly articles and offers a comprehensive overview of deep learning approaches applied to personalized ECG diagnostics. Moreover, the challenges these methods encounter are investigated, along with future research directions, culminating in insights into how the integration of deep learning can transform personalized ECG diagnosis and enhance cardiac care. By emphasizing both the strengths and limitations of current methodologies, this review underscores the immense potential of deep learning to refine and redefine ECG analysis in clinical practice, paving the way for more accurate, efficient, and personalized cardiac diagnostics.
The Ohio State University（俄亥俄州立大学）；Wuhan University of Technology（武汉理工大学）
Electrocardiogram (ECG) is a widely used reliable, non-invasive approach for cardiovascular disease diagnosis. With the rapid growth of ECG examinations and the insufficiency of cardiologists, accurate and automatic diagnosis of ECG signals has become a hot research topic. Deep learning methods have demonstrated promising results in predictive healthcare tasks. In this paper, we developed a deep neural network for multi-label classification of cardiac arrhythmias in 12-lead ECG recordings. Experiments on a public 12-lead ECG dataset showed the effectiveness of our method. The proposed model ac…
Electrocardiogram (ECG) signals are beneficial in diagnosing cardiovascular diseases, which are one of the leading causes of death. However, they are often contaminated by noise artifacts and affect the automatic and manual diagnosis process. Automatic deep learning-based examination of ECG signals can lead to inaccurate diagnosis, and manual analysis involves rejection of noisy ECG samples by clinicians, which might cost extra time. To address this limitation, we present a two-stage deep learning-based framework to automatically detect the noisy ECG samples. Through extensive experiments and …
ECGadv: Generating Adversarial Electrocardiogram to Misguide Arrhythmia Classification System
The Hong Kong University of Science and Technology（香港科技大学）；Southern University of Science and Technology, Peng Cheng Laboratory（南方科技大学鹏城实验室）；Huazhong University of Science and Technology（华中科技大学）
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…
Zhejiang University（浙江大学）；RealDoctor AI Research Centre（RealDoctor人工智能研究中心）；Shanghai Polytechnic University（上海第二工业大学）；University of Notre Dame（圣母大学）
A large number of people suffer from life-threatening cardiac abnormalities, and electrocardiogram (ECG) analysis is beneficial to determining whether an individual is at risk of such abnormalities. Automatic ECG classification methods, especially the deep learning based ones, have been proposed to detect cardiac abnormalities using ECG records, showing good potential to improve clinical diagnosis and help early prevention of cardiovascular diseases. However, the predictions of the known neural networks still do not satisfactorily meet the needs of clinicians, and this phenomenon suggests that…
Electrocardiogram (ECG) synthesis is the area of research focused on generating realistic synthetic ECG signals for medical use without concerns over annotation costs or clinical data privacy restrictions. Traditional ECG generation models consider a single ECG lead and utilize GAN-based generative models. These models can only generate single lead samples and require separate training for each diagnosis class. The diagnosis classes of ECGs are insufficient to capture the intricate differences between ECGs depending on various features (e.g. patient demographic details, co-existing diagnosis c…
University of Alberta（阿尔伯塔大学）；Canadian VIGOUR Centre（加拿大活力中心）
The 12-lead electrocardiogram (ECG) is a commonly used tool for detecting cardiac abnormalities such as atrial fibrillation, blocks, and irregular complexes. For the PhysioNet/CinC 2020 Challenge, we built an algorithm using gradient boosted tree ensembles fitted on morphology and signal processing features to classify ECG diagnosis. For each lead, we derive features from heart rate variability, PQRST template shape, and the full signal waveform. We join the features of all 12 leads to fit an ensemble of gradient boosting decision trees to predict probabilities of ECG instances belonging to ea…
The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院查尔斯·布朗夫曼个性化医学研究所）；Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院西奈山临床智能中心）；Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院遗传学与基因组科学系）；The Hasso Plattner Institute for Digital Health at Mount Sinai（西奈山哈索·普拉特纳数字健康研究所）；Department of Medicine, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院医学系）；Mount Sinai Heart, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院西奈山心脏中心）；Department of Cardiology, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院心脏病学系）；Department of Medicine, NYU Langone Health（纽约大学朗格尼健康中心医学系）；The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院帕梅拉·斯克拉精神病基因组学部门）；Department of Psychiatry, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院精神病学系）；Department of Biomedical Engineering, Tel Aviv University（特拉维夫大学生物医学工程系）；Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院医学系肾脏病科）
The electrocardiogram (ECG) is a ubiquitous diagnostic modality. Convolutional neural networks (CNNs) applied towards ECG analysis require large sample sizes, and transfer learning approaches result in suboptimal performance when pre-training is done on natural images. We leveraged masked image modeling to create the first vision-based transformer model, HeartBEiT, for electrocardiogram waveform analysis. We pre-trained this model on 8.5 million ECGs and then compared performance vs. standard CNN architectures for diagnosis of hypertrophic cardiomyopathy, low left ventricular ejection fraction…
Compact Neural Network Algorithm for Electrocardiogram Classification
Centro de Física Aplicada y Tecnología Avanzada（应用物理与先进技术中心）；Instituto de Ciencias Nucleares（核科学研究所）；Instituto Tecnológico y de Estudios Superiores de Monterrey（蒙特雷技术与高等研究学院）
Infomining, Co. Ltd.（Infomining有限公司）；KAIST College of business（韩国科学技术院商学院）
The performances of commonly used electrocardiogram (ECG) diagnosis models have recently improved with the introduction of deep learning (DL). However, the impact of various combinations of multiple DL components and/or the role of data augmentation techniques on the diagnosis have not been sufficiently investigated. This study proposes an ensemble-based multi-view learning approach with an ECG augmentation technique to achieve a higher performance than traditional automatic 12-lead ECG diagnosis methods. The data analysis results show that the proposed model reports an F1 score of 0.840, whic…
Electrocardiogram (ECG) is one of the non-invasive and low-risk methods to monitor the condition of the human heart. Any abnormal pattern(s) in the ECG signal is an indicative measure of malfunctioning of the heart, termed as arrhythmia. Due to the lack of human expertise and high probability to misdiagnose, computer-aided diagnosis and analysis are preferred. In this work, we perform arrhythmia detection with an optimized neural network having piecewise linear approximation based activation function to alleviate the complex computations in the traditional activation functions. Further, we pro…
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）
University of Alberta（阿尔伯塔大学）；Canadian VIGOUR Centre（加拿大VIGOUR中心）；Alberta Machine Intelligence Institute（阿尔伯塔机器智能研究所）
Electrocardiogram (ECG) abnormalities are linked to cardiovascular diseases, but may also occur in other non-cardiovascular conditions such as mental, neurological, metabolic and infectious conditions. However, most of the recent success of deep learning (DL) based diagnostic predictions in selected patient cohorts have been limited to a small set of cardiac diseases. In this study, we use a population-based dataset of >250,000 patients with >1000 medical conditions and >2 million ECGs to identify a wide range of diseases that could be accurately diagnosed from the patient's first in-hospital …
Personalized Heart Disease Detection via ECG Digital Twin Generation
College of Computer Science and Technology, Zhejiang University（浙江大学计算机科学与技术学院）；University of Illinois at Urbana-Champaign（伊利诺伊大学厄巴纳-香槟分校）；Guangdong Provincial People’s Hospital, Southern Medical University（南方医科大学广东省人民医院）；Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences（广东省人民医院广东省心血管病研究所、广东省医学科学院）；School of Public Health, Zhejiang University（浙江大学公共卫生学院）
CarDS-Plus ECG Platform: Development and Feasibility Evaluation of a Multiplatform Artificial Intelligence Toolkit for Portable and Wearable Device Electrocardiograms
Yale School of Medicine（耶鲁医学院）；Yale New Haven Hospital（耶鲁-纽黑文医院）；Yale School of Public Health（耶鲁公共卫生学院）
Canadian VIGOUR Centre, University of Alberta（阿尔伯塔大学加拿大VIGOUR中心）；University of Alberta（阿尔伯塔大学）；Alberta Health Services（阿尔伯塔卫生服务局）；Alberta Machine Intelligence Institute（阿尔伯塔机器智能研究所）
Pandemic outbreaks such as COVID-19 occur unexpectedly, and need immediate action due to their potential devastating consequences on global health. Point-of-care routine assessments such as electrocardiogram (ECG), can be used to develop prediction models for identifying individuals at risk. However, there is often too little clinically-annotated medical data, especially in early phases of a pandemic, to develop accurate prediction models. In such situations, historical pre-pandemic health records can be utilized to estimate a preliminary model, which can then be fine-tuned based on limited av…
The University of Tennessee（田纳西大学）；University of Oklahoma Health Sciences Center（俄克拉荷马大学健康科学中心）
Cardiac disease is the leading cause of death in the US. Accurate heart disease detection is of critical importance for timely medical treatment to save patients' lives. Routine use of electrocardiogram (ECG) is the most common method for physicians to assess the electrical activities of the heart and detect possible abnormal cardiac conditions. Fully utilizing the ECG data for reliable heart disease detection depends on developing effective analytical models. In this paper, we propose a two-level hierarchical deep learning framework with Generative Adversarial Network (GAN) for automatic diag…
Electrocardiogram (ECG) signal is an important physiological signal which contains cardiac information and is the basis to diagnosis cardiac related diseases. In this paper, several innovative and efficient methods based on adaptive filter and empirical mode decomposition (EMD) to denoise ECG signal contaminated by various kinds of noise, including baseline wander (BW), power line interference (PLI), electrode motion artifact (EM) and muscle artifact (MA), are proposed. We first present a novel method based on EMD and adaptive filter for the removal of BW and PLI in ECG signal. We then extend …
Unlocking the diagnostic potential of electrocardiograms through information transfer from cardiac magnetic resonance imaging
School of Computation, Information and Technology, Technical University of Munich（慕尼黑工业大学计算、信息与技术学院）；University of Zurich（苏黎世大学）；School of Medicine, Klinikum Rechts der Isar, Technical University of Munich（慕尼黑工业大学雷赫特-伊萨尔医院医学院）；Imperial College London（伦敦帝国学院）；Munich Center for Machine Learning（慕尼黑机器学习中心）
An Electrocardiogram Foundation Model Built on over 10 Million Recordings with External Evaluation across Multiple Domains
National Institute of Health Data Science, Peking University（北京大学国家健康数据科学研究院）；Department of Cardiology, Massachusetts General Hospital（麻省总医院心内科）；Department of Biomedical Informatics, School of Medicine, Emory University（埃默里大学医学院生物医学信息学系）；Department of Biomedical Engineering, Georgia Institute of Technology（佐治亚理工学院生物医学工程系）；Harvard Medical School（哈佛医学院）；Department of Neurology, Beth Israel Deaconess Medical Center（贝斯以色列医疗中心神经科）；Department of Computing, Data Science Institute, Imperial College London（伦敦帝国学院计算系、数据科学研究所）；Zhongshan School of Medicine, Sun Yat-sen University（中山医学院，孙逸仙大学）；Institute of Medical Technology, Peking University Health Science Center（北京大学医学技术研究所，北京大学医学部）；Institute for Artificial Intelligence, Peking University（北京大学人工智能研究院）
Texas A&M University（得克萨斯农工大学）；Dell Inc.（戴尔公司）；Heart Artery and Vein Center of Fresno（弗雷斯诺心脏动脉与静脉中心）
Recent introduction of wearable single-lead ECG devices of diverse configurations has caught the intrigue of the medical community. While these devices provide a highly affordable support tool for the caregivers for continuous monitoring and to detect acute conditions, such as arrhythmia, their utility for cardiac diagnostics remains limited. This is because clinical diagnosis of many cardiac pathologies is rooted in gleaning patterns from synchronous 12-lead ECG. If synchronous 12-lead signals of clinical quality can be synthesized from these single-lead devices, it can transform cardiac care…
Healthcare Technology and Innovation Center (HTIC), Indian Institute of Technology (IIT-M)（印度理工学院马德拉斯分校医疗技术与创新中心）；Indian Institute of Technology, Madras (IITM)（印度理工学院马德拉斯分校）
Cardiac arrhythmia is a prevalent and significant cause of morbidity and mortality among cardiac ailments. Early diagnosis is crucial in providing intervention for patients suffering from cardiac arrhythmia. Traditionally, diagnosis is performed by examination of the Electrocardiogram (ECG) by a cardiologist. This method of diagnosis is hampered by the lack of accessibility to expert cardiologists. For quite some time, signal processing methods had been used to automate arrhythmia diagnosis. However, these traditional methods require expert knowledge and are unable to model a wide range of arr…
Technion-IIT（以色列理工学院）；École Polytechnique, Institut Polytechnique de Paris（巴黎理工学院综合理工学院）；Uppsala University（乌普萨拉大学）；Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学）
Objective: Machine learning techniques have been used extensively for 12-lead electrocardiogram (ECG) analysis. For physiological time series, deep learning (DL) superiority to feature engineering (FE) approaches based on domain knowledge is still an open question. Moreover, it remains unclear whether combining DL with FE may improve performance. Methods: We considered three tasks intending to address these research gaps: cardiac arrhythmia diagnosis (multiclass-multilabel classification), atrial fibrillation risk prediction (binary classification), and age estimation (regression). We used an …
Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学）；Uppsala University（乌普萨拉大学）；Telehealth Center from Hospital das Clínicas da Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学医院临床中心远程医疗中心）；Hospital das Clínicas da Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学医院临床中心（注：此处原文本中“Telehealth Center from Hospital das Clínicas da Universidade Federal de Minas Gerais”中的“Hospital das Clínicas da Universidade Federal de Minas Gerais”是更基础的机构，按要求提取到大学级别或包含的独立机构，此处直接提取该医院作为机构名））
We present a model for predicting electrocardiogram (ECG) abnormalities in short-duration 12-lead ECG signals which outperformed medical doctors on the 4th year of their cardiology residency. Such exams can provide a full evaluation of heart activity and have not been studied in previous end-to-end machine learning papers. Using the database of a large telehealth network, we built a novel dataset with more than 2 million ECG tracings, orders of magnitude larger than those used in previous studies. Moreover, our dataset is more realistic, as it consist of 12-lead ECGs recorded during standard i…
Waseda University（早稻田大学）；The University of Electro-Communications（电气通信大学）；University of Tsukuba（筑波大学）；RIKEN AIP（理化学研究所革新智能统合研究中心）
This work aims to assess the reality and feasibility of the adversarial attack against cardiac diagnosis system powered by machine learning algorithms. To this end, we introduce adversarial beats, which are adversarial perturbations tailored specifically against electrocardiograms (ECGs) beat-by-beat classification system. We first formulate an algorithm to generate adversarial examples for the ECG classification neural network model, and study its attack success rate. Next, to evaluate its feasibility in a physical environment, we mount a hardware attack by designing a malicious signal genera…
Manifold Learning for Personalized and Label-Free Detection of Cardiac Arrhythmias
Department of Electrical and Computer Engineering, Princeton University, Princeton, 08544, New Jersey, USA（电气与计算机工程系，普林斯顿大学）；Princeton Precision Health, Princeton University, Princeton, 08544, New Jersey, USA（普林斯顿精准健康，普林斯顿大学）；Omenn-Darling Bioengineering Institute, Princeton University, 35 Ivy Lane, Princeton, 08540, New Jersey, USA（Omenn-Darling生物工程研究所，普林斯顿大学）
Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学）；Uppsala University（乌普萨拉大学）；Hospital das Clínicas da Universidade Federal de Minas Gerais（米纳斯吉拉斯联邦大学临床医院）；Glasgow University（格拉斯哥大学）
The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electroca…
International Institute of Information Technology（国际信息技术研究所）
Early detection of cardiovascular diseases is crucial for effective treatment and an electrocardiogram (ECG) is pivotal for diagnosis. The accuracy of Deep Learning based methods for ECG signal classification has progressed in recent years to reach cardiologist-level performance. In clinical settings, a cardiologist makes a diagnosis based on the standard 12-channel ECG recording. Automatic analysis of ECG recordings from a multiple-channel perspective has not been given enough attention, so it is essential to analyze an ECG recording from a multiple-channel perspective. We propose a model tha…
The Chinese University of Hong Kong（香港中文大学）；Institute of Future Cities, The Chinese University of Hong Kong（香港中文大学未来城市研究所）；Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong（香港中文大学李嘉诚健康科学研究所）
Cardiovascular diseases (CVDs) are the number one cause of death worldwide. While there is growing evidence that the atrial fibrillation (AF) has strong associations with various CVDs, this heart arrhythmia is usually diagnosed using electrocardiography (ECG) which is a risk-free, non-intrusive, and cost-efficient tool. Continuously and remotely monitoring the subjects' ECG information unlocks the potentials of prompt pre-diagnosis and timely pre-treatment of AF before the development of any life-threatening conditions/diseases. Ultimately, the CVDs associated mortality could be reduced. In th…
ECG-Expert-QA: A Benchmark for Evaluating Medical Large Language Models in Heart Disease Diagnosis
Zhejiang University School of Medicine（浙江大学医学院）；The First Affiliated Hospital（第一附属医院）；Liangzhu Laboratory（良渚实验室）；Shandong Jianzhu University（山东建筑大学）；FUXI AI Lab（伏羲人工智能实验室）；Beijing Normal University（北京师范大学）；Southern University of Science and Technology（南方科技大学）；China University of Geosciences (Wuhan)（中国地质大学（武汉））；Hangzhou Baorun Biotechnology Co., Ltd.（杭州宝润生物科技有限公司）
MambaCapsule: Towards Transparent Cardiac Disease Diagnosis with Electrocardiography Using Mamba Capsule Network
State Key Laboratory of Transvascular Implantation Devices and TIDRI, Zhejiang University（浙江大学血管介入关键实验室及TIDRI）；School of Public Health, Zhejiang University and Zhejiang Key Laboratory of Medical Imaging Artificial Intelligence（浙江大学公共卫生学院及浙江省医学影像人工智能重点实验室）；State Key Laboratory of Transvascular Implantation Devices of The Second Affiliated Hospital and Liangzhu Laboratory, Zhejiang University（浙江大学第二附属医院血管介入关键实验室及梁渚实验室）；Department of Gastroenterology, First Hospital of Quanzhou Affiliated to Fujian Medical University（福建医科大学泉州第一医院消化内科）；School of Medicine, Stanford University（斯坦福大学医学院）
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…
Medical diagnoses can shape and change the life of a person drastically. Therefore, it is always best advised to collect as much evidence as possible to be certain about the diagnosis. Unfortunately, in the case of the Brugada Syndrome (BrS), a rare and inherited heart disease, only one diagnostic criterion exists, namely, a typical pattern in the Electrocardiogram (ECG). In the following treatise, we question whether the investigation of ECG strips by the means of machine learning methods improves the detection of BrS positive cases and hence, the diagnostic process. We propose a pipeline tha…
University of Pittsburgh（匹兹堡大学）；SINGULAR MEDICAL (USA) INC.（美国 singular 医疗公司）；University of Notre Dame（圣母大学）
Life-threatening ventricular arrhythmias (VA) are the leading cause of sudden cardiac death (SCD), which is the most significant cause of natural death in the US. The implantable cardioverter defibrillator (ICD) is a small device implanted to patients under high risk of SCD as a preventive treatment. The ICD continuously monitors the intracardiac rhythm and delivers shock when detecting the life-threatening VA. Traditional methods detect VA by setting criteria on the detected rhythm. However, those methods suffer from a high inappropriate shock rate and require a regular follow-up to optimize …
