Development and feasibility of a smartphone, ECG and GPS based system for remotely monitoring exercise in cardiac rehabilitation

Background Despite its efficacy and cost-effectiveness, exercise-based cardiac rehabilitation is undertaken by less than one-third of clinically eligible cardiac patients in every country for which data is available. Reasons for non-participation include the unavailability of hospital-based rehabilitation programs, or excessive travel time and distance. For this reason, there have been calls for the development of more flexible alternatives. Methodology and Principal Findings We developed a system to enable walking-based cardiac rehabilitation in which the patient's single-lead ECG, heart rate, GPS-based speed and location are transmitted by a programmed smartphone to a secure server for real-time monitoring by a qualified exercise scientist. The feasibility of this approach was evaluated in 134 remotely-monitored exercise assessment and exercise sessions in cardiac patients unable to undertake hospital-based rehabilitation. Completion rates, rates of technical problems, detection of ECG changes, pre- and post-intervention six minute walk test (6 MWT), cardiac depression and Quality of Life (QOL) were key measures. The system was rated as easy and quick to use. It allowed participants to complete six weeks of exercise-based rehabilitation near their homes, worksites, or when travelling. The majority of sessions were completed without any technical problems, although periodic signal loss in areas of poor coverage was an occasional limitation. Several exercise and post-exercise ECG changes were detected. Participants showed improvements comparable to those reported for hospital-based programs, walking significantly further on the post-intervention 6 MWT, 637 m (95% CI: 565–726), than on the pre-test, 524 m (95% CI: 420–655), and reporting significantly reduced levels of cardiac depression and significantly improved physical health-related QOL. Conclusions and Significance The system provided a feasible and very flexible alternative form of supervised cardiac rehabilitation for those unable to access hospital-based programs, with the potential to address a well-recognised deficiency in health care provision in many countries. Future research should assess its longer-term efficacy, cost-effectiveness and safety in larger samples representing the spectrum of cardiac morbidity and severity.

Characterising an ECG signal using statistical modelling : a feasibility study

For clinical use, in electrocardiogram (ECG) signal analysis it is important to detect not only the centre of the P wave, the QRS complex and the T wave, but also the time intervals, such as the ST segment. Much research focused entirely on qrs complex detection, via methods such as wavelet transforms, spline fitting and neural networks. However, drawbacks include the false classification of a severe noise spike as a QRS complex, possibly requiring manual editing, or the omission of information contained in other regions of the ECG signal. While some attempts were made to develop algorithms to detect additional signal characteristics, such as P and T waves, the reported success rates are subject to change from person-to-person and beat-to-beat. To address this variability we propose the use of Markov-chain Monte Carlo statistical modelling to extract the key features of an ECG signal and we report on a feasibility study to investigate the utility of the approach. The modelling approach is examined with reference to a realistic computer generated ECG signal, where details such as wave morphology and noise levels are variable.

Computation of ECG signal features using MCMC modelling in software and FPGA reconfigurable hardware

Computational optimisation of clinically important electrocardiogram signal features, within a single heart beat, using a Markov-chain Monte Carlo (MCMC) method is undertaken. A detailed, efficient data-driven software implementation of an MCMC algorithm has been shown. Initially software parallelisation is explored and has been shown that despite the large amount of model parameter inter-dependency that parallelisation is possible. Also, an initial reconfigurable hardware approach is explored for future applicability to real-time computation on a portable ECG device, under continuous extended use.

Syntactic Approach to ECG Rhythm Analysis

A diagnostic system for ECG rhythm monitoring based on syntactic approaches to pattern recognition is presented here. The method proposed exploits the difference in shape and structure between arrhythmic and normal ECG patterns to generate distinctly different descriptions in terms of a chosen set of primitives. A given frame of signal is first approximated piecewise linearly into a set of line segments which are completely specified in terms of their length and slope values. The slope values are quantized into seven distinct levels and a unit-length line segment with a slope value in each of these levels is coded as a slope symbol. Seven such slope symbols constitute the set of primitives. The given signal is represented as a string of such symbols based on the length and angle of the line segments approximating the signal. Context-free languages are used for describing the classes of abnormal and normal ECG patterns considered here. Analysis of actual ECG data shows efficiency comparable with that of existing methods and a saving in processing time.

Homomorphic Analysis and Modeling of ECG Signals

Homomorphic analysis and pole-zero modeling of electrocardiogram (ECG) signals are presented in this paper. Four typical ECG signals are considered and deconvolved into their minimum and maximum phase components through cepstral filtering, with a view to study the possibility of more efficient feature selection from the component signals for diagnostic purposes. The complex cepstra of the signals are linearly filtered to extract the basic wavelet and the excitation function. The ECG signals are, in general, mixed phase and hence, exponential weighting is done to aid deconvolution of the signals. The basic wavelet for normal ECG approximates the action potential of the muscle fiber of the heart and the excitation function corresponds to the excitation pattern of the heart muscles during a cardiac cycle. The ECG signals and their components are pole-zero modeled and the pole-zero pattern of the models can give a clue to classify the normal and abnormal signals. Besides, storing only the parameters of the model can result in a data reduction of more than 3:1 for normal signals sampled at a moderate 128 samples/s

Component wave delineation of ECG by filtering in the Fourier domain

A complete solution to the fundamental problem of delineation of an ECG signal into its component waves by filtering the discrete Fourier transform of the signal is presented. The set of samples in a component wave is transformed into a complex sequence with a distinct frequency band. The filter characteristics are determined from the time signal itself. Multiplication of the transformed signal with a complex sinusoidal function allows the use of a bank of low-pass filters for the delineation of all component waves. Data from about 300 beats have been analysed and the results are highly satisfactory both qualitatively and quantitatively.

ECG component delineation by Prony's method

A simple, non-iterative method for component wave delineation from the electrocardiogram (ECG) is derived by modelling its discrete cosine transform (DCT) as a sum of damped cosinusoids. Amplitude, phase, damping factor and frequency parameters of each of the cosinusoids are estimated by the extended Prony method. Different component waves are represented by non-overlapping clusters of model poles in the z plane and thus a component wave is derived by the addition of the inverse transformed (IDCT) impulse responses of the poles in the cluster. Akaike's information criterion (AIC) is used to determine the model order. The method performed satisfactory even in the presence of artifacts. The efficacy of the method is illustrated by analysis of continuous strips of ECG data.

Analysis of ECG by multipulse excited linear prediction model

He propose a new time domain method for efficient representation of the KCG and delineation of its component waves. The method is based on the multipulse Linear prediction (LP) coding which is being widely used in speech processing. The excitation to the LP synthesis filter consists of a few pulses defined by their locations and amplitudes. Based on the amplitudes and their distribution, the pulses are suitably combined to delineate the component waves. Beat to beat correlation in the ECG signal is used in QRS periodicity prediction. The method entails a data compression of 1 in 6. The method reconstructs the signal with an NMSE of less than 5%.

Diseño y evaluación de métodos de supresión del artefacto causado en el ECG por las compresiones torácicas proporcionadas por el dispositivo mecánico LUCAS.

[Es]En este proyecto se analizan el diseño y la evaluación de dos métodos para la supresión de la interferencia generada por las compresiones torácicas proporcionadas por el dispositivo mecánico LUCAS, en el electrocardiograma (ECG) durante el masaje de resucitación cardiopulmonar. El objetivo es encontrar un método que elimine el artefacto generado en el ECG de una manera efectiva, que permita el diagnóstico fiable del ritmo cardiaco. Encontrar un método eficaz sería de gran ayuda para no tener que interrumpir el masaje de resucitación para el análisis correcto del ritmo cardiaco, lo que supondría un aumento en las probabilidades de resucitación. Para llevar a cabo el proyecto se ha generado una base de datos propia partiendo de registros de paradas cardiorrespiratorias extra-hospitalarias. Esta nueva base de datos contiene 410 cortes correspondientes a 86 pacientes, siendo todos los episodios de 30 segundos de duración y durante los cuales el paciente, recibe masaje cardiaco. Por otro lado, se ha desarrollado una interfaz gráfica para caracterizar los métodos de supresión del artefacto. Esta, muestra las señales del ECG, de impedancia torácica y del ECG tras eliminar el artefacto en tiempo. Mediante esta herramienta se han procesado los registros aplicando un filtro adaptativo y un filtro de coeficientes constantes. La evaluación de los métodos se ha realizado en base a la sensibilidad y especificidad del algoritmo de clasificación de ritmos con las señales ECG filtradas. La mayor aportación del proyecto, por tanto, es el desarrollo de una potente herramienta eficaz para evaluar métodos de supresión del artefacto causado en el ECG por las compresiones torácicas al realizar el masaje de resucitación cardiopulmonar, y su posterior diagnóstico. Un instrumento que puede ser implementado para analizar episodios de resucitación de cualquier tipo de procedencia y capaz de integrar nuevos métodos de supresión del artefacto.

Smartphone ECG for evaluation of STEMI: Results of the ST LEUIS Pilot Study

© 2015 Elsevier Inc. All rights reserved.Background 12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care. Objective To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG. Methods 6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory. Results The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL. Conclusions Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology.

Low Complexity All-Pass Based Polyphase Decimation Filters for ECG Monitoring

This paper presents a low complexity high efficiency decimation filter which can be employed in EletroCardioGram (ECG) acquisition systems. The decimation filter with a decimation ratio of 128 works along with a third order sigma delta modulator. It is designed in four stages to reduce cost and power consumption. The work reported here provides an efficient approach for the decimation process for high resolution biomedical data conversion applications by employing low complexity two-path all-pass based decimation filters. The performance of the proposed decimation chain was validated by using the MIT-BIH arrhythmia database and comparative simulations were conducted with the state of the art.

Embedded platform for ECG biometric recognition

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia de Electrónica e Telecomunicações