SQUWA: Signal Quality Aware DNN Architecture for Enhanced Accuracy in Atrial Fibrillation Detection from Noisy PPG Signals

Atrial fibrillation (AF), a common cardiac arrhythmia, significantly increases the risk of stroke, heart disease, and mortality. Photoplethysmography (PPG) offers a promising solution for continuous AF monitoring, due to its cost efficiency and integration into wearable devices. Nonetheless, PPG signals are susceptible to corruption from motion artifacts and other factors often encountered in ambulatory settings. Conventional approaches typically discard corrupted segments or attempt to reconstruct original signals, allowing for the use of standard machine learning techniques. However, this reduces dataset size and introduces biases, compromising prediction accuracy and the effectiveness of continuous monitoring. We propose a novel deep learning model, Signal Quality Weighted Fusion of Attentional Convolution and Recurrent Neural Network (SQUWA), designed to learn how to retain accurate predictions from partially corrupted PPG. Specifically, SQUWA innovatively integrates an attention mechanism that directly considers signal quality during the learning process, dynamically adjusting the weights of time series segments based on their quality. This approach enhances the influence of higher-quality segments while reducing that of lower-quality ones, effectively utilizing partially corrupted segments. This approach represents a departure from the conventional methods that exclude such segments, enabling the utilization of a broader range of data, which has great implications for less disruption when monitoring of AF risks and more accurate estimation of AF burdens. Our extensive experiments show that SQUWA outperform existing PPG-based models, achieving the highest AUCPR of 0.89 with label noise mitigation. This also exceeds the 0.86 AUCPR of models trained with using both electrocardiogram (ECG) and PPG data.

A Deep Learning Method for Beat-Level Risk Analysis and Interpretation of Atrial Fibrillation Patients during Sinus Rhythm

Atrial Fibrillation (AF) is a common cardiac arrhythmia. Many AF patients experience complications such as stroke and other cardiovascular issues. Early detection of AF is crucial. Existing algorithms can only distinguish ``AF rhythm in AF patients'' from ``sinus rhythm in normal individuals'' . However, AF patients do not always exhibit AF rhythm, posing a challenge for diagnosis when the AF rhythm is absent. To address this, this paper proposes a novel artificial intelligence (AI) algorithm to distinguish ``sinus rhythm in AF patients'' and ``sinus rhythm in normal individuals'' in beat-level. We introduce beat-level risk interpreters, trend risk interpreters, addressing the interpretability issues of deep learning models and the difficulty in explaining AF risk trends. Additionally, the beat-level information fusion decision is presented to enhance model accuracy. The experimental results demonstrate that the average AUC for single beats used as testing data from CPSC 2021 dataset is 0.7314. By employing 150 beats for information fusion decision algorithm, the average AUC can reach 0.7591. Compared to previous segment-level algorithms, we utilized beats as input, reducing data dimensionality and making the model more lightweight, facilitating deployment on portable medical devices. Furthermore, we draw new and interesting findings through average beat analysis and subgroup analysis, considering varying risk levels.

Deciphering Heartbeat Signatures: A Vision Transformer Approach to Explainable Atrial Fibrillation Detection from ECG Signals

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.

RawECGNet: Deep Learning Generalization for Atrial Fibrillation Detection from the Raw ECG

Introduction: Deep learning models for detecting episodes of atrial fibrillation (AF) using rhythm information in long-term, ambulatory ECG recordings have shown high performance. However, the rhythm-based approach does not take advantage of the morphological information conveyed by the different ECG waveforms, particularly the f-waves. As a result, the performance of such models may be inherently limited. Methods: To address this limitation, we have developed a deep learning model, named RawECGNet, to detect episodes of AF and atrial flutter (AFl) using the raw, single-lead ECG. We compare the generalization performance of RawECGNet on two external data sets that account for distribution shifts in geography, ethnicity, and lead position. RawECGNet is further benchmarked against a state-of-the-art deep learning model, named ArNet2, which utilizes rhythm information as input. Results: Using RawECGNet, the results for the different leads in the external test sets in terms of the F1 score were 0.91--0.94 in RBDB and 0.93 in SHDB, compared to 0.89--0.91 in RBDB and 0.91 in SHDB for ArNet2. The results highlight RawECGNet as a high-performance, generalizable algorithm for detection of AF and AFl episodes, exploiting information on both rhythm and morphology.

Advancing ECG Diagnosis Using Reinforcement Learning on Global Waveform Variations Related to P Wave and PR Interval

The reliable diagnosis of cardiac conditions through electrocardiogram (ECG) analysis critically depends on accurately detecting P waves and measuring the PR interval. However, achieving consistent and generalizable diagnoses across diverse populations presents challenges due to the inherent global variations observed in ECG signals. This paper is focused on applying the Q learning reinforcement algorithm to the various ECG datasets available in the PhysioNet/Computing in Cardiology Challenge (CinC). Five ECG beats, including Normal Sinus Rhythm, Atrial Flutter, Atrial Fibrillation, 1st Degree Atrioventricular Block, and Left Atrial Enlargement, are included to study variations of P waves and PR Interval on Lead II and Lead V1. Q-Agent classified 71,672 beat samples in 8,867 patients with an average accuracy of 90.4% and only 9.6% average hamming loss over misclassification. The average classification time at the 100th episode containing around 40,000 samples is 0.04 seconds. An average training reward of 344.05 is achieved at an alpha, gamma, and SoftMax temperature rate of 0.001, 0.9, and 0.1, respectively.

Photoplethysmography based atrial fibrillation detection: an updated review from July 2019

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant health ramifications, including an elevated susceptibility to ischemic stroke, heart disease, and heightened mortality. Photoplethysmography (PPG) has emerged as a promising technology for continuous AF monitoring for its cost-effectiveness and widespread integration into wearable devices. Our team previously conducted an exhaustive review on PPG-based AF detection before June 2019. However, since then, more advanced technologies have emerged in this field. This paper offers a comprehensive review of the latest advancements in PPG-based AF detection, utilizing digital health and artificial intelligence (AI) solutions, within the timeframe spanning from July 2019 to December 2022. Through extensive exploration of scientific databases, we have identified 59 pertinent studies. Our comprehensive review encompasses an in-depth assessment of the statistical methodologies, traditional machine learning techniques, and deep learning approaches employed in these studies. In addition, we address the challenges encountered in the domain of PPG-based AF detection. Furthermore, we maintain a dedicated website to curate the latest research in this area, with regular updates on a regular basis.

SiamAF: Learning Shared Information from ECG and PPG Signals for Robust Atrial Fibrillation Detection

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. It is associated with an increased risk of stroke, heart failure, and other cardiovascular complications, but can be clinically silent. Passive AF monitoring with wearables may help reduce adverse clinical outcomes related to AF. Detecting AF in noisy wearable data poses a significant challenge, leading to the emergence of various deep learning techniques. Previous deep learning models learn from a single modality, either electrocardiogram (ECG) or photoplethysmography (PPG) signals. However, deep learning models often struggle to learn generalizable features and rely on features that are more susceptible to corruption from noise, leading to sub-optimal performances in certain scenarios, especially with low-quality signals. Given the increasing availability of ECG and PPG signal pairs from wearables and bedside monitors, we propose a new approach, SiamAF, leveraging a novel Siamese network architecture and joint learning loss function to learn shared information from both ECG and PPG signals. At inference time, the proposed model is able to predict AF from either PPG or ECG and outperforms baseline methods on three external test sets. It learns medically relevant features as a result of our novel architecture design. The proposed model also achieves comparable performance to traditional learning regimes while requiring much fewer training labels, providing a potential approach to reduce future reliance on manual labeling.

PPG to ECG Signal Translation for Continuous Atrial Fibrillation Detection via Attention-based Deep State-Space Modeling

An electrocardiogram (ECG or EKG) is a medical test that measures the heart's electrical activity. ECGs are often used to diagnose and monitor a wide range of heart conditions, including arrhythmias, heart attacks, and heart failure. On the one hand, the conventional ECG requires clinical measurement, which restricts its deployment to medical facilities. On the other hand, single-lead ECG has become popular on wearable devices using administered procedures. An alternative to ECG is Photoplethysmography (PPG), which uses non-invasive, low-cost optical methods to measure cardiac physiology, making it a suitable option for capturing vital heart signs in daily life. As a result, it has become increasingly popular in health monitoring and is used in various clinical and commercial wearable devices. While ECG and PPG correlate strongly, the latter does not offer significant clinical diagnostic value. Here, we propose a subject-independent attention-based deep state-space model to translate PPG signals to corresponding ECG waveforms. The model is highly data-efficient by incorporating prior knowledge in terms of probabilistic graphical models. Notably, the model enables the detection of atrial fibrillation (AFib), the most common heart rhythm disorder in adults, by complementing ECG's accuracy with continuous PPG monitoring. We evaluated the model on 55 subjects from the MIMIC III database. Quantitative and qualitative experimental results demonstrate the effectiveness and efficiency of our approach.

Compressor-Based Classification for Atrial Fibrillation Detection

Atrial fibrillation (AF) is one of the most common arrhythmias with challenging public health implications. Automatic detection of AF episodes is therefore one of the most important tasks in biomedical engineering. In this paper, we apply the recently introduced method of compressor-based text classification to the task of AF detection (binary classification between heart rhythms). We investigate the normalised compression distance applied to $\Delta$RR and RR-interval sequences, the configuration of the k-Nearest Neighbour classifier, and an optimal window length. We achieve good classification results (avg. sensitivity = 97.1%, avg. specificity = 91.7%, best sensitivity of 99.8%, best specificity of 97.6% with 5-fold cross-validation). Obtained performance is close to the best specialised AF detection algorithms. Our results suggest that gzip classification, originally proposed for texts, is suitable for biomedical data and continuous stochastic sequences in general.

Learning Beyond Similarities: Incorporating Dissimilarities between Positive Pairs in Self-Supervised Time Series Learning

By identifying similarities between successive inputs, Self-Supervised Learning (SSL) methods for time series analysis have demonstrated their effectiveness in encoding the inherent static characteristics of temporal data. However, an exclusive emphasis on similarities might result in representations that overlook the dynamic attributes critical for modeling cardiovascular diseases within a confined subject cohort. Introducing Distilled Encoding Beyond Similarities (DEBS), this paper pioneers an SSL approach that transcends mere similarities by integrating dissimilarities among positive pairs. The framework is applied to electrocardiogram (ECG) signals, leading to a notable enhancement of +10\% in the detection accuracy of Atrial Fibrillation (AFib) across diverse subjects. DEBS underscores the potential of attaining a more refined representation by encoding the dynamic characteristics of time series data, tapping into dissimilarities during the optimization process. Broadly, the strategy delineated in this study holds the promise of unearthing novel avenues for advancing SSL methodologies tailored to temporal data.