Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with elevated health risks, where timely detection is pivotal for mitigating stroke-related morbidity. This study introduces an innovative hybrid methodology integrating unsupervised deep learning and gradient boosting models to improve AF detection. A 19-layer deep convolutional autoencoder (DCAE) is coupled with three boosting classifiers-AdaBoost, XGBoost, and LightGBM (LGBM)-to harness their complementary advantages while addressing individual limitations. The proposed framework uniquely combines DCAE with gradient boosting, enabling end-to-end AF identification devoid of manual feature extraction. The DCAE-LGBM model attains an F1-score of 95.20%, sensitivity of 99.99%, and inference latency of four seconds, outperforming existing methods and aligning with clinical deployment requirements. The DCAE integration significantly enhances boosting models, positioning this hybrid system as a reliable tool for automated AF detection in clinical settings.
Atrial fibrillation (AF) detection from electrocardiogram (ECG) signals is crucial for early diagnosis and management of cardiovascular diseases. However, deploying robust AF detection models across different datasets with significant domain variations remains a challenge. In this paper, we use test-time data augmentation (TTA) to address the cross-domain problem and enhance AF detection performance. We use a publicly available dataset for training - Physionet Computing in Cardiology Challenge 2017 -, while collecting a distinct test set, creating a cross-domain scenario. We employ a neural network architecture that integrates transformer-based encoding of ECG signals and convolutional layers for spectrogram feature extraction. The model combines the latent representations obtained from both encoders to classify the input signals. By incorporating TTA during inference, we enhance the model's performance, achieving an F1 score of 76.6\% on our test set. Furthermore, our experiments demonstrate that the model becomes more resilient to perturbations in the input signal, enhancing its robustness. We show that TTA can be effective in addressing the cross-domain problem, where training and test data originate from disparate sources. This work contributes to advancing the field of AF detection in real-world scenarios.
This study introduces a novel application of a Generative Pre-trained Transformer (GPT) model tailored for photoplethysmography (PPG) signals, serving as a foundation model for various downstream tasks. Adapting the standard GPT architecture to suit the continuous characteristics of PPG signals, our approach demonstrates promising results. Our models are pre-trained on our extensive dataset that contains more than 200 million 30s PPG samples. We explored different supervised fine-tuning techniques to adapt our model to downstream tasks, resulting in performance comparable to or surpassing current state-of-the-art (SOTA) methods in tasks like atrial fibrillation detection. A standout feature of our GPT model is its inherent capability to perform generative tasks such as signal denoising effectively, without the need for further fine-tuning. This success is attributed to the generative nature of the GPT framework.
The growing demand for accurate, continuous, and non-invasive health monitoring has propelled multi-sensor data fusion to the forefront of healthcare technology. This review aims to provide an overview of the development of fusion frameworks in the literature and common terminology used in fusion literature. The review introduces the fusion classification standards and methods that are most relevant from an algorithm development perspective. Applications of the reviewed fusion frameworks in fields such as defense, autonomous driving, robotics, and image fusion are also discussed to provide contextual information on the various fusion methodologies that have been developed in this field. This review provides a comprehensive analysis of multi-sensor data fusion methods applied to health monitoring systems, focusing on key algorithms, applications, challenges, and future directions. We examine commonly used fusion techniques, including Kalman filters, Bayesian networks, and machine learning models. By integrating data from various sources, these fusion approaches enhance the reliability, accuracy, and resilience of health monitoring systems. However, challenges such as data quality and differences in acquisition systems exist, calling for intelligent fusion algorithms in recent years. The review finally converges on applications of fusion algorithms in biomedical inference tasks like heartbeat detection, respiration rate estimation, sleep apnea detection, arrhythmia detection, and atrial fibrillation detection.
Atrial fibrillation is a commonly encountered clinical arrhythmia associated with stroke and increased mortality. Since professional medical knowledge is required for annotation, exploiting a large corpus of ECGs to develop accurate supervised learning-based atrial fibrillation algorithms remains challenging. Self-supervised learning (SSL) is a promising recipe for generalized ECG representation learning, eliminating the dependence on expensive labeling. However, without well-designed incorporations of knowledge related to atrial fibrillation, existing SSL approaches typically suffer from unsatisfactory capture of robust ECG representations. In this paper, we propose an inter-intra period-aware ECG representation learning approach. Considering ECGs of atrial fibrillation patients exhibit the irregularity in RR intervals and the absence of P-waves, we develop specific pre-training tasks for interperiod and intraperiod representations, aiming to learn the single-period stable morphology representation while retaining crucial interperiod features. After further fine-tuning, our approach demonstrates remarkable AUC performances on the BTCH dataset, \textit{i.e.}, 0.953/0.996 for paroxysmal/persistent atrial fibrillation detection. On commonly used benchmarks of CinC2017 and CPSC2021, the generalization capability and effectiveness of our methodology are substantiated with competitive results.
Atrial fibrillation (AF) is characterized by irregular electrical impulses originating in the atria, which can lead to severe complications and even death. Due to the intermittent nature of the AF, early and timely monitoring of AF is critical for patients to prevent further exacerbation of the condition. Although ambulatory ECG Holter monitors provide accurate monitoring, the high cost of these devices hinders their wider adoption. Current mobile-based AF detection systems offer a portable solution. However, these systems have various applicability issues, such as being easily affected by environmental factors and requiring significant user effort. To overcome the above limitations, we present AcousAF, a novel AF detection system based on acoustic sensors of smartphones. Particularly, we explore the potential of pulse wave acquisition from the wrist using smartphone speakers and microphones. In addition, we propose a well-designed framework comprised of pulse wave probing, pulse wave extraction, and AF detection to ensure accurate and reliable AF detection. We collect data from 20 participants utilizing our custom data collection application on the smartphone. Extensive experimental results demonstrate the high performance of our system, with 92.8% accuracy, 86.9% precision, 87.4% recall, and 87.1% F1 Score.
The progression of deep learning and the widespread adoption of sensors have facilitated automatic multi-view fusion (MVF) about the cardiovascular system (CVS) signals. However, prevalent MVF model architecture often amalgamates CVS signals from the same temporal step but different views into a unified representation, disregarding the asynchronous nature of cardiovascular events and the inherent heterogeneity across views, leading to catastrophic view confusion. Efficient training strategies specifically tailored for MVF models to attain comprehensive representations need simultaneous consideration. Crucially, real-world data frequently arrives with incomplete views, an aspect rarely noticed by researchers. Thus, the View-Centric Transformer (VCT) and Multitask Masked Autoencoder (M2AE) are specifically designed to emphasize the centrality of each view and harness unlabeled data to achieve superior fused representations. Additionally, we systematically define the missing-view problem for the first time and introduce prompt techniques to aid pretrained MVF models in flexibly adapting to various missing-view scenarios. Rigorous experiments involving atrial fibrillation detection, blood pressure estimation, and sleep staging-typical health monitoring tasks-demonstrate the remarkable advantage of our method in MVF compared to prevailing methodologies. Notably, the prompt technique requires finetuning less than 3% of the entire model's data, substantially fortifying the model's resilience to view missing while circumventing the need for complete retraining. The results demonstrate the effectiveness of our approaches, highlighting their potential for practical applications in cardiovascular health monitoring. Codes and models are released at URL.
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.
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.
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.
Atrial fibrillation (AF) increases the risk of stroke. Electrocardiogram (ECG) is used for AF detection, while photoplethysmography (PPG) is simple to use and appropriate for long-term monitoring. We have developed a novel approach to detect AF from smartwatch-based wrist PPG signals. To the best of our knowledge, this is the first study to employ 1D CycleGAN for the reconstruction of 1D wrist PPG signals, since the quality of wrist PPG signals is very poor due to motion artifacts and acquisition site limitations. Our proposed approach is validated on a dataset of 21,278 10s long wrist PPG segments. The dataset was divided into two halves and two experiments were conducted. One half was used for training and the other half for testing and vice versa. Our classification model (Self-AFNet) with 1D-CycleGAN for restoration achieves an accuracy of 96.41% and 97.09% for both splits, respectively. There is a noteworthy improvement in accuracy (2.94% and 5.08% for test splits, respectively) for restored signals as compared to unrestored PPG. AF detection task was also performed using ECG signals with the matched PPG signals to assess the validity of employing reconstructed PPG-based AF classification. Self-AFNet managed to achieve an accuracy of 98.07% and 98.97%, respectively using two ECG splits which is comparable to the performance of AF detection utilizing reconstructed PPG segments. This study reflects that reconstructed wrist PPG signals acquired from wearable devices can be used for reliable detection of atrial fibrillation, which can significantly help in the reduction of the risk of stroke.
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.
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.
Photoplethysmography (PPG) is a cost-effective and non-invasive technique that utilizes optical methods to measure cardiac physiology. PPG has become increasingly popular in health monitoring and is used in various commercial and clinical wearable devices. Compared to electrocardiography (ECG), PPG does not provide substantial clinical diagnostic value, despite the strong correlation between the two. Here, we propose a subject-independent attention-based deep state-space model (ADSSM) to translate PPG signals to corresponding ECG waveforms. The model is not only robust to noise but also data-efficient by incorporating probabilistic prior knowledge. To evaluate our approach, 55 subjects' data from the MIMIC-III database were used in their original form, and then modified with noise, mimicking real-world scenarios. Our approach was proven effective as evidenced by the PR-AUC of 0.986 achieved when inputting the translated ECG signals into an existing atrial fibrillation (AFib) detector. ADSSM enables the integration of ECG's extensive knowledge base and PPG's continuous measurement for early diagnosis of cardiovascular disease.
Atrial fibrillation (AF) is one of the most common arrhythmias with challenging public health implications. Therefore, automatic detection of AF episodes on ECG is one of the essential tasks in biomedical engineering. In this paper, we applied the recently introduced method of compressor-based text classification with gzip algorithm for AF detection (binary classification between heart rhythms). We investigated the normalized compression distance applied to RR-interval and $\Delta$RR-interval sequences ($\Delta$RR-interval is the difference between subsequent RR-intervals). Here, the configuration of the k-nearest neighbour classifier, an optimal window length, and the choice of data types for compression were analyzed. We achieved good classification results while learning on the full MIT-BIH Atrial Fibrillation database, close to the best specialized AF detection algorithms (avg. sensitivity = 97.1\%, avg. specificity = 91.7\%, best sensitivity of 99.8\%, best specificity of 97.6\% with fivefold cross-validation). In addition, we evaluated the classification performance under the few-shot learning setting. Our results suggest that gzip compression-based classification, originally proposed for texts, is suitable for biomedical data and quantized continuous stochastic sequences in general.
In this paper, we propose a novel contrastive learning based deep learning framework for patient similarity search using physiological signals. We use a contrastive learning based approach to learn similar embeddings of patients with similar physiological signal data. We also introduce a number of neighbor selection algorithms to determine the patients with the highest similarity on the generated embeddings. To validate the effectiveness of our framework for measuring patient similarity, we select the detection of Atrial Fibrillation (AF) through photoplethysmography (PPG) signals obtained from smartwatch devices as our case study. We present extensive experimentation of our framework on a dataset of over 170 individuals and compare the performance of our framework with other baseline methods on this dataset.
Rapid, reliable, and accurate interpretation of medical time-series signals is crucial for high-stakes clinical decision-making. Deep learning methods offered unprecedented performance in medical signal processing but at a cost: they were compute-intensive and lacked interpretability. We propose Sparse Mixture of Learned Kernels (SMoLK), an interpretable architecture for medical time series processing. SMoLK learns a set of lightweight flexible kernels that form a single-layer sparse neural network, providing not only interpretability, but also efficiency, robustness, and generalization to unseen data distributions. We introduce a parameter reduction techniques to reduce the size of SMoLK's networks while maintaining performance. We test SMoLK on two important tasks common to many consumer wearables: photoplethysmography (PPG) artifact detection and atrial fibrillation detection from single-lead electrocardiograms (ECGs). We find that SMoLK matches the performance of models orders of magnitude larger. It is particularly suited for real-time applications using low-power devices, and its interpretability benefits high-stakes situations.
Electrocardiography analysis is widely used in various clinical applications and Deep Learning models for classification tasks are currently in the focus of research. Due to their data-driven character, they bear the potential to handle signal noise efficiently, but its influence on the accuracy of these methods is still unclear. Therefore, we benchmark the influence of four types of noise on the accuracy of a Deep Learning-based method for atrial fibrillation detection in 12-lead electrocardiograms. We use a subset of a publicly available dataset (PTBXL) and use the metadata provided by human experts regarding noise for assigning a signal quality to each electrocardiogram. Furthermore, we compute a quantitative signal-to-noise ratio for each electrocardiogram. We analyze the accuracy of the Deep Learning model with respect to both metrics and observe that the method can robustly identify atrial fibrillation, even in cases signals are labelled by human experts as being noisy on multiple leads. False positive and false negative rates are slightly worse for data being labelled as noisy. Interestingly, data annotated as showing baseline drift noise results in an accuracy very similar to data without. We conclude that the issue of processing noisy electrocardiography data can be addressed successfully by Deep Learning methods that might not need preprocessing as many conventional methods do.
Atrial Fibrillation is a common form of irregular heart rhythm that can be very dangerous. Our primary goal is to analyze Atrial Fibrillation data within ECGs to develop a model based only on RR-Intervals, or the length between heart-beats, to create a real time classification model for Atrial Fibrillation to be implemented in common heart-rate monitors on the market today. Physionet's MIT-BIH Atrial Fibrillation Database \cite{goldberger2000physiobank} and 2017 Challenge Database \cite{clifford2017af} were used to identify patterns of Atrial Fibrillation and test classification models on. These two datasets are very different. The MIT-BIH database contains long samples taken with a medical grade device, which is not useful for simulating a consumer device, but is useful for Atrial Fibrillation pattern detection. The 2017 Challenge database includes short ($<60sec$) samples taken with a portable device and reveals many of the challenges of Atrial Fibrillation classification in a real-time device. We developed multiple SVM models with three sets of extracted features as predictor variables which gave us moderately high accuracies with low computational intensity. With robust filtering techniques already applied in many Photoplethysmograph-based consumer heart-rate monitors, this method can be used to develop a reliable real time model for Atrial Fibrillation detection in consumer-grade heart-rate monitors.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and associated with a high risk for serious conditions like stroke. The use of wearable devices embedded with automatic and timely AF assessment from electrocardiograms (ECGs) has shown to be promising in preventing life-threatening situations. Although deep neural networks have demonstrated superiority in model performance, their use on wearable devices is limited by the trade-off between model performance and complexity. In this work, we propose to use lightweight convolutional neural networks (CNNs) with parameterised hypercomplex (PH) layers for AF detection based on ECGs. The proposed approach trains small-scale CNNs, thus overcoming the limited computing resources on wearable devices. We show comparable performance to corresponding real-valued CNNs on two publicly available ECG datasets using significantly fewer model parameters. PH models are more flexible than other hypercomplex neural networks and can operate on any number of input ECG leads.