A topological approach to delineation and arrhythmic beats detection in unprocessed long-term ECG signals.

Background And Objective: Arrhythmias are one of the most common symptoms of cardiac failure. They are usually diagnosed using ECG recordings, particularly long ambulatory recordings (AECG). These recordings are tedious to interpret by humans due to their extent (up to 48 h) and the relative scarcity of arrhythmia events. This makes automated systems for detecting various AECG anomalies indispensable. In this work we present a novel procedure based on topological principles (Morse theory) for detecting arrhythmic beats in AECG. It works in nearly real-time (delayed by a 14 s window), and can be applied to raw (unprocessed) ECG signals.

Methods: The procedure is based on a subject-specific adaptation of the one-dimensional discrete Morse theory (ADMT), which represents the signal as a sequence of its most important extrema. The ADMT algorithm is applied twice; for low-amplitude, high-frequency noise removal, and for detection of the characteristic waves of individual ECG beats. The waves are annotated using the ADMT algorithm and template matching. The annotated beats are then compared to the adjacent beats with two measures of similarity: the distance between two beats, and the difference in shape between them. The two measures of similarity are used as inputs to a decision tree algorithm that classifies the beats as normal or abnormal. The classification performance is evaluated with the leave-one-record-out cross-validation method.

Results: Our approach was tested on the MIT-BIH database, where it exhibited a classification accuracy of 92.73%, a sensitivity of 73.35%, a specificity of 96.70%, a positive predictive value of 88.01%, and a negative predictive value of 95.73%.

Conclusions: Compared to related studies, our algorithm requires less preprocessing while retaining the capability to detect and classify beats in almost real-time. The algorithm exhibits a high degree of accuracy in beats detection and classification that are at least comparable to state-of-the-art methods.