This thesis deals with a proposition of an algorithm for QRS complex and typical ECG waves boundaries detection. It incorporates a literature research focused on heart electrophysiology and commonly used methods for ECG fiducial points detection and delineation. Out of the presented methods an algorithm based on a continuous wavelet transform is implemented. Detection and delineation algorithm is tested on CSE standard signal database towards references determined both manually and automatically. Obtained results are compared to other congenerous methods. The diploma thesis is further concerned with an algorithm modification for experimental electrocardiograms of isolated rabbit hearts. Recording specifics of these data are introduced. Additionally, based on time and frequency analysis, particular modifications of the algorithm are proposed and realized. Due to a large extent of records functionality is verified on randomly selected database samples. Efficiency of the modified algorithm is evaluated through manually annotated references.

The thesis is focused on the study of detection of QRS complex in time a frequency domain. The aim is to implement selected methods and their comparison to assess the effectiveness of QRS complex.

nÃo hà / Sistemas automÃticos de auxÃlio ao diagnÃstico visam à extraÃÃo de mÃtricas especÃficas, podendo ser por algoritmos computacionais, de forma a subsidiar a anÃlise por parte do especialista de condiÃÃes orgÃnicas e fisiolÃgicas do paciente. No contexto da cardiologia, referidos sistemas sÃo particularmente importantes quando aplicados no processamento de sinais de longa duraÃÃo, como o eletrocardiograma (ECG) de 24 horas. As tÃcnicas para segmentaÃÃo e extraÃÃo automÃtica de parÃmetros do sinal ECG propostas nesta tese abrangem diversos campos de pesquisa. Inicialmente, o sistema realiza a detecÃÃo e a segmentaÃÃo do complexo QRS, relacionado à despolarizaÃÃo ventricular. Como metodologia, utiliza-se a combinaÃÃo das tÃcnicas do limiar adaptativo, das transformadas de Hilbert e Wavelet e do filtro derivativo com uma nova abordagem de reduÃÃo de prÃ-processamento e de seleÃÃo do fator de escala da Wavelet. Ao final desta etapa, obtÃm-se a sÃrie de intervalos RR, a sÃrie de duraÃÃes de cada complexo QRS e de suas amplitudes. No segundo momento, tem-se a detecÃÃo e a segmentaÃÃo da onda T, relacionada à repolarizaÃÃo ventricular. PropÃe-se um novo modelo matemÃtico do comportamento morfolÃgico da onda T baseado na funÃÃo Gaussiana, modificada por um procedimento matemÃtico de inserÃÃo de assimetria. Uma vez obtidos os parÃmetros de modelagem para uma dada morfologia predominante de onda T, a funÃÃo de correlaÃÃo cruzada à utilizada para a detecÃÃo do pico e uma tÃcnica baseada no cÃlculo da Ãrea de trapÃzios à utilizada para a localizaÃÃo do final da forma de onda. Dentre as mÃtricas derivadas das informaÃÃes extraÃdas, destaca-se a sÃrie de intervalos QT, segmento que vai do inÃcio de cada complexo QRS ao final de cada onda T. Finalizado o processo de segmentaÃÃo, dois estudos de caso sÃo realizados: subtraÃÃo da atividade ventricular em sinais eletrogramas atriais de pacientes com fibrilaÃÃo atrial (FA) e anÃlise de sÃries de variabilidade da frequÃncia cardÃaca (VFC) de um conjunto de pacientes idosos selecionados pelo AmbulatÃrio de Geriatria do Hospital UniversitÃrio WÃlter CantÃdio. A partir de experimentos de validaÃÃo em bases de dados diversas com anotaÃÃes manuais dos batimentos, obtÃm-se as seguintes taxas de detecÃÃo e erros de delineamento para o complexo QRS: sensibilidade de 99,51%, preditividade positiva de 99,44%, erro mÃdio de inÃcio (QRS onset) de 2,85  9,90 ms e erro mÃdio de final (QRS offset) de 2,83  12,26 ms. Com relaÃÃo à detecÃÃo e segmentaÃÃo da onda T, obtÃm-se os seguintes resultados: sensibilidade de 99,48%, preditividade positiva de 99,53%, erro mÃdio de localizaÃÃo de pico de 0,51  8,06 ms e erro mÃdio de localizaÃÃo de final da forma de onda de 0,11  11,73 ms. Quanto ao primeiro estudo de caso de uso dos pontos fiduciais detectados, a potÃncia mÃdia dos sinais eletrogramas atriais, apÃs a subtraÃÃo da atividade ventricular, à significativamente reduzida para frequÃncias acima de 10 Hz, predominantemente associadas ao complexo QRS, bem como para frequÃncias na faixa de 3 a 5 Hz, relacionadas à atividade elÃtrica de repolarizaÃÃo ventricular. Para o segundo estudo, a anÃlise do comportamento de mÃtricas no domÃnio da frequÃncia associadas à atividade do sistema nervoso simpÃtico permite o reconhecimento de tendÃncias prÃprias e caracterÃsticas, no que tange a aspectos de funcionamento/disautonomia do sistema nervoso autonÃmico, de cada classe prÃ-determinada de idosos segundo os conceitos de fenÃtipo de fragilidade: idosos frÃgeis, prÃ-frÃgeis e robustos. Os resultados obtidos sugerem que o conjunto de metodologias desenvolvidas para a segmentaÃÃo do sinal ECG apresenta altas taxas de precisÃo, repetibilidade e robustez a uma ampla gama de morfologias, podendo ser aplicado em diversos contextos de auxÃlio ao diagnÃstico. Dadas as mÃtricas e sÃries temporais que podem ser extraÃdas, os referidos mÃtodos tambÃm podem dar suporte a processos de investigaÃÃo clÃnica e desenvolvimento de marcadores/indicadores de eventos cardiovasculares adversos.

This master’s thesis deals with the detection of QRS complex detection using zero crossing counts. QRS detection is an important part of the analysis of ECG signal. From the point of determining the R wave detection is based on the other waves and intervals necessary for the diagnosis of heart. This method is very effective even for very noisy signals. Implementation of the method in Matlab, and the success of detection is tested on the CSE and MIT-BIH database. The optimization algorithm is an optional value for the detector.

Tese de mestrado integrado. Bioengenharia. Área de Especialização de Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 2012

The Cardiac Rhythm Management Division of St. Jude Medical specializes in the development of implantable cardioverter defibrillators that improve the quality of life for patients diagnosed with a variety of cardiac arrhythmias, especially for patients prone to sudden cardiac death. With the goal to improve detection of cardiac arrhythmias, this study explored the value in time-frequency analysis of intracardiac electrogram in four steps. The first two steps characterized, in the frequency domain, the waveforms that construct the cardiac cycle. The third step developed a new algorithm that putatively provides the least computationally expensive way to identifying cardiac waveforms in the frequency domain. Lastly, this novel approach to analyzing intracardiac electrogram was compared to a threshold crossing algorithm that strictly operates in the time domain and that is currently utilized by St. Jude Medical. The new algorithm demonstrated an equally effective method in identifying the QRS complex on the ventricular channel. The next steps in pursing time-frequency analysis of intracardiac electrogram include implementing the new algorithm on a testing platform that emulates the latest implantable cardioverter defibrillator manufactured by St. Jude Medical and pursuing a similar algorithm that can be employed on the atrial channel.

No description available.

L'évaluation de l'asynchronisme mécanique ventriculaire sous stress a soulevé une attention importante en tant que facteur prédictif de la réponse au traitement de resynchronisation cardiaque (CRT). De plus, il semble exister une relation significative entre le devenir du patient et la présence d’asynchronisme au repos. Plusieurs méthodes échocardiographiques peuvent être utilisées pour évaluer l’asynchronisme. Cependant, parmi toutes les différentes méthodologies ou index existant dans ce domaine, aucun critère ne fait l’unanimité. Cette thèse étudie l'importance des techniques d'imagerie nucléaire dans le cadre de l’évaluation de l’asynchronisme cardiaque induit par le stress en utilisant trois différents modèles canins expérimentaux. Le premier chapitre vise à examiner les effets du stress sur le synchronisme de la contraction du ventricule gauche (VG) en utilisant l'imagerie synchronisée de perfusion myocardique dans une cohorte canine normale. Le stress a été induit par différents niveaux d’infusion de dobutamine sur six sujets sains. Les paramètres hémodynamiques et l’asynchronisme ont été évalués par des mesures de pressions ventriculaires. L'analyse de phase sur l’imagerie s’est effectuée en utilisant un logiciel commercialement disponible (QGS) et un logiciel interne (MHI4MPI), basée sur le déplacement et l’épaississement des parois ventriculaires. L’augmentation de la concentration de dobutamine a démontré une amélioration de la capacité fonctionnelle et une réduction de l’asynchronisme ventriculaire. L’analyse de l’asynchronisme calculée à partir de l’épaississement de la paroi semble plus robuste et plus sensible que l’utilisation du déplacement des parois. (Salimian et. al., J Nucl Cardiol., 2014) Le second chapitre étudie les différents paramètres d’asynchronisme au repos et à différents niveaux de stress dans un modèle de cardiomyopathie dilatée et à QRS étroit. Ce modèle a été créé sur dix chiens par tachycardie via stimulation de l'apex du ventricule droit pendant 3-4 semaines, permettant d’atteindre une fraction d'éjection cible de 35% ou moins. Le stress a ensuite été induit par une perfusion de dobutamine jusqu'à un maximum de 20 μg/kg/min. Les données hémodynamiques et l’asynchronisme ont été analysés par des mesures de pression ventriculaire et l’analyse de l’imagerie dynamique du compartiment sanguin. L’importante variabilité individuelle des sujets inclus dans notre cohorte empêche toute conclusion définitive sur la mesure de l’asynchronisme interventriculaire. Cependant, les différents niveaux de stress, même dans des intervalles rapprochés, ont démontré un effet significatif sur les paramètres hémodynamiques et l’asynchronisme. (Salimian et. al., J Nucl Cardiol., 2015) La troisième section vise à déterminer si l’estimation du mode de stimulation optimal effectuée au repos demeure le choix optimal lorsque le niveau d’activité cardiaque s’intensifie pour des sujets avec bloc auriculo-ventriculaire (AV) et fonction ventriculaire normale. Cinq chiens ont été soumis à une ablation du nœud AV et des sondes de stimulation ont été insérées dans l'oreillette droite pour la détection, l’apex du ventricule droit (VD) et une veine postérolatérale du VG pour la stimulation. Cinq modes de stimulation ont été utilisés : LV pur, biventriculaire (BiV) avec pré-activation de 20 ms du LV (LVRV20), BiV pur, BiV avec pré-activation de 20 ms du VD (RVLV20), VD pur. Des niveaux jusqu’à 20 μg/kg/min de dobutamine ont été atteints. Le stress a modifié l’étendue de l’asynchronisme de base et ce, pour tous les modes de stimulation. De plus, les effets physiologiques intrinsèques du stress permettent une évaluation plus précise de l’asynchronisme ventriculaire, diminuant la variabilité inter-sujet. Le mode de stimulation LVRV20 semble le mode optimal dans ce modèle, supportant l’utilisation de la stimulation bi-ventriculaire. / Assessment of ventricular mechanical dyssynchrony (MD) under stress has attracted a large amount of attention as a stronger predictor of response to cardiac resynchronization therapy (CRT) and as a parameter whose variation bears a greater relationship to clinical outcomes than resting-MD either in CRT candidates or another subset of patients. Several echocardiographic methods can be used to assess stress-MD. However, no standardized approach is currently used to explore stress-induced variations in inter- and intraventricular MD. This dissertation studies the importance of nuclear imaging techniques in assessing stress-induced MD variations by providing three different experimental canine models. The first chapter sought to examine the impacts of stress on the left ventricular (LV) synchrony with phase analysis of gated SPECT myocardial perfusion imaging (GMPS) within a normal canine cohort. Stress was induced by different levels of dobutamine infusion in six healthy subjects. Hemodynamic and LV MD parameters were assessed by LV pressure measurements and phase analysis of GMPS using commercially available QGS software and in-house MHI4MPI software with thickening- and displacement-based methodology. The increase of dobutamine level was shown to be in accordance with the improvement of LV functional capacity and reduction of MD parameters. MD analysis based on wall thickening was more robust and sensitive than the global wall displacement. (Salimian et. al., J Nucl Cardiol., 2014) The second chapter investigated the range of difference in inter- and intraventricular MD parameters from rest to various levels of stress in a dilated cardiomyopathy (DCM) and narrow QRS complex model. Ten large dogs were submitted to tachycardia-induced DCM by pacing the right ventricular apex for 3-4 weeks to reach a target ejection fraction of 35% or less. Stress was then induced by infusion of dobutamine up to a maximum of 20 μg/kg/min. Hemodynamic and MD data were analyzed by LV pressure measurements and gated-blood pool SPECT (GBPS) imaging. Individual differences in the magnitude and pattern of change in the various levels of stress precluded any definitive conclusion about interventricular MD. However, different levels of stress, even in close intervals, showed a significant positive impact on hemodynamic and intraventricular MD parameters. (Salimian et. al., J Nucl Cardiol., 2015) The third chapter sought to examine if the optimal pacing mode at rest could be the best one during the maximum stress level in terms of MD parameters in subjects with an atrioventricular (AV) block and normal function. Five dogs were submitted to AV node ablation and pacing leads were placed in the right atrium for sensing, in right ventricular (RV) apex, and in posterolateral LV vein for pacing in five modes of LV, biventricular (BiV) with 20 ms of LV pre-activation (LVRV20), BiV, BiV with 20 ms of RV pre-activation (RVLV20) and RV pacing. Stress was induced by dobutamine infusion up to a maximum of 20 μg/kg/min. Data analyses were the same as chapter one. Dobutamine stress changed the extent of resting-LV MD at all pacing modes. Intrinsic physiologic effects of stress resulted in more accurate MD assessment with lesser variability in subjects who underwent pacing. LVRV20 was the preferred site of stimulation in this model rather than single-site pacing.

The thesis deals with detection of T-wave alternans. The presence of T-wave in surface ECG is recognized as a marker of electrical instability of heart in stage his repolarization, arise increased risk of emergence ventricular fibrillation and sudden cardiac death. The goal of our project is familiarize with methods of detection T-wave alternans. In particular spectral method and spectral method which was realized in variant for running reading values in time (“sliding window”). To suggest a QRS complex detector, localize the T-wave and to make TWA detection using spectral method and modified spectral method. This project is to be made in C language in appropriate user interface.

This thesis deals with analysis of T-wave Alternans (TWA), periodical changes of T wave in ECG signal. Presence of these alternans may predict higher risk of sudden cardiac death. From the several possible ways of TWA classification, the training algorithms of self organizing maps are used in this thesis. Result of the thesis is a program, which in the first step detects QRS complexes in the signal. Then, in the next step, gained reference points are used for T-waves detection. Detected waves are represented by a vector of significant points, which is used as an input for artificial neural network. Final output of the program is a decision about presence of TWA in the signal and its rate.