Automatic Real Time Detection of Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Timely diagnosis of the arrhythmia, particularly transient episodes, can be difficult since patients may be asymptomatic. In this study, we describe a robust algorithm for automatic detection of AF based on the randomness, variability and complexity of the heart beat interval (RR) time series. Specifically, we employ a new statistic, the Turning Points Ratio, in combination with the Root Mean Square of Successive RR Differences and Shannon Entropy to characterize this arrhythmia. The detection algorithm was tested on two databases, namely the MIT-BIH Atrial Fibrillation Database and the MIT-BIH Arrhythmia Database. These databases contain several long RR interval series from a multitude of patients with and without AF and some of the data contain various forms of ectopic beats. Using thresholds and data segment lengths determined by Receiver Operating Characteristic (ROC) curves we achieved a high sensitivity and specificity (94.4% and 95.1%, respectively, for the MIT-BIH Atrial Fibrillation Database). The algorithm performed well even when tested against AF mixed with several other potentially confounding arrhythmias in the MIT-BIH Arrhythmia Database (Sensitivity = 90.2%, Specificity = 91.2%).

[1]  L Glass,et al.  Automatic detection of atrial fibrillation using the coefficient of variation and density histograms of RR and ΔRR intervals , 2001, Medical and Biological Engineering and Computing.

[2]  P. Wolf,et al.  Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. , 1991, Stroke.

[3]  A. Oto,et al.  Prediction of atrial fibrillation recurrence after cardioversion by P wave signal-averaged electrocardiography. , 1999, International journal of cardiology.

[4]  A. Belanger,et al.  The Framingham study. , 1976, British medical journal.

[5]  D. Levy,et al.  Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. , 1998, Circulation.

[6]  S. Connolly,et al.  Follow-up of atrial fibrillation: The initial experience of the Canadian Registry of Atrial Fibrillation. , 1996, European heart journal.

[7]  Robert Olszewski,et al.  [Detection of patients at risk for paroxysmal atrial fibrillation (PAF) by signal averaged P wave, standard ECG and echocardiography]. , 2006, Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego.

[8]  Shantanu Sarkar,et al.  A Detector for a Chronic Implantable Atrial Tachyarrhythmia Monitor , 2008, IEEE Transactions on Biomedical Engineering.

[9]  C. Israel,et al.  Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. , 2004, Journal of the American College of Cardiology.

[10]  David Newman,et al.  New-Onset Atrial Fibrillation : Sex Differences in Presentation, Treatment, and Outcome , 2001 .

[11]  François Portet,et al.  P wave detector with PP rhythm tracking: evaluation in different arrhythmia contexts , 2008, Physiological measurement.

[12]  A. Torbicki,et al.  Detection of patients at risk for recurrence of atrial fibrillation after successful electrical cardioversion by signal-averaged P-wave ECG. , 1997, International journal of cardiology.

[13]  A J Camm,et al.  Identification of Atrial Fibrillation Episodes in Ambulatory Electrocardiographic Recordings: Validation of a Method for Obtaining Labeled R‐R Interval Files , 1995, Pacing and clinical electrophysiology : PACE.

[14]  R. Page,et al.  Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. , 1994, Circulation.

[15]  C. Israel,et al.  Prediction of early recurrence of atrial fibrillation after external cardioversion by means of P wave signal-averaged electrocardiogram , 2003, Zeitschrift für Kardiologie.

[16]  A. Hofman,et al.  Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. , 2006, European heart journal.

[17]  A. Antoniadis,et al.  High Accuracy of Automatic Detection of Atrial Fibrillation Using Wavelet Transform of Heart Rate Intervals , 2002, Pacing and clinical electrophysiology : PACE.

[18]  I. Dotsinsky Atrial wave detection algorithm for discovery of some rhythm abnormalities , 2007, Physiological measurement.

[19]  D Brodnick,et al.  Review of methods to predict and detect atrial fibrillation in post-cardiac surgery patients. , 1999, Journal of electrocardiology.

[20]  P. Defaye,et al.  Prevalence of supraventricular arrhythmias from the automated analysis of data stored in the DDD pacemakers of 617 patients: the AIDA study , 1998, Pacing and clinical electrophysiology : PACE.

[21]  L. Clavier,et al.  Automatic P-wave analysis of patients prone to atrial fibrillation , 2006, Medical and Biological Engineering and Computing.

[22]  Amanda Neil,et al.  Cardiac Event Recorders Yield More Diagnoses and Are More Cost-effective than 48-Hour Holter Monitoring in Patients with Palpitations: A Controlled Clinical Trial , 1996, Annals of Internal Medicine.

[23]  M Fukunami,et al.  Detection of Patients at Risk for Paroxysmal Atrial Fibrillation During Sinus Rhythm by P Wave‐Triggered Signal‐Averaged Electrocardiogram , 1991, Circulation.

[24]  J. Rawles,et al.  Is the pulse in atrial fibrillation irregularly irregular? , 1986, British heart journal.

[25]  Jeff Walden,et al.  Ventricular response in atrial fibrillation: random or deterministic? , 1999, American journal of physiology. Heart and circulatory physiology.

[26]  Jeffrey M. Hausdorff,et al.  Physionet: Components of a New Research Resource for Complex Physiologic Signals". Circu-lation Vol , 2000 .

[27]  Leon Glass,et al.  A method for detection of atrial fibrillation using RR intervals , 2000, Computers in Cardiology 2000. Vol.27 (Cat. 00CH37163).

[28]  R. Goldberg To the Framingham data, turn, turn, turn. , 2009, Circulation.

[29]  Frédéric Costes,et al.  Frequent and Prolonged Asymptomatic Episodes of Paroxysmal Atrial Fibrillation Revealed by Automatic Long‐Term Event Recorders in Patients with a Negative 24‐Hour Holter , 2002, Pacing and clinical electrophysiology : PACE.