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Deep learning (DL) has been introduced in automatic heart-abnormality classification using ECG signals, while its application in practical medical procedures is limited. A systematic review is performed from perspectives of the ECG database, preprocessing, DL methodology, evaluation paradigm, performance metric, and code availability to identify research trends, challenges, and opportunities for DL-based ECG arrhythmia classification. Specifically, 368 studies meeting the eligibility criteria are included. A total of 223 (61%) studies use MIT-BIH Arrhythmia Database to design DL models. A total of 138 (38%) studies considered removing noise or artifacts in ECG signals, and 102 (28%) studies performed data augmentation to extend the minority arrhythmia categories. Convolutional neural networks are the dominant models (58.7%, 216) used in the reviewed studies while growing studies have integrated multiple DL structures in recent years. A total of 319 (86.7%) and 38 (10.3%) studies explicitly mention their evaluation paradigms, i.e., intra- and inter-patient paradigms, respectively, where notable performance degradation is observed in the inter-patient paradigm. Compared to the overall accuracy, the average F 1 score, sensitivity, and precision are significantly lower in the selected studies. To implement the DL-based ECG classification in real clinical scenarios, leveraging diverse ECG databases, designing advanced denoising and data augmentation techniques, integrating novel DL models, and deeper investigation in the inter-patient paradigm could be future research opportunities. [ABSTRACT FROM AUTHOR]

An automatic electrocardiogram (ECG) myocardial infarction detection system needs to satisfy several requirements to be efficient in real-world practice. These requirements, such as reliability, less complexity, and high performance in decision-making, remain very important in a realistic clinical environment. In this study, we investigated an automatic ECG myocardial infarction detection system and presented a new approach to evaluate its robustness and durability performance in classifying the myocardial infarction (with no feature extraction) under different noise types. We employed three well-known supervised machine learning models: support vector machine (SVM), k-nearest neighbors (KNN), and random forest (RF), and tested the performance and robustness of these techniques in classifying normal (NOR) and myocardial infarction (MI) using real ECG records from the PTB database after normalization and segmentation of the data, with a suggested inter-patient paradigm separation as well as noise from the MIT-BIH noise stress test database (NSTDB). Finally, we measured four metrics: accuracy, precision, recall, and F1-score. The simulation revealed that all of the models performed well, with values of over 0.50 at lower SNR levels, in terms of all the metrics investigated against different types of noise, indicating that they are encouraging and acceptable under extreme noise situations are are thus considered sustainable and robust models for specific forms of noise. All of the methods tested could be used as ECG myocardial infarction detection tools in real-world practice under challenging circumstances. [ABSTRACT FROM AUTHOR]

Deep learning (DL) has been introduced in automatic heart-abnormality classification using ECG signals, while its application in practical medical procedures is limited. A systematic review is performed from perspectives of the ECG database, preprocessing, DL methodology, evaluation paradigm, performance metric, and code availability to identify research trends, challenges, and opportunities for DL-based ECG arrhythmia classification. Specifically, 368 studies meeting the eligibility criteria are included. A total of 223 (61%) studies use MIT-BIH Arrhythmia Database to design DL models. A total of 138 (38%) studies considered removing noise or artifacts in ECG signals, and 102 (28%) studies performed data augmentation to extend the minority arrhythmia categories. Convolutional neural networks are the dominant models (58.7%, 216) used in the reviewed studies while growing studies have integrated multiple DL structures in recent years. A total of 319 (86.7%) and 38 (10.3%) studies explicitly mention their evaluation paradigms, i.e., intra- and inter-patient paradigms, respectively, where notable performance degradation is observed in the inter-patient paradigm. Compared to the overall accuracy, the average F1 score, sensitivity, and precision are significantly lower in the selected studies. To implement the DL-based ECG classification in real clinical scenarios, leveraging diverse ECG databases, designing advanced denoising and data augmentation techniques, integrating novel DL models, and deeper investigation in the inter-patient paradigm could be future research opportunities.

Monitoring single-channel EEG is a promising home-based approach for insomnia identification. Currently, many automatic sleep stage scoring approaches based on single-channel EEG have been developed, whereas few studies research on automatic insomnia identification based on single-channel EEG labelled with sleep stage annotations. In this paper, we propose a one-dimensional convolutional neural network (1D-CNN) model for automatic insomnia identification based on single-channel EEG labelled with sleep stage annotations, and further investigate the identification performance based on different sleep stages EEG epochs. Single-channel EEG on 9 insomnia patients and 9 healthy subjects was used in this study. We constructed 4 subdatasets from EEG epochs based on the sleep stage annotations: All sleep stage dataset (ALL-DS), REM sleep stage dataset (REM-DS), light sleep stage dataset (LSS-DS), and SWS sleep stage dataset (SWS-DS). Subsequently, 4 subdatasets were fed into our 1D-CNN. We conducted experiments under intra-patient and inter-patient paradigms, respectively. Our experiments demonstrated that our 1D-CNN leveraging 3 subdatasets composed of REM, LSS and SWS epochs, respectively, achieved higher average accuracies in comparison with baseline methods under both intra-patient and inter-patient paradigms. The experimental results also indicated that amongst all the sleep stages, 1D-CNN leveraging REM and SWS epochs exhibited the best insomnia identification average accuracies in intra-patient paradigm, which are 98.98% and 99.16% respectively, whereas no statistically significant difference was found in inter-patient paradigm. For automatic insomnia identification based on single-channel EEG labelled with sleep stage annotations, 1D-CNN model introduced in this paper could achieve superior performance than traditional methods.

• The feature extraction method based on MI detection performing a novel combination of global energy entropy features based on MODWPT and local morphological features is proposed. • The method of energy entropy based on MODWPT not only enlarges the local characteristics via time-frequency analysis but also captures the small and short changes of 12 leads ECG based on the probability distribution of energy. • Automated detection method has the characteristic of interpretability according with diagnostic logic and strategy of clinician and specific change of ECG for MI. • The proposed work has more vital clinical significance based upon inter-patient paradigm. • The quantization method has achieved superior results with few features compared to other detection methods. The 12 leads electrocardiogram (ECG) is an effective tool to diagnose myocardial infarction (MI) on account of its inexpensive, noninvasive and convenient. Many methodologies have been widely adopted to detect it. However, much existing method did not integrate with diagnostic logic of clinician and practical application. The aim of the paper is to provide an automated interpretable detection method of myocardial infarction. The paper presents a novel method fusing energy entropy and morphological features for MI detection via 12 leads ECG. Specifically, ECG signals are firstly decomposed by maximal overlap discrete wavelet packet transform (MODWPT), then energy entropy is calculated from the decomposed coefficients as global features. Area, kurtosis coefficient, skewness coefficient and standard deviation extracted from QRS wave and ST-T segment of ECG beat are computed as local morphological features. Combining global features based on record and local features based on beat for single lead, all the 12 leads features are fused as the ultimate feature vector. What's more, different methods including principal component analysis (PCA), linear discriminant analysis (LDA) and locality preserving projection (LPP) are employed to reduce the computational complexity and redundant information. Meanwhile, principal component features are ranked by F-value. To evaluate the proposed method, PTB (Physikalisch-Technische Bundesanstalt) database and inter-patient paradigm are employed. Compared with different algorithms, support vector machine (SVM) using radial basis kernel function combined with 10-fold cross validation achieves the best average performance with accuracy of 99.81%, sensitivity of 99.56%, precision of 99.74% and F1 of 99.70% based on 18 features in the intra-patient paradigm. By contrast, the accuracy is 92.69% with only 22 features for the inter-patient paradigm. The experimental results present a superior performance compared to the state-of-the-art method. Meanwhile, above approach has the characteristic of interpretability according with diagnostic logic and strategy of clinician and specific change of ECG for MI. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death worldwide. Immediate and accurate diagnoses of cardiovascular disease are essential for saving lives. Although most of the previously reported works have tried to classify heartbeats accurately based on the intra-patient paradigm, they suffer from category imbalance issues since abnormal heartbeats appear much less regularly than normal heartbeats. Furthermore, most existing methods rely on data preprocessing steps, such as noise removal and R-peak location. In this study, we present a robust classification system using a multilevel discrete wavelet transform densely network (MDD-Net) for the accurate detection of normal, coronary artery disease (CAD), myocardial infarction (MI) and congestive heart failure (CHF). First, the raw ECG signals from different databases are divided into same-size segments using an original adaptive sample frequency segmentation algorithm (ASFS). Then, the fusion features are extracted from the MDD-Net to achieve great classification performance. We evaluated the proposed method considering the intra-patient and inter-patient paradigms. The average accuracy, positive predictive value, sensitivity and specificity were 99.74%, 99.09%, 98.67% and 99.83%, respectively, under the intra-patient paradigm, and 96.92%, 92.17%, 89.18% and 97.77%, respectively, under the inter-patient paradigm. Moreover, the experimental results demonstrate that our model is robust to noise and class imbalance issues.

The automatic diagnosis of arrhythmia using machine learning has been a hot topic and extensively researched recently. A common problem is class imbalance that could make the deep learning models easily trapped into biased learning towards the majority class while ignoring rare classes during reasoning. When conducting inter-patient experiments, the inherent individual difference makes the condition even worse. Current deep learning methods generally take elaborate data modification strategies like data augmentation that complicate the training process. This paper, however, presents a special Hybrid Convolutional Transformer Network (HCTNet) that could effectively extract decisive patterns by drawing on doctors' diagnosis experience in structure design. Meanwhile, a novel logit adjusted loss is applied to enlarge the pairwise margin between different classes so that the HCTNet could be highly sensitive to rare anomalies. In the experiments, the proposed method has outperformed most state-of-the-arts on the benchmark of the MIT-BIH database: the F1 scores for the three primary arrhythmias (N, S, V) are 97.5%, 61.5%, and 88.3%, respectively under the inter-patient paradigm. • A novel Hybrid Convolutional Transformer Network is proposed to classify arrhythmias. • The structure of HCTNet is designed following the diagnosis process of human doctors. • The HCTNet computes efficiently using raw time-series ECGs without transformation. • A logit adjusted loss is adopted to enhance the model's sensitivity to rare classes. • The HCTNet outperforms many state-of-the-arts under intra-/inter-patient paradigms. [ABSTRACT FROM AUTHOR]

The new advances in multiple types of devices and machine learning models provide opportunities for practical automatic computer-aided diagnosis (CAD) systems for ECG classification methods to be practicable in an actual clinical environment. This imposes the requirements for the ECG arrhythmia classification methods that are inter-patient. We aim in this paper to design and investigate an automatic classification system using a new comprehensive ECG database inter-patient paradigm separation to improve the minority arrhythmical classes detection without performing any features extraction. We investigated four supervised machine learning models: support vector machine (SVM), k-nearest neighbors (KNN), Random Forest (RF), and the ensemble of these three methods. We test the performance of these techniques in classifying: Normal beat (NOR), Left Bundle Branch Block Beat (LBBB), Right Bundle Branch Block Beat (RBBB), Premature Atrial Contraction (PAC), and Premature Ventricular Contraction (PVC), using inter-patient real ECG records from MIT-DB after segmentation and normalization of the data, and measuring four metrics: accuracy, precision, recall, and f1-score. The experimental results emphasized that with applying no complicated data pre-processing or feature engineering methods, the SVM classifier outperforms the other methods using our proposed inter-patient paradigm, in terms of all metrics used in experiments, achieving an accuracy of 0.83 and in terms of computational cost, which remains a very important factor in implementing classification models for ECG arrhythmia. This method is more realistic in a clinical environment, where varieties of ECG signals are collected from different patients. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death worldwide. Immediate and accurate diagnoses of cardiovascular disease are essential for saving lives. Although most of the previously reported works have tried to classify heartbeats accurately based on the intra-patient paradigm, they suffer from category imbalance issues since abnormal heartbeats appear much less regularly than normal heartbeats. Furthermore, most existing methods rely on data preprocessing steps, such as noise removal and R-peak location. In this study, we present a robust classification system using a multilevel discrete wavelet transform densely network (MDD-Net) for the accurate detection of normal, coronary artery disease (CAD), myocardial infarction (MI) and congestive heart failure (CHF). First, the raw ECG signals from different databases are divided into same-size segments using an original adaptive sample frequency segmentation algorithm (ASFS). Then, the fusion features are extracted from the MDD-Net to achieve great classification performance. We evaluated the proposed method considering the intra-patient and inter-patient paradigms. The average accuracy, positive predictive value, sensitivity and specificity were 99.74%, 99.09%, 98.67% and 99.83%, respectively, under the intra-patient paradigm, and 96.92%, 92.17%, 89.18% and 97.77%, respectively, under the inter-patient paradigm. Moreover, the experimental results demonstrate that our model is robust to noise and class imbalance issues. [ABSTRACT FROM AUTHOR]