A Novel Method For Irregular Heartbeat Identification

In ECG Signal Using Nonlinear Filtering and ANN

Mohammad Reza Balazadeh Bahar
#
, Hosein Balazadeh Bahar
#
, Manouchehr Bahrami
#
, Abbas Ali Hoseinpour Feizi
##

#
Department of Electronic, Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran.
m_bahar@live.com, hbbahar@tabrizu.ac.ir, mbahrami@tabrizu.ac.ir
##
Department of Hematology and Oncology, Tabriz Medical Sciences University, Tabriz, Iran.
hpourfeizi@tbzmed.ac.ir


AbstractThe Electrocardiogram (ECG) is an important method
of assessment for cardiac disease recognition, and its analysis is a
key task in the diagnosis and treatment of patients with cardiac
disease. ECG signal investigation is based on PQRST
partitioning and then the detection of possible abnormalities. In
this paper, a new method is proposed for R-peak and T-wave
recognition using nonlinear filtering. The proposed method
examined many types of healthy and abnormal ECG signals and
precisely identified R-peak and T-wave locations. A combination
of Artificial Neural Network (ANN) together with a
recommended filtering method resulted in a new efficient method
for cardiac disease recognition. ANN is trained with pseudo
normal and abnormal segments of ECG signals. The
recommended filter allocates R and T locations and by
accurately recalling ANN discriminates between healthy and
abnormal heartbeats. The designed filter and ANN precisely
identified Atrial Fibrillation (AF) and Unstable Angina (UA)
with inverse T-waves. Furthermore, the aforementioned method
seems to be developable for many types of irregular heartbeat
identification, and could be an advance tool for heartbeat
classification. The results verify that recommended method
discriminates healthy heartbeats with 100 % certainty. Also, the
achieved overall accuracy for heartbeat classification is 92.39 %.


Keywords Electrocardiogram, Artificial Neural Network,
Nonlinear filtering, Irregular heartbeat identification, Atrial
Fibrillation, Unstable Angina with inverse T-wave.

I. INTRODUCTION
Nowadays, electrocardiography is a common approach for
diagnosing cardiac diseases in medical centers. Obviously,
diagnosis of the electrocardiogram (ECG) signal alone is not
important. It depends on the accurate analysis of the signal by
a specialized physician and his / her previous experience [1,2].
Electronic and computer engineers intend to pave the way
in helping cardiologists in diagnose the illness. Using ANN
(Artificial Neural Network) based methods for ECG signal
analysis, classification and arrhythmia recognition [3-5] seems
to be a superior procedure. Although, there may be
uncertainties as to which considerations should be taken to
alleviate them. Additionally, ANN-based method may be
applied to ECG signals for adaptive noise removal [6]. In this
work, we propose a new precise method for cardiac disease
identification. The recommended approach consists of
nonlinear filtering and ANN. The present article begins with
introducing nonlinear filtering for ECG signal segmentation,
and then studying ANN with ECG signal abnormalities. The
resultant recalling ANN, diagnoses the irregular changes in
the ECG signal. Furthermore, the applied approach is capable
of classifying many types of healthy and irregular heartbeats.
In this article, we study Atrial Fibrillation (AF) and
Unstable Angina (UA) with inverse T-wave cases. AF is the
most common chronic arrhythmia associated with an adverse
prognosis. It is estimated that 2.2 million Americans have
intermittent or sustained AF. The incidence of AF increases
with advancing age. The clinical risk factors for AF include
advancing age, diabetes, hypertension, congestive heart failure,
rheumatic and non-rheumatic valve disease, and myocardial
infarction. The echocardiographic risk factors for non-
rheumatic AF include left atrial enlargement, increased left
ventricular wall thickness, and reduced left ventricular
fractional shortening. AF is an independent risk factor for
stroke, resulting in an approximate 3 to 5 fold increased risk.
Furthermore, whereas the attributable risks for most stroke
risk factors decline with advancing age, the attributable risks
for stroke associated with AF dramatically increase with age
[7].
Unstable angina annually accounts for more than 1 million
hospital admissions; 6 to 8 percent of patients with this
condition have nonfatal myocardial infarction, or die within
the first year after diagnosis. Various definitions of unstable
angina have been proposed, but in 1989 Braunwald devised a
classification system to ensure the uniformity of
categorization, as well as diagnostic and prognostic
information. This system is used to classify angina according
to the severity of the clinical manifestation, defined as acute
angina while at rest, subacute angina while at rest, or new
onset of accelerated angina; the clinical circumstances in
which unstable angina develops, defined as either angina in
the presence or absence of other conditions or angina within
two weeks after an acute myocardial infarction; and whether
or not electrocardiographic abnormalities are present [8].
Atrial Fibrillation is determined by abnormal R-R intervals
heartbeats and Unstable Angina at rest may lead to the
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development of inverse T-wave [9]. ANN can be trained
[10,11] with R-R intervals and normal and abnormal T-waves
to indicate Atrial Fibrillation and Unstable Angina with
inverse T-wave. The proposed method based on nonlinear
filtering and ANN seems to accurately detect Atrial
Fibrillation and Unstable Angina with inverse T-wave. Also,
joining nonlinear filtering and ANN may lead to a reduction in
errors in abnormalities recognition. Furthermore, the proposed
procedure seems to be developable for the recognition of
many other cardiac diseases and heartbeat classification.
The remainder of the article is organized as follows. In
section II we discuss the materials and methods utilized in this
paper. Section III describes the locating of ECG signal R-peak
and T-wave. Section IV explains Atrial Fibrillation
recognition, and section V explains Unstable Angina with
inverse T-wave identification. In Section VI the results are
demonstrated and the comparisons with prior works have been
made. Section VII discusses the results. Finally, the
conclusions are drawn in section VIII.
II. MATERIALS AND METHODS
The electrocardiogram (ECG) is the objective symbol of
cardiac electrical activities, which are reflected on the skin as
electrical potential changes. These signals are received by
metal electrodes connected to the body and rib cage, and are
amplified by a sensitive voltmeter called an
electrocardiograph. ECG derivations actually record the
instantaneous potential difference between electrodes, so the
electrocardiogram appears on a strip or screen of an
oscilloscope.
Upon electrocardiography, some data such as age, gender,
blood pressure, height, weight, signs and drugs should be
mentioned so that the interpretation of the electrocardiogram
is performed easily. Electrocardiography is especially useful
in diagnosing the disease which prevents the normal
performance of the heart, including disorders of the rate or
rhythm of the heart, conductive disorders, large size of the
cardiac chambers, existence of myocardial infarction and
disorders of electrolyte equivalence [1].
Electrocardiograms consist of the various parts of the
waves including P-wave, QRS complex, T-wave, ST segment
(part) and U wave (which usually indicates an unnatural state)
[1,2].
In Fig. 1, an example of a natural ECG signal is given, and
the designation of its different parts are indicated. The ST
segment continues from the end of the S wave through to the
beginning of T and indicates the initial phase of the ventricular
depolarization. The distance of PR includes the beginning of
the P wave through that of the R wave and indicates the time
necessary for passing the wave of electric stimulation from the
auricule through to the purkinje fibers. Under normal
circumstances the distance time of PR in adults is 0.12-0.2
second.
The measurement of the QRS Complex is accomplished
from the beginning of the Q wave or R wave (if there is no Q
wave) through to the end of the S wave and its duration is
normally between 0.04 0.1 second [1,12]. Although, these
amounts (rates) will change in patients.

Fig. 1 Natural ECG signal.

The article presents nonlinear filtering for R-peak and T-
wave recognition (Section III). The presented filtering
technique is an innovative method for ECG signal
segmentation. Indeed, the neural network is a calculative
model which is a directive graph consisting of nodes
representing units or neurons and internode connections.
Learning in a common neural network is conducted by
regulating the weights by a learning law. The network is
typically trained to complete an input model or to calculating
one function from its input. At the start of learning, through
thoroughly mistaken weights, the network performs un-
ideally when carrying out one of these functions. Finally, one
hopes that the network performs well through regulated
weights. The learning or novelty rules do not change unless
new things exist for learning [13,14]. The ANN model is
trained with pseudo abnormal R-R intervals for Atrial
Fibrillation recognition (Section IV). In addition, ANN model
are trained with upward and downward Gaussian functions as
psuedo normal and abnormal T-waves for Unstable Angina
with inverse T-wave recognition (Section V).
III. R-PEAK AND T-WAVE DETECTION IN ECG SIGNAL
A typical ECG signal has spectrum of 0 to 40 Hz.
Additionally, the P wave, QRS complex and T-wave have
particular PSD (Power Spectral Density) in the spectrum [15].
We utilize nonlinear filtering to detect ECG signal
components. By means of the proposed filtering method, R-
peak and T-wave location in the ECG signal will be acquired,
which facilitates further processing of the ECG signal. The
filtering block diagram for R-peak and T-wave indication is
illustrated in Fig. 2.




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Fig. 2 Overall ECG signal R-peak and T-wave locating filter.
Initially, the ECG signal is passed into a noise filter to
remove unwanted signals, together with electrical line effect.
In the second stage of Fig. 2, the signal is passed into a band
pass filter to determine the R-peak and T-wave locations. The
cut-off frequencies of the band pass filter are adjusted on a
particular spectrum to R-peak and T-wave recognition. The
low and high cut-off frequencies of the band pass filter for R-
peak detection are 50 Hz and 125 Hz, and for T-wave

detection are 30 Hz and 40 Hz. The ECG signal sampling rate
is 250 Hz. Experimental and simulation results verify
reliability of the designed band pass filters for detection of R-
peak and T-wave in normal and abnormal ECG signals. Also,
experimental results show that a third order Butterworth filter
is suitable for R-peak determination and a fourth order
Butterworth filter is suitable to determine T-waves. The
designed band pass filter transfer function for locating R-
peaks is defined by Equation 1.

The designed band pass filter
transfer function for T-wave locating is set out in Equation 2.

A1 A2.

A3.

1 B1.

B2.

B3.

B4.

A1 A2 A3
0.206572

0.413144

0.206572


B1 B2 B3 B4
0.905078

0.597907

0.290736

0.195815


(1)

C1 C2.

C3.

C4.

C5.

1 D1.

D2.

D3.

D4.

D5.

D6.

D7.

D8.

C1 C2 C3 C4 C5
0.000013

0.000053

0.000079

0.000053

0.000013


D1 D2 D3 D4 D5 D6 D7 D8
6.955312

21.823062

40.240556

47.639874

37.065778

18.515546

5.435714

0.719910


(2)


The next stages are added to create logical R and T-wave
indicators. The third stage in Fig. 2 provides the absolute
value of the signal which makes the overall filter nonlinear.
The absolute stage makes positive the signal values. This
stage facilitates construction of logical indicators for R-peak
and T-wave. In stage four, as illustrated in Fig. 2, a low pass
filter with 50 Hz cut-off frequency is utilized to determine
signal peaks. In stage five, the signal has become smoother.
The smoothed signal will lead to better comparison where less
glitches affect the logical output. The threshold generator
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stage in Fig. 2 computes the average of the samples in a signal
block. Finally, the comparator creates R-peak and T-wave
indicators. All samples in the signal block (output of the
smoothing stage) which are higher than threshold are assigned
one, otherwise they are assigned zero. Double construction
blocks of locating filters (Fig. 2), independently identify R-
peaks and T-waves. An example of R-peak and T-wave
indicators for Unstable Angina with inverse T-wave ECG
signal is illustrated in Fig. 3.

Fig. 3 R-peak and T-wave indicators for Unstable Angina with T-wave
inversion.

Utilizing the locating filter (Fig. 2), R-peak and T-wave
locations are successfully detected in Healthy, Unstable
Angina with inverse T-wave, ST elevated, Bradycardia and
Atrial Fibrillation ECG signals.
IV. ATRIAL FIBRILLATION
Atrial Fibrillation (AF), the most common arrhythmia
encountered in clinical practice, has a very complex and
incompletely understood pathophysiology with various
triggers and substrates interacting in multiple ways. Clinically,
AF is characterized by progression from paroxysmal to
persistent AF, failure to restore and maintain sinus rhythm,
but also in an increased risk of thrombogenesis and embolism
[16]. Results of various therapeutic interventions are often
disappointing, at least in part due to their empirical application.
Subsequently, the search for diagnostic tools to better
characterize the disease process in order then to better guide
therapeutic decisions has been advocated [17]. It is a common
observation that fibrillation waves of the surface ECG have
various appearances, ranging from fine to coarse, and from
disorganized to organized, and that the ventricular rate
response varies in a rather unpredictable fashion. Even though
the first ECG documentation of human AF was made by
Einthoven 100 years ago [18], it was only very recently that
ECG analysis of fibrillatory waves was suggested for
exploring AF pathophysiology and for predicting the patients
response to therapy [19,20].
An Atrial Fibrillation signal is passed into locating filtering
stages for the purpose of R-peak indication, and the result
obtained is demonstrated in Fig. 4.

Fig. 4 R-peak indication for Atrial Fibrillation signal.

It is obvious that the heart beat rate varies in time duration
for the AF case which is detected via the R indicator. For clear
comparison, a healthy heartbeat with R-peaks identified by the
proposed locating filter is demonstrated in Fig. 5. The healthy
heart beat has fixed R-R intervals, although it varies in AF.

Fig. 5 R-peak indication for Healthy signal.

In this paper, the neural network is employed for AF
recognition. Radial Basis Function Artificial Neural
Network (RBF-ANN) [10] is applied for arrhythmia Atrial
Fibrillation (AF) heart beat recognition. Initially, data is
prepared for ANN learning the purposes and then ANN
recalling process with unseen data [10,11] is carried out in the
following steps:



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1. Data Preparation Procedure
By applying the locating filter (Section III), the R-peak
location is detected for healthy and AF signals. Subsequently,
R-R intervals are determined and normalized.
2. ANN Learning
An RBF network with 10 inputs and 1 output is trained
with varying and non-varying R-R intervals. Stable R-R
interval indicates a healthy heartbeat and sets the ANN output
to 1. Variable R-R interval signifies AF and sets the ANN
output to -1.
3. ANN Recall
ANN is recalled with healthy and AF signals to determine
the irregular heartbeat. The sample results achieved for the
RBF network output using MATLAB are tabulated in Table 1.
As illustrated in Table 1, the output of ANN is positive and
near 1 for healthy subjects, and negative and close to -1 for
AF. The results obtained in Table 1 indicate that ANN
modeling combined with the recommend filtering approach,
accurately identify Atrial Fibrillation.
V. UNSTABLE ANGINA WITH INVERSE T-WAVE
Unstable angina (UA) is the clinical bridge between stable
angina and myocardial infarction (MI). Signs of the three
conditions often overlap, and 15% to 25% of patients will
have an MI within the first week after angina strikes. About
one-third of patients will have an MI within 3 months of the
angina attack. If an electrocardiogram has been recorded
during an episode of chest pain, the presence or absence of
transient ST-T abnormalities is noted [21]. (The presence of
such abnormalities is associated with more severe underlying
disease.)
The significance of the development of new T-wave
inversion was studied in patients with unstable angina. The
electrocardiograms during hospitalization in the coronary care
unit were analyzed for the occurrence of new T-wave
inversions greater than or equal to 2 mm, and correlated with
findings of a coronary angiography and at a follow-up stage.
Development of new T-wave inversion greater than or equal
to 2 mm in patients with unstable angina is predictive of
significant coronary artery stenosis, and identifies a subgroup
with poor prognosis when treated medically [9]. An example
of Unstable Angina with inverse T-wave ECG signal is shown
in Fig. 6.
Comparing Figures 1 and 6 show the changes in T-waves
and characteristics of ECG signals for Unstable Angina with
inverse T-wave. Our purpose in this work is to diagnose the
abovementioned changes and type of illness in people via
ANN. The utilized RBF network is able to study changes in T-
waves. Considering the importance of ST segment in ECG
signal, referring to reference [22], the diagnosis of this
segment and its changes can be studied with personal
computers.


Fig. 6 Unstable Angina with Inverse T-wave ECG signal.

Unstable Angina (UA) with inverse T-waves are identified
with a similar approach as explained in Section 4. Where,
initially data is prepared for ANN learning and then ANN the
recall process with unseen data [10,11] is carried out in the
following steps:
1. Data Preparation Procedure
By applying the locating filter (Section 3), the T-wave start
location is detected and samples saved for 0.4 second (100
samples) then samples are shifted to zero and normalized.
2. ANN Learning
An RBF network with 100 inputs and 1 output trained with
upward Gaussian functions as a normal T-wave and
downward Gaussian functions as an abnormal T-wave. The
output of ANN for a normal T-wave is 1 and for an abnormal
T-wave is -1. A sample of inverse T-wave, upward and
downward Gaussian functions is illustrated in Fig. 7.

Fig. 7 Inverse T-wave, upward and downward Gaussian functions.
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3.

ANN Recall
ANN is recalled with healthy and abnormal ECG signals
for determining the Inverse T-wave. The sample resu
lts
achieved from the RBF network output using MATLAB a
re
tabulated in Table 2. The Figures in Table 2 confir
m that the
output of ANN is positive and near 1 for healthy su
bjects and
negative and close to -1 for UA with inverse T-wave
s. Hence,
the obtained results show that the ANN model combin
ed with
the recommend locating filter accurately determines
Unstable
Angina with inverse T-wave.
VI.

RESULTS AND COMPARISONS WITH PRIOR WORKS

The recommended methods proposed in sections IV and V
are examined with normal and abnormal heartbeat sig
nals [23].
The achieved accuracy and precision for detection o
f the AF
cases and healthy heartbeats using recommended meth
od of
section 4 are demonstrated in Table 3.
The achieved accuracy and precision for detection of the
UA with inverse T-wave cases and healthy heartbeats using
recommended method of section V are demonstrated in Table
4.
As demonstrated in Tables 3 and 4, the recommended
method classifies healthy heartbeats in two cases with 100 %
accuracy. Also, the achieved accuracy for UA with inverse T-
wave cases is 94.59 % and for AF cases is 75 %. The results
prove that this method is capable of precise discrimination of
abnormal cases. The high accuracy is resulted for healthy and
UA with inverse T-wave cases.
The prior works which have been made for heartbeat
classification has an overall accuracy of 66.3 % to 77.4 % [24],
89.1 % [25] and 86.67 % [26]. Where, the achieved overall
accuracy using the proposed method is 92.39% and its higher
than prior works.


Table 1 RBF network output for Atrial Fibrillation and Healthy signals.









Table 2 RBF network output for UA with inverse T-wave and Healthy signals.
Samples 1 2 3 4 5
UA with inverse T-wave -

1

-0.6366

-0.2605

-0.9141

-0.8252

-0.6218

UA with inverse T-wave

-

2

-1.1329

-1.0232

-1.1102

-0.9529

-1.0787

UA with inverse T-wave - 3 -0.7502 -0.7531 -0.6029 -0.3868 -0.8907
UA with inverse T-wave - 4 -0.7849 -0.7446 -0.9576 -1.1538 -1.0671
Healthy - 1 0.9551 0.8465 0.9943 1.0805 0.9979
Healthy - 2 0.8383 0.7835 0.8314 0.7987 0.8379
Healthy -

3

1.0163

1.0118

0.9740

1.0165

1.0935

Healthy -

4

0.7842

0.8210

0.8190

0.7865

0.7457


Table 3 The accuracy and precision of proposed method for AF detection.
Case Accuracy Precision
Healthy

100 %

96.06 %

AF

75 %

54.66 %


Table 4 The accuracy and precision of proposed method for UA with inverse T-wave detection.
Case Accuracy Precision
Healthy

100 %

90.16 %

UA with inverse T-wave 94.59 % 83.32 %




Samples 1 2 3 4 5
AF - 1 -0.5940 -0.4678 -0.7242 -0.4500 -0.4971
Healthy -

1

0.8912

0.9275

0.9263

0.8236

0.7740

Healthy -

2

0.8301

0.8134

0.9536

0.9495

0.8002

Healthy -

3

0.9684

0.9854

0.9868

0.9812

0.9729

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VII.

DISCUSSION

The proposed method is examined on one AF case and 3
normal healthy subjects. The ANN output results were
negative and near -1 for AF case and positive and close to 1
for healthy subjects. Also, the proposed method is examined
on 4 UA with inverse T-wave cases and 4 normal healthy
subjects. The ANN output results were negative and near -1
for cases of UA with inverse T-waves and positive and near 1
for healthy subjects. The results achieved verify that the
recommended procedure is able to precisely and accurately
distinguish normal and abnormal heartbeats in two different
cases. Hence, we will be able to develop the proposed method
for the recognition other abnormal heartbeats. It is also
possible to train ANN with irregular parts of the ECG signal
for cardiac disease recognition. The recommended locating
filter indicates PQRST segments and recalling ANN results
indicate the healthiness rate.
VIII.

CONCLUSION

In this paper, we proposed a new method for R-peak and T-
wave recognition in ECG signals using a nonlinear filtering
technique. The approach used in this method is able to
accurately detect R-peaks and T-waves in normal and

abnormal ECG signals. The locating filter precisely detects R-
peaks and T-waves in Healthy, Unstable Angina with inverse
T-wave, ST elevated, Bradycardia and Atrial Fibrillation cases.
This method facilitates the classifying of different ECG
signals. Applying the ANN method for the detection of
heartbeat abnormalities and a combination of ANN with the
proposed filter creates an innovative method for cardiac
disease identification. The proposed method easily identifies
Atrial Fibrillation by introducing irregular heartbeat R-R
intervals into ANN. Additionally in this work, T-wave
inversion in Unstable Angina is recognized using the ANN
model. The results obtained indicate that ANN is capable of
precisely and accurately discriminating Unstable Angina with
inverse T-wave heartbeats from healthy heartbeats.
Furthermore, the procedure is developable for the
identification of many other irregular heartbeats. The
classification accuracies of proposed method are 100 %,
94.59 % and 75 % for Healthy, Unstable Angina with inverse
T-wave and AF cases. The results verify that recommended
method discriminates healthy heartbeats with 100 % certainty.
Also, the achieved overall accuracy is 92.39 %.
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http://ijetsp.info/article/IJETSPV1I203.pdf
International Journal of Emerging Trends in Signal Processing
ISSN(Online)2319-9784, Volume 1 ,Issue 2, January 2013
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