On-device Prior Knowledge Incorporated Learning for Personalized Atrial Fibrillation Detection

2021 ◽  
Vol 20 (5s) ◽  
pp. 1-25
Author(s):  
Zhenge Jia ◽  
Yiyu Shi ◽  
Samir Saba ◽  
Jingtong Hu

Atrial Fibrillation (AF), one of the most prevalent arrhythmias, is an irregular heart-rate rhythm causing serious health problems such as stroke and heart failure. Deep learning based methods have been exploited to provide an end-to-end AF detection by automatically extracting features from Electrocardiogram (ECG) signal and achieve state-of-the-art results. However, the pre-trained models cannot adapt to each patient’s rhythm due to the high variability of rhythm characteristics among different patients. Furthermore, the deep models are prone to overfitting when fine-tuned on the limited ECG of the specific patient for personalization. In this work, we propose a prior knowledge incorporated learning method to effectively personalize the model for patient-specific AF detection and alleviate the overfitting problems. To be more specific, a prior-incorporated portion importance mechanism is proposed to enforce the network to learn to focus on the targeted portion of the ECG, following the cardiologists’ domain knowledge in recognizing AF. A prior-incorporated regularization mechanism is further devised to alleviate model overfitting during personalization by regularizing the fine-tuning process with feature priors on typical AF rhythms of the general population. The proposed personalization method embeds the well-defined prior knowledge in diagnosing AF rhythm into the personalization procedure, which improves the personalized deep model and eliminates the workload of manually adjusting parameters in conventional AF detection method. The prior knowledge incorporated personalization is feasibly and semi-automatically conducted on the edge, device of the cardiac monitoring system. We report an average AF detection accuracy of 95.3% of three deep models over patients, surpassing the pre-trained model by a large margin of 11.5% and the fine-tuning strategy by 8.6%.

2019 ◽  
Vol 30 (1) ◽  
pp. 45-58 ◽  
Author(s):  
Jeyson A. Castillo ◽  
Yenny C. Granados ◽  
Carlos Augusto Fajardo Ariza

Atrial Fibrillation (AF) is the most common cardiac arrhythmia worldwide. It is associated with reduced quality of life and increases the risk of stroke and myocardial infarction. Unfortunately, many cases of AF are asymptomatic and undiagnosed, which increases the risk for the patients. Due to its paroxysmal nature, the detection of AF requires the evaluation, by a cardiologist, of long-term ECG signals. In Colombia, it is difficult to have access to an early diagnosis of AF because of the associated costs to the detection and the geographical distribution of cardiologists. This work is part of a macro project that aims to develop a specific-patient portable device for the detection of AF. This device will be based on a Convolutional Neural Network (CNN). We aim to find a suitable CNN model, which later could be implemented in hardware. Diverse techniques were applied to improve the answer regarding accuracy, sensitivity, specificity, and precision. The final model achieves an accuracy of , a specificity of , a sensitivity of  and a precision of . During the development of the model, the computational cost and memory resources were taking into account in order to obtain an efficient hardware model in a future implementation of the device.


Author(s):  
Michael E. Field ◽  
DaJuanicia N. Holmes ◽  
Richard L. Page ◽  
Gregg C. Fonarow ◽  
Roland A. Matsouaka ◽  
...  

Background - Antiarrhythmic drug (AAD) therapy for atrial fibrillation (AF) can be associated with both proarrhythmic and noncardiovascular toxicities. Practice guidelines recommend tailored AAD therapy for AF based on patient-specific characteristics, such as coronary artery disease and heart failure, to minimize adverse events. However, current prescription patterns for specific AADs and the degree to which these guidelines are followed in practice are unknown. Methods - Patients enrolled in the Get With The Guidelines-AFIB registry with a primary diagnosis of AF discharged on an AAD between 1/2014 and 11/2018 were included. We analyzed rates of prescription of each AAD in several subgroups including those without structural heart disease. We classified AAD use as guideline-concordant or non-guideline concordant based on six criteria derived from the AHA/ACC/HRS AF Guidelines. Guideline concordance for amiodarone was not considered applicable, since its use is not specifically contraindicated in the guidelines for reasons such as structural heart disease or renal function. We analyzed guideline-concordant AAD use by specific patient and hospital characteristics, and regional and temporal trends. Results - Among 21,921 patients from 123 sites, the median age was 69 years, 46% female, and 51% had paroxysmal AF. The most commonly prescribed AAD was amiodarone (38%). Sotalol (23.2%) and dofetilide (19.2%) were each more commonly prescribed than either flecainide (9.8%) or propafenone (4.8%). Overall guideline-concordant AAD prescription at discharge was 84%. Guideline-concordant AAD use by drug was as follows: dofetilide 93%, sotalol 66%, flecainide 68%, propafenone 48%, and dronedarone 80%. There was variability in rate of guideline-concordant AAD use by hospital and geographic region. Conclusions - Amiodarone remains the most commonly prescribed AAD for AF followed by sotalol and dofetilide. Rates of guideline-concordant AAD use were high and there was significant variability by specific drugs, hospitals, and regions, highlighting opportunities for additional quality improvement.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Silvain ◽  
F Hidden-Lucet ◽  
C Maupain ◽  
S Dinanian ◽  
...  

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur


2021 ◽  
Vol 11 (13) ◽  
pp. 5908
Author(s):  
Raquel Cervigón ◽  
Brian McGinley ◽  
Darren Craven ◽  
Martin Glavin ◽  
Edward Jones

Although Atrial Fibrillation (AF) is the most frequent cause of cardioembolic stroke, the arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent. Automated detection of AF in ECG signals is important for patients with implantable cardiac devices, pacemakers or Holter systems. Such resource-constrained systems often operate by transmitting signals to a central server where diagnostic decisions are made. In this context, ECG signal compression is being increasingly investigated and employed to increase battery life, and hence the storage and transmission efficiency of these devices. At the same time, the diagnostic accuracy of AF detection must be preserved. This paper investigates the effects of ECG signal compression on an entropy-based AF detection algorithm that monitors R-R interval regularity. The compression and AF detection algorithms were applied to signals from the MIT-BIH AF database. The accuracy of AF detection on reconstructed signals is evaluated under varying degrees of compression using the state-of-the-art Set Partitioning In Hierarchical Trees (SPIHT) compression algorithm. Results demonstrate that compression ratios (CR) of up to 90 can be obtained while maintaining a detection accuracy, expressed in terms of the area under the receiver operating characteristic curve, of at least 0.9. This highlights the potential for significant energy savings on devices that transmit/store ECG signals for AF detection applications, while preserving the diagnostic integrity of the signals, and hence the detection performance.


2020 ◽  
Vol 10 (11) ◽  
pp. 3833 ◽  
Author(s):  
Haidar Almubarak ◽  
Yakoub Bazi ◽  
Naif Alajlan

In this paper, we propose a method for localizing the optic nerve head and segmenting the optic disc/cup in retinal fundus images. The approach is based on a simple two-stage Mask-RCNN compared to sophisticated methods that represent the state-of-the-art in the literature. In the first stage, we detect and crop around the optic nerve head then feed the cropped image as input for the second stage. The second stage network is trained using a weighted loss to produce the final segmentation. To further improve the detection in the first stage, we propose a new fine-tuning strategy by combining the cropping output of the first stage with the original training image to train a new detection network using different scales for the region proposal network anchors. We evaluate the method on Retinal Fundus Images for Glaucoma Analysis (REFUGE), Magrabi, and MESSIDOR datasets. We used the REFUGE training subset to train the models in the proposed method. Our method achieved 0.0430 mean absolute error in the vertical cup-to-disc ratio (MAE vCDR) on the REFUGE test set compared to 0.0414 obtained using complex and multiple ensemble networks methods. The models trained with the proposed method transfer well to datasets outside REFUGE, achieving a MAE vCDR of 0.0785 and 0.077 on MESSIDOR and Magrabi datasets, respectively, without being retrained. In terms of detection accuracy, the proposed new fine-tuning strategy improved the detection rate from 96.7% to 98.04% on MESSIDOR and from 93.6% to 100% on Magrabi datasets compared to the reported detection rates in the literature.


Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S62
Author(s):  
Matthew R. Reynolds ◽  
Candace L. Gunnarsson ◽  
Michael P. Ryan ◽  
Sarah Rosemas ◽  
Paul D. Ziegler ◽  
...  

2018 ◽  
Vol 71 (1) ◽  
pp. 93-102 ◽  
Author(s):  
Jennifer Wiley ◽  
Tim George ◽  
Keith Rayner

Two experiments investigated the effects of domain knowledge on the resolution of ambiguous words with dominant meanings related to baseball. When placed in a sentence context that strongly biased toward the non-baseball meaning (positive evidence), or excluded the baseball meaning (negative evidence), baseball experts had more difficulty than non-experts resolving the ambiguity. Sentence contexts containing positive evidence supported earlier resolution than did the negative evidence condition for both experts and non-experts. These experiments extend prior findings, and can be seen as support for the reordered access model of lexical access, where both prior knowledge and discourse context influence the availability of word meanings.


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