Automatic estimation of the correlation dimension for the analysis of electrocardiograms

The main purpose of the present work is the definition of a fully automatic procedure for correlation dimension (D₂) estimation. In the first part, the procedure for the estimation of the correlation dimension (D₂) is proposed and tested on various types of mathematical models: chaotic (Lorenz and Henon models), periodical (sinusoidal waves) and stochastic (Gaussian and uniform noise). In all cases, accurate D₂ estimates were obtained. The procedure can detect the presence of multiple scaling regions in the correlation integral function. The connection between the presence of multiple scaling regions and multiple dynamic activities cooperating in a system is investigated through the study of composite time series. In the second part of the paper, the proposed algorithm is applied to the study of cardiac electrical activity through the analysis of electrocardiographic signals (ECG) obtained from the commercially available MIT-BIH ECG arrhythmia database. Three groups of ECG signals have been considered: the ECGs of normal subjects and ECGs of subjects with atrial fibrillation and with premature ventricular contraction. D₂ estimates are computed on single ECG intervals (static analysis) of appropriate duration, striking a balance between stationarity requisites and accurate computation requirements. In addition, D₂ temporal variability is studied by analyzing consecutive intervals of ECG tracings (dynamic analysis). The procedure reveals the presence of multiple scaling regions in many ECG signals, and the D₂ temporal variability differs in the three ECG groups considered; it is greater in the case of atrial fibrillation than in normal sinus rhythms. This study points out the importance of considering both the static and dynamic D₂ analysis for a more complete study of the system under analysis. While the static analysis visualizes the underlying heart activity, dynamic D₂ analysis insights the time evolution of the underlying system. Received: 11 April 1997 / Accepted in revised form: 19 March 1999     

80例急性心肌梗死患者心电监护及护理

目的总结急性心肌梗死患者心电监护及护理经验。方法对本院性心肌梗死患者及时进行心电监护,对出现的心律失常者进行对症处理。结果本组80例患者中出现心律失常55例,其中室性心律失常48例,临床治愈45例;出现心室颤动7例,4例及时电复律转为窦性心律,3例抢救无效死亡。本组心律失常均发生在心肌梗死后1周内,尤其是发病24小时内,出现最多。结论心律失常是心肌梗死患者常见的并发症,也是患者死亡的主要原因,持续心电监护对患者心律失常的及时发现、明确诊断、指导抢救有重要意义。     

心肌细胞自发性搏动节律的分岔和混沌现象

心脏的节律是复杂的、非线性的;其节律复杂性的起源是多层次的。实验观察了心肌细胞自发性搏动节律的模式,以及改变细胞间耦合强度时节律的转化规律。表明在以正常灌流液灌流状态下,心肌细胞表现为多种不同的节律模式,可以是周期的,也可以是非周期的。当细胞间耦合强度下降时,心肌细胞节律发生转化,并经倍周期分岔进入混沌节律。实验结果有助于更好地理解心脏节律复杂性的起源。     

Treatment of Cardiac Arrhythmias with Synchronized Electrical Counter-shock

Synchronized electrical countershock is an intriguing new method for the treatment of ectopic tachycardias. The authors applied this treatment to 20 patients with chronic atrial fibrillation and, in 17 patients, sinus rhythm was restored immediately. An additional four patients with atrial flutter were successfully converted to sinus rhythm. One patient developed a hemiplegia two weeks after cardioversion. No other untoward side effects were observed. In two patients with ventricular fibrillation electrical countershock terminated the arrhythmia. After successful cardioversion of atrial fibrillation, a maintenance dose of quinidine is given to help maintain sinus rhythm. In spite of this precaution, one-half of the patients reverted to atrial fibrillation within a month. The quinidine was administered for two to three days in advance of cardioversion; on this regimen, 10 of 34 patients reverted to sinus rhythm on quinidine alone and did not require countershock. The exact place of this treatment of cardiac arrhythmias has not yet been clearly defined.     

Immediate Effects of Intravenous Verapamil in Cardiac Arrhythmias

Verapamil was administered by intravenous injection to 181 patients with various cardiac arrhythmias. The automaticity of the cardiac pacemaker was slowed in sinus, idionodal, and idioventricular tachycardia. In atrial fibrillation the drug usually slowed the ventricular response and often made it regular. In some cases atrial flutter was converted to sinus rhythm, the ventricular response being reduced in the remainder. Conversion of paroxysmal supraventricular tachycardia to sinus rhythm was consistently achieved. A favourable response occurred in four patients in whom arrhythmias were associated with pre-excitation syndromes. There were no adverse clinical side effects.     

Analysis of ECG in ventricular fibrillation in man and animals based on chaos theory

The methods of the chaos theory were used to estimate the degree of irregularity of ventricular fibrillation in human and experimental animals. To verify the hypothesis that the degree of chaos depends on the species of the living organisms, the parameters characterizing the degrees of irregularity of ventricular fibrillation were estimated and compared. The comparative analysis was performed using 32 fragments of electrocardiographic records from five patients with sudden ventricular fibrillation bouts and 215 episodes of induced fibrillation in 17 animals. It was shown that fibrillation in human and animals has a different degree of regularity and different values of the chaotic component. The highest values of chaos were recorded in dogs, the lowest degree of chaos was observed in human. Rabbits and rats are intermediate, between dogs and humans. The fractuality of the structure-function organization of myocardium is discussed.     

Algorithmic sequential decision-making in the frequency domain for life threatening ventricular arrhythmias and imitative artefacts: a diagnostic system

A preliminary study to approach the problem of reliably detecting life threatening ventricular arrhythmias in real time is described. An algorithm (DIAGNOSIS) has been developed in order to classify ECG signal records on the basis of the computation of four simple parameters calculated from a representation in the frequency domain. This algorithm uses a set or rules constituting an operative classification scheme based on the comparison of the parameters with a set of pre-established thresholds. This allows us to differentiate four general categories: ventricular fibrillation-flutter, ventricular rhythms, imitative artefacts and predominant sinus rhythm.     

Multistability property in cardiac ionic models of mammalian and human ventricular cells

The underlying mechanisms of irregular cardiac rhythms are still poorly understood. Many experimental and modeling studies are aimed at identifying factors which cause cardiac arrhythmias. However, a lack of understanding of heart rhythm dynamical properties makes it difficult to uncover precise mechanisms of electrical instabilities, and hence to predict the onset of heart rhythm disorders. We review and compare the existing methods of studying cardiac dynamics, including restitution protocol (S1-S2), dynamic restitution protocol and multistability test protocol (S1-CI-S2). We focus on cardiac cell dynamics to elucidate regularities of heart rhythm. We demonstrate the advantages of our newly proposed systematic approach of analysis of cardiac cell dynamics using mammalian Luo Rudy 1991 and human ventricular Ten Tusscher 2006 single cell models under healthy and diseased conditions such as altered K⁺ or Ca²⁺ related currents. We investigate the role of ionic properties and the shape of an action potential on the nonlinear dynamics of electrical processes in periodically stimulated cardiac cells. We show the existence of multistability property for human ventricular cells. Moreover, the multistability is proposed to be an intrinsic property of cardiac cells, and is also suggested to be one of the mechanisms which could underlie the sudden triggering of life-threatening ventricular arrhythmias in the human heart.     

心力衰竭合并房颤患者血浆脑钠肽水平及相关因素分析

目的:探讨心力衰竭合并房颤患者血浆脑钠肽水平变化及相关因素,为心血管疾病的临床诊断提供理论依据。方法:选取我院2011年1月-2013年1月收治的心力衰竭患者94例,分为窦性心律组和心房颤动组。分别抽取两组患者的血液样本并检测血浆中的BNP浓度,比较不同NYHA分级患者血浆内的脑钠肽水平的变化情况,记录左心房和左心室舒张末内径及房颤持续时间等。结果:心力衰竭合并心房颤动组与窦性心律组血浆BNP水平比较,心房颤动组高于窦性心律组;差异有统计学意义(P0.05);两组NYHA不同分级相互比较,Ⅱ级、Ⅲ级和Ⅳ级间的BNP水平,心房颤动组BNP水平均高于窦性心律组;差异显著具有统计学意义(P0.05);血浆BNP水平与患者年龄、左心房大小、左心室大小、房颤持续时间因素呈正相关(r分别为0.0.801,0.748,0.854和0.703,P0.05),与左心室射血分数呈负相关(r=-0.41,P0.05)。结论:BNP血浆浓度与心功能状态密切相关,BNP浓度的检测有助于临床心血管疾病的诊断。     

Nonlinear analysis of continuous ECG during sleep II. Dynamical measures

The hypothesis that cardiac rhythms are associated with chaotic dynamics implicating a healthy flexibility has motivated the investigation of continuous ECG with methods of nonlinear system theory. Sleep is known to be associated with modulations of the sympathetic and parasympathetic control of cardiac dynamics. Thus, the differentiation of ECG signals recorded during different sleep stages can serve to determine the usefulness of nonlinear measures in discriminating ECG states in general. For this purpose the following six nonlinear measures were implemented: correlation dimension D2, Lyapunov exponent L1. Kolmogorov entropy K2, as well as three measures derived from the analysis of unstable periodic orbits. Results of this study show that continuous ECG signals can be differentiated from linear stochastic surrogates by each of the nonlinear measures. The most significant finding with respect to the sleep-related differentiation of ECG signals is an increase in dominant chaoticity assessed by L1 and a reduction in the degrees of freedom estimated by D2 during REM sleep compared to slow wave sleep. Our findings suggest that the increase in dominant chaoticity during REM sleep with regard to time-continuous nonlinear analysis is comparable to an increased heart rate variability. The reduction in the correlation dimension may be interpreted as an expression of the withdrawal of respiratory influences during REM sleep. Received: 7 June 1999 / Accepted in revised form: 10 December 1999     

A New Algorithm to Diagnose Atrial Ectopic Origin from Multi Lead ECG Systems - Insights from 3D Virtual Human Atria and Torso

Rapid atrial arrhythmias such as atrial fibrillation (AF) predispose to ventricular arrhythmias, sudden cardiac death and stroke. Identifying the origin of atrial ectopic activity from the electrocardiogram (ECG) can help to diagnose the early onset of AF in a cost-effective manner. The complex and rapid atrial electrical activity during AF makes it difficult to obtain detailed information on atrial activation using the standard 12-lead ECG alone. Compared to conventional 12-lead ECG, more detailed ECG lead configurations may provide further information about spatio-temporal dynamics of the body surface potential (BSP) during atrial excitation. We apply a recently developed 3D human atrial model to simulate electrical activity during normal sinus rhythm and ectopic pacing. The atrial model is placed into a newly developed torso model which considers the presence of the lungs, liver and spinal cord. A boundary element method is used to compute the BSP resulting from atrial excitation. Elements of the torso mesh corresponding to the locations of the placement of the electrodes in the standard 12-lead and a more detailed 64-lead ECG configuration were selected. The ectopic focal activity was simulated at various origins across all the different regions of the atria. Simulated BSP maps during normal atrial excitation (i.e. sinoatrial node excitation) were compared to those observed experimentally (obtained from the 64-lead ECG system), showing a strong agreement between the evolution in time of the simulated and experimental data in the P-wave morphology of the ECG and dipole evolution. An algorithm to obtain the location of the stimulus from a 64-lead ECG system was developed. The algorithm presented had a success rate of 93%, meaning that it correctly identified the origin of atrial focus in 75/80 simulations, and involved a general approach relevant to any multi-lead ECG system. This represents a significant improvement over previously developed algorithms.     

Paradoxical Cardiac Rhythm in Rat Pups as a Possible Analog of the Sick Sinus Syndrome

Experiments with simultaneous recordings of ECG, electrogram of myocardial fibers of the right ventricle and neurogram of the right branch of vagus or sympathetic nerves were carried out on 3–18-day old rat pups. The electric activity recordings were performed under both in vivo and in situ conditions at unilateral or bilateral pneumothorax. It is established that the change in the cholinergic system activation level produced prior to pneumothorax decelerates the rhythm of cardiac contractions (CC) and induces periods of more frequent CC. After pneumothorax, this syndrome becomes more pronounced. The periods of alternation of the slow and fast rhythms may last for up to 1–2 min. The development of the pathological process leads to development of the sino-auricular and atrio-ventricular blocks. There appears a pattern of CC changes and complexes of the ventricular electric potentials that occur in decasecond and then in minute rhythms and are separated by periods of total asystole or preserved potentials of atrial excitation. When the electrograms of myocardium were recorded in rat pups under conditions of bilateral pneumothorax without any pharmacological intervention, it was possible to see a distortion of the sinus rhythm of CC developing for 2–2.5 h after respiration arrest and similar to the above-described distortion. The appearance and development of the phenomenon of the atypical cardiac rhythm is not directly related to the firing patterns of vagus and sympathetic nerves. At the same time, a correlation is clearly seen between the amplitude–frequency modulation of CC and discharges of vagus. A contraction of groups of respiratory muscles lasts for up to 30 min after pneumothorax, with occasional discharges seen in neurogram even after the complete immobilization of the animal. The development of the pathological process reveals a certain similarity with the phenomenon described in literature as the sinus node syndrome (tachy–bradycardia syndrome, TBS). Based on analysis of the cardiac rhythm transformation, it is suggested that the clinical TBS is a consequence of recapitulation, i.e., a successive release of ancient rhythms of excitation due to an impair of regulatory mechanisms.     

Effect of cimetidine on the heart conduction system]

An effect of cimetidine on ECG records has been investigated in a group of 40 patients with gastric or duodenal ulcers and coexisting circulatory disorders. For this purpose ECG has been recorded with Holter's technique (Medilog 2000) together with ECG-recording using high amplifying technique. An intravenous injection of 200 mg of cimetidine produced in some of patients inhibition of the sinus rhythm atrio-ventricular conduction disturbances as well as changes in the end phase of ECG ventricular image. The authors suggest, that intravenous administration of cimetidine to patients with cardiac diseases should be monitored with ECG recording.     

Calcium instabilities in mammalian cardiomyocyte networks

The degeneration of a regular heart rhythm into fibrillation (a chaotic or chaos-like sequence) can proceed via several classical routes described by nonlinear dynamics: period-doubling, quasiperiodicity, or intermittency. In this study, we experimentally examine one aspect of cardiac excitation dynamics, the long-term evolution of intracellular calcium signals in cultured cardiomyocyte networks subjected to increasingly faster pacing rates via field stimulation. In this spatially extended system, we observed alternans and higher-order periodicities, extra beats, and skipped beats or blocks. Calcium instabilities evolved nonmonotonically with the prevalence of phase-locking or Wenckebach rhythm, low-frequency magnitude modulations (signature of quasiperiodicity), and switches between patterns with occasional bursts (signature of intermittency), but period-doubling bifurcations were rare. Six ventricular-fibrillation-resembling episodes were pace-induced, for which significantly higher complexity was confirmed by approximate entropy calculations. The progressive destabilization of the heart rhythm by coexistent frequencies, seen in this study, can be related to theoretically predicted competition of control variables (voltage and calcium) at the single-cell level, or to competition of excitation and recovery at the cell network level. Optical maps of the response revealed multiple local spatiotemporal patterns, and the emergence of longer-period global rhythms as a result of wavebreak-induced reentries.     

Fuzzy K-nearest neighbor classifiers for ventricular arrhythmia detection

We report a study of the efficiency of 4 classifiers (the K-nearest-neighbor and single-nearest-prototype algorithms, each as parametrized by both Fuzzy C-Means and Fuzzy Covariance clustering) in the detection of ventricular arrhythmias in ECG traces characterized by 4 features derived from 7 spectral parameters. Principal components analysis was used in conjunction with a cardiologist's deterministic classification of 90 ECG traces to fix the number of trace classes to 5 (ventricular fibrillation/flutter, sinus rhythm, ventricular rhythms with aberrant complexes and 2 classes of artefact). Forty of the 90 traces were then defined as a test set; 5 different learning sets (numbering 25, 30, 35, 40 and 45 traces) were randomly selected from the remaining 50 traces; each learning set was used to parametrize both the classification algorithms using both fuzzy clustering algorithms and the parametrized classification algorithms were then applied to the test set. Optimal K for K-nearest-neighbor algorithms and optimal cluster volumes for Fuzzy Covariance algorithms were sought by trial and error to minimize classification differences with respect to the cardiologist's classification. Fuzzy Covariance clustering afforded significantly better perception of cluster structure than the Fuzzy C-Means algorithm, and the classifiers performed correspondingly with an overall empirical error ratio of just 0.10 for the K-nearest-neighbor algorithm parametrized by Fuzzy Covariance.     

Complexity and characteristic frequency studies in ECG signals of mice based on multiple scale factors

Existing methods of physiological signal analysis based on nonlinear dynamic theories only examine the complexity difference of the signals under a single sampling frequency. We developed a technique to measure the multifractal characteristic parameter intimately associated with physiological activities through a frequency scale factor. This parameter is highly sensitive to physiological and pathological status. Mice received various drugs to imitate different physiological and pathological conditions, and the distributions of mass exponent spectrum curvature with scale factors from the electrocardiogram (ECG) signals of healthy and drug injected mice were determined. Next, we determined the characteristic frequency scope in which the signal was of the highest complexity and most sensitive to impaired cardiac function, and examined the relationships between heart rate, heartbeat dynamic complexity, and sensitive frequency scope of the ECG signal. We found that all animals exhibited a scale factor range in which the absolute magnitudes of ECG mass exponent spectrum curvature achieve the maximum, and this range (or frequency scope) is not changed with calculated data points or maximal coarse-grained scale factor. Further, the heart rate of mice was not necessarily associated with the nonlinear complexity of cardiac dynamics, but closely related to the most sensitive ECG frequency scope determined by characterization of this complex dynamic features for certain heartbeat conditions. Finally, we found that the health status of the hearts of mice was directly related to the heartbeat dynamic complexity, both of which were positively correlated within the scale factor around the extremum region of the multifractal parameter. With increasing heart rate, the sensitive frequency scope increased to a relatively high location. In conclusion, these data provide important theoretical and practical data for the early diagnosis of cardiac disorders.     

Nonlinear analysis of continuous ECG during sleep I. Reconstruction

In recent years evidence has accumulated that ECG signals are of a nonlinear nature. It has been recognized that strictly periodic cardiac rhythms are not accompanied by healthy conditions but, on the contrary, by pathological states. Therefore, the application of methods from nonlinear system theory for the analysis of ECG signals has gained increasing interest. Crucial for the application of nonlinear methods is the reconstruction (embedding) of the time series in a phase space with appropriate dimension. In this study continuous ECG signals of 12 healthy subjects recorded during different sleep stages were analysed. Proper embedding dimension was determined by application of two techniques – the false nearest neighbours method and the saturation of the correlation dimension. Results for the ECG signals were compared with findings for simulated data (quasiperiodic dynamics, Lorenz data, white noise) and for phase randomized surrogates. Findings obtained with the two approaches suggest that embedding dimensions from 6 to 8 may be regarded as suitable for the topologically proper reconstruction of ECG signals. Received: 7 June 1999 / Accepted in revised form: 10 December 1999     

Cardiac arrhythmia classification using autoregressive modeling

Background  

Computer-assisted arrhythmia recognition is critical for the management of cardiac disorders. Various techniques have been utilized to classify arrhythmias. Generally, these techniques classify two or three arrhythmias or have significantly large processing times. A simpler autoregressive modeling (AR) technique is proposed to classify normal sinus rhythm (NSR) and various cardiac arrhythmias including atrial premature contraction (APC), premature ventricular contraction (PVC), superventricular tachycardia (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF).     

双极射频消融改良迷宫术治疗房颤的中远期疗效及其影响因素分析

目的:分析心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的术后中远期疗效及其影响因素。方法:选取2007年7月至2010年12月于我院行心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的72例患者,术后随访3至6年,获得患者术后十二导联心电图、24 h动态心电图和心脏彩超结果,并且记录术后药物应用、相关并发症、心功能恢复情况及生活质量是否改善等情况。根据心电图结果,将患者分为窦性心律组与非窦性心律组,应用统计学方法比较两组患者术前相关因素是否有差异。结果:截止至随访终点,有效随访的68例患者中窦性心律维持率为63.2%。单因素分析显示术前房颤病程、术前左室射血分数、是否合并三尖瓣成形或置换是影响手术效果的影响因素,多因素分析显示术前房颤病程、合并三尖瓣成形或置换是影响手术效果的危险因素。结论:心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的中晚期疗效好,术后并发症少,能够有效防止血栓栓塞,术前房颤病程长、合并三尖瓣成形或置换的患者术后中远期效果相对较差。     

Preliminary reference values for electrocardiography,echocardiography and myocardial morphometry in the European brown hare (Lepus europaeus)

The study aimed at defining reference values for electrocardiographic (ECG) and echocardiographic parameters as well as macroscopic dimensions of the heart and microscopic dimensions of cardiomyocytes in the European brown hare. The studies were conducted on 30 adult, clinically healthy hares of either sex caught in Poland. ECG and echocardiography were performed supravitally on anaesthetized hares. After euthanasia, gross and microscopic myocardial and cardiomyocyte dimensions were determined. Heart rate amounted to 140 ± 37.5 beats/min, the leading rhythm involved the sinus rhythm. P wave time was 26 ± 5 ms, PQ time was 80 ms, QRS time was 29 ± 3.5 ms, and ST was 97.5 ± 7 ms. Echocardiography determined a left ventricular wall end-diastolic diameter of 8.6 ± 2.0 mm and an intraventricular septum end-diastolic diameter of 5.75 ± 1.0 mm. The thickness of the interventricular septum corresponded to that of the free wall of the left ventricle, a finding consistent with physiological hypertrophy. Preliminary reference values were established for echocardiography. The findings were similar to those obtained at necropsy. The ECG and echocardiographic studies represent the first supravital examination of cardiac function in the hare. The obtained results illustrate adaptation of hare's myocardium to its mode of life. The cardiac findings resemble the athlete's heart syndrome described in humans. The findings may prove useful in further studies on the physiology of the cardio-vascular system in the hare.