A new algorithm to reduce T-wave over-sensing based on phase space reconstruction in S-ICD system

Abstract

The subcutaneous implantable cardioverter defibrillator (S-ICD) reduces mortality in individuals at high risk of sudden arrhythmic death, by rapid defibrillation of life-threatening arrhythmia. Unfortunately, S-ICD recipients are also at risk of inappropriate shock therapies, which themselves are associated with increased rates of mortality and morbidity. The commonest cause of inappropriate shock therapies is T wave oversensing (TWOS), where T waves are incorrectly counted as R waves leading to an overestimation of heart rate. It is important to develop a method to reduce TWOS and improve the accuracy of R-peak detection in S-ICD system. This paper introduces a novel algorithm to reduce TWOS based on phase space reconstruction (PSR); a common method used to analyse the chaotic characteristics of non-linear signals. The algorithm was evaluated against 34 records from University Hospital Southampton (UHS) and all 48 records from the MIT-BIH arrhythmia database. In the UHS analysis we demonstrated a sensitivity of 99.88%, a positive predictive value of 99.99% and an accuracy of 99.88% with reductions in TWOS episodes (from 166 to 0). Whilst in the MIT-BIH analysis we demonstrated a sensitivity of 99.87%, a positive predictive value of 99.99% and an accuracy of 99.91% for R wave detection. The average processing time for 1min ECG signals from all records is 2.9s. Our algorithm is sensitive for R-wave detection and can effectively reduce the TWOS with low computational complexity, and it would therefore have the potential to reduce inappropriate shock therapies in S-ICD recipients, which would significantly reduce shock related morbidity and mortality, and undoubtedly improving patient's quality of life.