Abstract
ObjectiveContinuous blood pressure (BP) provides valuable information for the disease management of patients with arrhythmias. The traditional intra-arterial method is too invasive for routine healthcare settings, whereas cuff-based devices are inferior in reliability and comfortable for long-term BP monitoring during arrhythmias. The study aimed to investigate an indirect method for continuous and cuff-less BP estimation based on electrocardiogram (ECG) and photoplethysmogram (PPG) signals during arrhythmias and to test its reliability for the determination of BP using invasive BP (IBP) as reference.MethodsThirty-five clinically stable patients (15 with ventricular arrhythmias and 20 with supraventricular arrhythmias) who had undergone radiofrequency ablation were enrolled in this study. Their ECG, PPG, and femoral arterial IBP signals were simultaneously recorded with a multi-parameter monitoring system. Fifteen features that have the potential ability in indicating beat-to-beat BP changes during arrhythmias were extracted from the ECG and PPG signals. Four machine learning algorithms, decision tree regression (DTR), support vector machine regression (SVR), adaptive boosting regression (AdaboostR), and random forest regression (RFR), were then implemented to develop the BP models.ResultsThe results showed that the mean value ± standard deviation of root mean square error for the estimated systolic BP (SBP), diastolic BP (DBP) with the RFR model against the reference in all patients were 5.87 ± 3.13 and 3.52 ± 1.38 mmHg, respectively, which achieved the best performance among all the models. Furthermore, the mean error ± standard deviation of error between the estimated SBP and DBP with the RFR model against the reference in all patients were −0.04 ± 6.11 and 0.11 ± 3.62 mmHg, respectively, which complied with the Association for the Advancement of Medical Instrumentation and the British Hypertension Society (Grade A) standards.ConclusionThe results indicated that the utilization of ECG and PPG signals has the potential to enable cuff-less and continuous BP estimation in an indirect way for patients with arrhythmias.
Highlights
Heart arrhythmia, known as irregular heartbeat or cardiac dysrhythmia, is a group of conditions characterized by a heartbeat that is irregular, too slow, or too fast (Kligfield et al, 2007)
The intra-arterial method is recommended for the Blood pressure (BP) measurement of patients with arrhythmias (Alpert et al, 2006)
In which individual initial calibration is first performed through the invasive BP (IBP) measured by artery intubation, followed by long-term tracking using the ECG-PPG–based method, would reduce the risks associated with prolonged artery cannulation and provide a non-invasive and accurate long-term continuous BP monitoring for patients with arrhythmias
Summary
Known as irregular heartbeat or cardiac dysrhythmia, is a group of conditions characterized by a heartbeat that is irregular, too slow, or too fast (Kligfield et al, 2007). Arrhythmias is an age-related disease (Hatch et al, 2011; Khurshid et al, 2018). The incidence of paroxysmal supraventricular arrhythmias is 14.8 per 100,000 person-years in adults aged 18 to 24 years, but in persons aged ≥65 years, the rate is increased to 231.9 per 100,000 person-years (Go et al, 2018). It is estimated that by 2050, supraventricular-related arrhythmias will affect approximately nine million individuals aged >60 years in China (Tse et al, 2013). With the growth of the aging population, arrhythmias will bring an increasing burden and challenge to public healthcare management
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