2.

-CARDIOVASCULAR APPLCIATIONS
The electrocardiogram (ECG) is a time-
varying signal originated by the ionic
current flow that causes the cardiac
fibers to contract and subsequently
relax. The surface ECG is obtained by
recording the potential difference
between two electrodes placed on the
skin. As such, a single cycle of the ECG
represents successive atrial and
ventricular polarizations which occur
with each heartbeat.

The firing of each component in the

heart’s conduction system adds up to
the ECG, resulting in a final periodic
wave. Moreover, different placements
of the electrode will result in different
waves, although they represent the
same vector (just projected in a different
space).

In this printed ECG we can see different leads. Lead II and V2 measure the vector in the opposite
projection, and thus the wave appears flipped in V2.
There are many different options to process an ECG. It can be either analog or digital, real time or off-line,
and application dependent. The main ECG processing scheme looks as follows;

2.1.-NOISE FILTERING
We will concentrate on noise filtering after the acquisition of the signal. All in all, there are three common
noise sources in an acquired ECG signal:

- Baseline wander.
- Power line interference.
- Muscle noise.

Each noise type is removed through specific methods with different advantages and drawbacks. However,
when filtering any biomedical signal care should be taken not to alter the desired information in any way.
A major concern is how the QRS complex influences the output of the filter. Large amplitude waves (such
as the QRS complex) pose a large unwanted input to the filter (it creates a large dynamic range to which
the filter should adapt, and such filters are complex).

As such, any distortion caused by the filter to the signal should be carefully quantified. An example of this
is the depression of the ST segment by a filter. This segment represents the main ventricular mass
contraction, if depressed it may indicate a loss in contractile mass: an infarction. However, if it is a result
of filtering, that filter should not be used for applications that may require ST segment monitoring.

2.1.1.-BASELINE WANDER
Baseline wander is composed by extraneous low-frequency (< 0.5
Hz) components caused by skin movements such as respiration, and
perspiration (sweat changes the electrode’s impedance). It hinders
the ECG analysis, mainly the low-frequency components such as the
ST segment.

There are two main approaches when dealing with this type of noise:

- Linear filtering (through both digital and analog means).

- Polynomial fitting.
Linear, time-invariant, high pass filtering requires choosing a low cut-off frequency in such a way that it
does not affect the lowest in frequency components of the ECG wave.

- During bradycardia, the heart beats about 40 times per minute, or 0.67 Hz. Applying a 0.5 Hz low
cut off frequency with a high order filter will prevent from losing any substantial information.
- Moreover, it is desirable to have a linear phase shift, in order to avoid phase distortion that may
alter cardiac temporal relationships in the ECG wave.

This filter can be implemented both analogically and digitally, in the analog case a passive first order high
pass filter will be enough, as they do not distort phase and there is no notable difference between higher
order filters in order to justify the cost of increasing it. However, when dealing with digital filters there
are two available options which have their advantages and drawbacks;

- FIR (Finite Impulse Response Filters) present a linear phase response, however the transition
band is not as sharp as in other types of filters.
- IIR (Infinite Impulse Response Filters) do not present a linear phase response, but their transition
band is much steeper, and thus they require a much lower order than FIR filters.

Another option are linear, time-variant, high pass filters. As baseline wander noise may be higher than
the aforementioned 0.5 Hz cut-off frequency, a good idea is to couple this cut-off frequency with the
prevailing heart rate, as the ECG spectrum shifts frequency with increasing heart rate. The first step would
be to estimate the RR interval, and use a scaled inverse of it as a cut-off frequency.

Polynomial fitting to representative points in the

ECG, and the remove the obtained fitted curve from
the original signal. These points must be selected
from a “silent” segment of the ECG signal, often the
best choice is the PQ interval. Afterwards, a
polynomial is fitted through the points. As already
known, higher order polynomials will provide a more
accurate estimate at the cost of higher
computational complexity, and cubic splines are a
popular approach.

The main drawback are the operations that involve identifying the QRS complexes and localization of PQ
intervals. Moreover, when very few intervals are present it performs poorly, and the performance of this
type of filtering depends strongly on the accuracy of PQ interval identification.
2.1.2.-POWER-LINE INTERFERENCE
Electromagnetic fields from power lines can cause 50/60 Hz sinusoidal interference possibly accompanied
by some of its harmonics (100/120 Hz, 150/180 Hz…). It can cause problems interpreting low amplitude
waveforms such as the P wave.

As with baseline wander, we can implement both analog and digital linear notch filters. A simple approach
is a complex conjugate pair of zeroes that lie on the unit circle ant the desired frequency. However, the
notch filter will attenuate also the frequencies close to the cut-off one. This can be improved by adding
two poles at the same angle as the zeroes but at a given radius. This will determine the bandwidth of the
notch filter. Nevertheless, this will produce ringing artifacts.

In the case of non-linear filtering we can subtract the power line interference (PLI) sinusoid extracted by
filtering the observed signal. A possible implementation of such a filter consists on;

- The amplitude of the sinusoid 𝑣(𝑛) = sin(𝜔𝑜 · 𝑛) is adapted to the power line interference
through the use of an error function 𝑒(𝑛) = 𝑥(𝑛) − 𝑣(𝑛), where 𝑥(𝑛) represents the raw ECG
signal.
- The error function is dependent of the DC value of 𝑥(𝑛), but it can be removed by using the first
difference 𝑒 ′ (𝑛) = 𝑒(𝑛) − 𝑒(𝑛 − 1).
- Now, depending on the sign of 𝑒′(𝑛), the value of 𝑣(𝑛) is adapted by an negative or positive
increment 𝛼, as follows: 𝑣 ∗ (𝑛) = 𝑣(𝑛) + 𝛼 · 𝑠𝑖𝑔𝑛( 𝑒 ′ (𝑛)).
- Finally, the output is obtained by subtracting the interference estimate from the input:
𝒚(𝒏) = 𝒙(𝒏) − 𝒗∗ (𝒏)
Note that if 𝛼 is too small the filter will poorly track the changes in the power line interference, as it takes
too many steps to adjust to it. However, if 𝛼 is too big there will be extra noise because the filter
overshoots the values constantly.

Finally, a quick graphical comparison of the aforementioned types of filtering.

There are some additional techniques to filter the power line noise, one of them is estimation-
subtraction, a very coarse method in which we have to take an isoelectric segment (this is, a segment
whose points should be all at the same level). Estimate the amplitude and phase of the interference in
that segment, and finally subtract it from the entire cycle.

2.1.3.-MUSCLE NOISE
Muscle noise can cause severe problems as low-amplitude waveforms can be obstructed, especially in
recordings during exercise. It is not a predictable or periodic signal, and it is not common to all subjects.
It is stochastic in nature, and as such it cannot be filtered in advance because it overlaps with the PQRST
spectral content.

But, as the ECG is a repetitive signal, techniques such as ensemble averaging can be applied to reduce
its impact on the overall wave. However, muscle noise remains a largely unsolved problem.
2.2.-QRS DETECTION
Note that beat detection and QRS detection are synonyms. A QRS detector main structure looks as
follows;

The first linear filtering can be coarse if heart beat

detection is the only goal of the application. Note that
the QRS spectrum central frequency is located at 10 to
25 Hz, with a bandwidth of 5 to 10 Hz. T and P waves
have a much lower spectrum. A filter according to this
data can be designed in order to reduce the amount
of noise and obtain the best possible SNR for the
whole signal.

Additionally the nonlinear transformation will further

enhance the SNR by transforming the QRS wave into a
single pulse suited for threshold detection, some
examples of this are: signal rectification or squaring.

Finally, the decision rule will account for a threshold and measure the pulse duration.

The QRS detector performance is measured in terms of probability as follows;