title: ADARRI: a novel method to detect spurious R-peaks in the electrocardiogram for heart rate variability analysis in the intensive care unit.
abstract: We developed a simple and fully automated method for detecting artifacts in the R-R interval (RRI) time series of the ECG that is tailored to the intensive care unit (ICU) setting. From ECG recordings of 50 adult ICU-subjects we selected 60 epochs with valid R-peak detections and 60 epochs containing artifacts leading to missed or false positive R-peak detections. Next, we calculated the absolute value of the difference between two adjacent RRIs (adRRI), and obtained the empirical probability distributions of adRRI values for valid R-peaks and artifacts. From these, we calculated an optimal threshold for separating adRRI values arising from artifact versus non-artefactual data. We compared the performance of our method with the methods of Berntson and Clifford on the same data. We identified 257,458 R-peak detections, of which 235,644 (91.5%) were true detections and 21,814 (8.5%) arose from artifacts. Our method showed superior performance for detecting artifacts with sensitivity 100%, specificity 99%, precision 99%, positive likelihood ratio of 100 and negative likelihood ratio <0.001 compared to Berntson's and Clifford's method with a sensitivity, specificity, precision and positive and negative likelihood ratio of 99%, 78%, 82%, 4.5, 0.013 for Berntson's method and 55%, 98%, 96%, 27.5, 0.460 for Clifford's method, respectively. A novel algorithm using a patient-independent threshold derived from the distribution of adRRI values in ICU ECG data identifies artifacts accurately, and outperforms two other methods in common use. Furthermore, the threshold was calculated based on real data from critically ill patients and the algorithm is easy to implement.
authors.affiliation: Neurology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. dennisjrebergen@gmail.com.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Rebergen
authors.affiliation: Neurology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Sunil B
authors.initials: SB
authors.lastname: Nagaraj
authors.affiliation: Neurology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenthal
authors.affiliation: Neurology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Matt T
authors.initials: MT
authors.lastname: Bianchi
authors.affiliation: Department of Clinical Neurophysiology, Medisch Spectrum and MIRA- Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. box 217, 7500 AE, Enschede, The Netherlands.
authors.forename: Michel J A M
authors.initials: MJAM
authors.lastname: van Putten
authors.affiliation: Neurology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
mesh_terms: D000465:Algorithms; D016477:Artifacts; D001331:Automation; D016638:Critical Illness; D004562:Electrocardiography; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D012984:Software
keywords: ECG artifacts; Heart rate variability; ICU; Intensive care