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      Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network

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          Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow1. Widely available digital ECG data and the algorithmic paradigm of deep learning2 present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F1 score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.

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          Identity Mappings in Deep Residual Networks

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            Is Open Access

            Delving Deep into Rectifiers: Surpassing Human-Level Performance on ImageNet Classification

            Rectified activation units (rectifiers) are essential for state-of-the-art neural networks. In this work, we study rectifier neural networks for image classification from two aspects. First, we propose a Parametric Rectified Linear Unit (PReLU) that generalizes the traditional rectified unit. PReLU improves model fitting with nearly zero extra computational cost and little overfitting risk. Second, we derive a robust initialization method that particularly considers the rectifier nonlinearities. This method enables us to train extremely deep rectified models directly from scratch and to investigate deeper or wider network architectures. Based on our PReLU networks (PReLU-nets), we achieve 4.94% top-5 test error on the ImageNet 2012 classification dataset. This is a 26% relative improvement over the ILSVRC 2014 winner (GoogLeNet, 6.66%). To our knowledge, our result is the first to surpass human-level performance (5.1%, Russakovsky et al.) on this visual recognition challenge.
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              Automated diagnosis of arrhythmia using combination of CNN and LSTM techniques with variable length heart beats

              Arrhythmia is a cardiac conduction disorder characterized by irregular heartbeats. Abnormalities in the conduction system can manifest in the electrocardiographic (ECG) signal. However, it can be challenging and time-consuming to visually assess the ECG signals due to the very low amplitudes. Implementing an automated system in the clinical setting can potentially help expedite diagnosis of arrhythmia, and improve the accuracies. In this paper, we propose an automated system using a combination of convolutional neural network (CNN) and long short-term memory (LSTM) for diagnosis of normal sinus rhythm, left bundle branch block (LBBB), right bundle branch block (RBBB), atrial premature beats (APB) and premature ventricular contraction (PVC) on ECG signals. The novelty of this work is that we used ECG segments of variable length from the MIT-BIT arrhythmia physio bank database. The proposed system demonstrated high classification performance in the handling of variable-length data, achieving an accuracy of 98.10%, sensitivity of 97.50% and specificity of 98.70% using ten-fold cross validation strategy. Our proposed model can aid clinicians to detect common arrhythmias accurately on routine screening ECG.

                Author and article information

                Nature Medicine
                Nat Med
                Springer Nature
                January 2019
                January 7 2019
                January 2019
                : 25
                : 1
                : 65-69
                © 2019




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