An adaptive QRS detection algorithm for ultra-long-term ECG recordings

Background: Accurate detection of QRS complexes during mobile, ultra-long-term ECG monitoring is challenged by instances of high heart rate, dramatic and persistent changes in signal amplitude, and intermittent deformations in signal quality that arise due to subject motion, background noise, and misplacement of the ECG electrodes. Purpose: We propose a revised QRS detection algorithm which addresses the above-mentioned challenges. Methods and results: Our proposed algorithm is based on a state-of-the-art algorithm after applying two key modifications. The first modification is implementing local estimates for the amplitude of the signal. The second modification is a mechanism by which the algorithm becomes adaptive to changes in heart rate. We validated our proposed algorithm against the state-of-the-art algorithm using short-term ECG recordings from eleven annotated databases available at Physionet, as well as four ultra-long-term (14-day) ECG recordings which were visually annotated at a central ECG core laboratory. On the database of ultra-long-term ECG recordings, our proposed algorithm showed a sensitivity of 99.90% and a positive predictive value of 99.73%. Meanwhile, the state-of-the-art QRS detection algorithm achieved a sensitivity of 99.30% and a positive predictive value of 99.68% on the same database. The numerical efficiency of our new algorithm was evident, as a 14-day recording sampled at 200 Hz was analyzed in approximately 157 s. Conclusions: We developed a new QRS detection algorithm. The efficiency and accuracy of our algorithm makes it a good fit for mobile health applications, ultra-long-term and pathological ECG recordings, and the batch processing of large ECG databases.