A comparison of entropy approaches for AF discrimination.

OBJECTIVE: This study focuses on the comparison of single entropy measures for ventricular response analysis-based AF detection.

APPROACH: To enhance the performance of entropy-based AF detectors, we developed a normalized fuzzy entropy, [Formula: see text], a novel metric that (1) uses a fuzzy function to determine vector similarity, (2) replaces probability estimation with density estimation for entropy approximation, (3) utilizes a flexible distance threshold parameter, and (4) adjusts for heart rate by subtracting the natural log value of the mean RR interval. An AF detector based on [Formula: see text] was trained using the MIT-BIH atrial fibrillation (AF) database, and tested on the MIT-BIH normal sinus rhythm (NSR) and MIT-BIH arrhythmia databases. The [Formula: see text]-based AF detector was compared to AF detectors based on three other entropy measures: sample entropy ([Formula: see text]), fuzzy measure entropy ([Formula: see text]) and coefficient of sample entropy ([Formula: see text]), over three standard window sizes.

MAIN RESULTS: To classify AF and non-AF rhythms, [Formula: see text] achieved the highest area under receiver operating characteristic curve (AUC) values of 92.72%, 95.27% and 96.76% for 12-, 30- and 60-beat window lengths respectively. This was higher than the performance of the next best technique, [Formula: see text], over all windows sizes, which provided respective AUCs of 91.12%, 91.86% and 90.55%. [Formula: see text] and [Formula: see text] resulted in lower AUCs (below 90%) over all window sizes. [Formula: see text] also provided superior performance for all other tested statistics, including the Youden index, sensitivity, specificity, accuracy, positive predictivity and negative predictivity. In conclusion, we show that [Formula: see text] can be used to accurately identify AF from RR interval time series. Furthermore, longer window lengths (up to one minute) increase the performance of all entropy-based AF detectors under evaluation except the [Formula: see text]-based method.

SIGNIFICANCE: Our results demonstrate that the new developed normalized fuzzy entropy is an accurate measure for detecting AF.