A Different approach for Cardiac Arrhythmia Classification using Random Forest

Algorithm
Allam Jaya prakash,Samit Ari
Department of Electronics and Communication Engineering, National Institute of Technology, Rourkela,India
E-mail: allamjayaprakash@gmail.com

Published in Healthcare Technology Letters; Received on xxx; Revised on xxx.

ECG plays a most important role in finding cardiac disorders of the heart. Cardiac arrhythmias occur in a short duration of time which can’t
be distinguishable by a human eye. The finding of arrhythmias is a tedious task since slight changes in electro cardiogram signal (ECG)
may lead to life-threatening. Diagnosis and medication at an early stage of cardiac arrhythmia may facilitate to reduce the mortality rate of
the heart patients. This paper presents an accurate system for the classification of 5 types of ECG arrhythmias namely Paced (P), Premature
ventricular contraction (V), Normal (N), Right bundle branch block (R) and Left bundle branch block (L). In the proposed technique, random
forest classifier (RF) is used as classifier to classify ECG arrhythmias. The projected model of cardiac arrhythmia recognition system covers
3 stages they’re pre-processing, feature extraction and classification. In the first stage, filtered the ECG signal raw data and finding the R-peak
locations of the ECG signal. Dual tree complex wavelet transform (DTCWT) is employed to extract the feature vector from the ECG signal
within the second stage. The final feature vector consists of an extracted feature set using DTCWT and four other temporal features of the
ECG signal. The final feature set is applied as an input to the random forest (RF) classifier. Classifier performance is evaluated using MIT-BIH
physionet database. Finally RF classifier achieved overall accuracy of 98.78% on an individual basis once tested over five kinds of physionet
MIT-BIH arrhythmia database. The proposed arrangement of framework effectively classified five kinds of ECG arrhythmias. The proposed
RF classifier performs better than other reported techniques for the ECG arrhythmia classification.

1. Introduction: Electrocardiogram (ECG) is the recording
of the electrical phenomenon at the heart that represents the
variability of heart rate. Any deviation from the normal heart rate,
disturbance in rhythm, site of origin or conduction of cardiac
electric impulse is considered as an arrhythmia. Most of the
arrhythmias are seldom occurring and can’t be distinguished by a
person’s eye. Long duration of ECG record called as ambulatory
electrocardiogram are required to identify the abnormalities present
in a patient. Moreover, huge variations in temporal and some other
morphological characteristics from one patient to the other patient
make detection of abnormalities is a challenging task. Hence it is
very difficult to analyse and recognize these arrhythmias manually
by an expert cardiologist also. Hence we require an automatic
computer-aided diagnostic (CAD) system that can quickly detect
abnormalities within the patient.
In literature, there are many algorithms proposed on automatic
classification of ECG arrhythmias. Most of them have done ECG
classification in the subsequent stages i) pre-processing ii) feature
extraction iii) classification. In this feature extraction techniques
include both time and frequency domain features. Some of the
temporal features include R-R intervals, Q-R intervals, QRS
complex duration, R-S intervals, ST time segments. These temporal
features are not enough for classification since there is a huge
variation in the other morphological patterns within the same
patient. Hence some of the researchers have reported the mixture
of both frequency and time features as reported in [1]. Many
transformation techniques like S transform, Fourier transform (FT)
and discrete wavelet transform (DWT) [2] are used to extract the
features from the pre-processed data. Extracted features are given
to the input of a classifier for classification into respective classes.
Some of the classifiers are artificial neural networks (ANN) [3],
support vector machine (SVM) [4] etc.
Detection of cardiac arrhythmias by applying Hidden Markov
models is reported in [5].This algorithm has demonstrated very
good promising results in classifying ventricular arrhythmias and
detection of low amplitude P wave detection. In [6], the author
presented a customized electrocardiogram (ECG) beat classifier
using a mixture of experts (MOE) methodology. Linear vector
quantization (LVQ) and self-organizing maps (SOM) are two
classification models based on clustering technique, LVQ is a
supervised learning technique which classifies the feature vector
corresponding to the label of the cluster pattern (code word) into
which is clustered. In SOM, each centring of the cluster (prototype
or code word) is represented by some weights of a neuron which is
assigned to correlate in the feature map. The classifier is modelled
using mixture of SOM and LVQ approaches. The network is
designed in such a way that LVQ gives superior classification
performance for classes 1 and 3 however for class 2 and 4 SOM
gives superior performance. Overall classification accuracy of 94%
is reported using this mixture of expert’s approach.
A unique technique is proposed in [7] for a patient-
adapted ECG heartbeat classification that consists of four stages
namely, pre-processing, feature extraction, feature selection and
classification. Features are extracted in temporal and frequency
domain. Frequency domain features include coefficients obtained
by applying stock well transform. 184 samples around each R
peak are taken by combining 4 temporal features (Pre R-R, Post
R-R, average R-R, local R-R) and 180 samples of frequency
domain features and obtained better classification results but poor
sensitivity as reported in [7].
To address the above limitations, a novel approach of random
forest (RF) classifier is proposed for the classification of ECG
arrhythmias. Random forest is a highly powerful machine learning
algorithm which is based on supervised learning.[8] Random forest
algorithm can use individually for both classification and the
regression kind of difficulties. As name suggests that this algorithm
creates the forest with many number of random trees .
The remaining paper is organized as follows: Section 2 presents
MIT-BIH database that is used to evaluate the performance of
the proposed classification algorithm. Section 3 contains proposed
framework. Section 4 shows the results and discussion of the
proposed algorithm. The conclusion of the work is explained in
section 5.
2. ECG data Processing: MIT-BIH ECG Arrhythmia database
is utilised for assessing the performance of the proposed classifier

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technique. The database consists of some deadly arrhythmias. Most
ECG Data Acquisition
of the researchers consider as the standard database for detection of
cardiac arrhythmias. The database contains forty-eight files of ECG
recordings, and every file includes 30 min of ECG segment selected

(i) Pre-processing
Normalization
from 24 hours recordings of 48 specific patients. The first 23
recordings correspond to the routine clinical recordings while the
remaining recordings contain the complex ventricular, junctional, Filtering
and supraventricular arrhythmias [9]. These ECG recordings are
sampled at 360 Hz and band-pass filtered at 0.1-100 Hz. Fig.1 R-peak detection
represents the plot of record 100 from MIT-BIH ECG signal
database. Annotation file contains labels for each rhythm that are
detected by using a simple slope sensitive detector. These labels are
used in the training and testing phase of the implemented algorithm.

Morphological features
Temporal features
AC power
In this work, five different types of cardiac arrhythmias namely

(ii) Feature Extraction

Select a window ( 192
paced (P), premature ventricular contraction (V), Normal (N), right samples from right and
Kurtosis
bundle branch block (RBBB) and left bundle branch block (LBBB) left) around the R-peak
arrhythmias are classified by implementing the proposed method. Skewness

Timing
DTCWT features
information

Extracted Features Extracted Features

Total Feature Vector

Random Forest Classifier

P V N RBBB LBBB

Figure 2: Block diagram of proposed methodology

Figure 1: Plot of 100m ECG signal record from MIT-BIH database

(1) AC power: It represents the total power content in

3. Proposed Framework: The complete proposed methodology
for the arrhythmia classification is shown in Fig.2 which includes
the acquisition of ECG data, pre-processing, feature extraction and
classification.
3.1. Pre-processing and R-peak detection: The preprocessing stage
contains the subsequent two steps: (i) The amplitude of ECG signals
is normalised to a mean zero, and therefore the amplitude variance
for every ECG signal is eliminated. (ii) Every ECG signal is filtered
using a bandpass filter at 0.1-100 Hz to get rid of the noises. The
R-peak of the electrocardiogram signal is determined by the Pan-
Tompkins algorithm [10] from the pre-processed ECG signal.
3.2. Feature extraction: Extracting unique good features provide
better classification accuracy. In this work we extracted four
temporal features AC power, kurtosis, skewness, timing
information from Electrocardiogram signal but these features
alone are not sufficient to classify the arrhythmias. Therefore these
features are appended to the morphological features extracted
with the help of Dual tree complex wavelet transform (DTCWT)
[11]. Feature extraction portion is described in the Figure.2 block
diagram.
3.2.1. Temporal features: Temporal features are also called as time
domain features and these are very easy to extract from the signal.
AC power, kurtosis, skewness, timing information are extracted
from QRS complex of respective cardiac cycle. If r[n] represents
the QRS complex signal.
Electrocardiogram QRS complex signal.
p =E(r[n]2 ) (1)
(2) Kurtosis: It indicates the sharpedness of the Electrocardiogram
QRS complex signal.
E[(r − µ)4 ]
kurt(r) = (2)
σ4
(3) Skewness: More precisely skewness indicates the shortage of
symmetry of the distribution or data set.
E[(r − µ)3 ]
skew(r) = (3)
σ3
(4) Timing information: It is the measure of deviation from constant
beat rate calculated by using R-R interval ratio.
Tj − Tj−1
IRj = (4)
Tj+1 − Tj
where Tj indicates the time at which meant for beat J occurs.
3.2.2. Morphological features: These features are extracted with
the help of dual-tree complex wavelet transform [11]. The physionet
MIT-BIH database ECG signals are sampled at 360 samples/sec as
a consequence frequency component in ECG signal is in the range
of 0-180 Hz. In this work coefficients of the DTCWT calculated
across the QRS complexes of the electrocardiogram signal.
DTCWT is a powerful technique and it is not sufferred with shift
variance, oscillation and aliasing like DWT and other techniques.
Due to these abilities DTCWT is preferrable for extracting

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morphological features of the QRS complexes. The detection
and reconstruction of a signal having singularities become very
difficult due to the oscillation of the coefficients between positive
and negative values around the singularities in discrete wavelet
transform. This problem overcome by dual tree complex wavelet
transform.
Figure 3: Three levels of DTCWT
Dual tree CWT has complex valued wavelt and scaling function
and they are given as like below
ϕc (t) = ϕreal (t) + jϕim (t) (5)
φc (t) = φreal (t) + jφim (t) (6)
The dual tree complex wavelet uses two real wavelet filters: one is
for collecting real part and another one is for collecting imaginary
part of the resulting transform. Figure 3 shows 3 levels of DTCWT.
Tree A handles the real part and tree B handles the imaginary part
of the of the complex wavelet transform.
3.3. Classifier: Random forest is a smart tool for multi-
classification problems with good classification accuracy. In geneal
random forest classifier is the extension of random tree classifier
and it has multiple decision trees.[12] Random forest technique
was invented by Leo breiman from university of California,United
states. Random forest classifier has the ability to handle large
number of input data. Random forest algorithm integrates multiple
decision trees and provides overall aggregate predictions of those
trees.
Figure 4: Generalised random forest structure
In the proposed random forest applies decision random trees to
classify arrhythmias based on applied features, where the applied
features are extracted by using DTCWT technique [13].During
random forest training, individual decision tree utilise a subgroup
of the features (along with labels information) to develop output
classification model. Each random tree established a classification
based on its trained model and vote for one arrhythmia class among
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all the five classes (P,V,N,R,L). The Random forest algorithm is an
approach with several decision trees [14]. In this work 10-fold cross
validation is used to avoid overfitting problems. 10 different sub-
models were build on 10 training sets consists of 90% of the whole
data. The remaining 10% were used each model [15].
4. Experimental results:
4.1. Data selection: In this piece of work, Performance of the
proposed technique is evaluated by using 48 files of MIT-BIH
arrhythmia database and each file accomadate 30 mins of ECG
signal portion choosen from the 24 hours recording of 48 different
patient files. All the MIT-BIH signals are sampled at 360 hertz.The
following five types of arrhythmias named as Paced (P), Premature
ventricular contraction (V), Normal (N), Right bundle branch block
(R) and Left bundle branch block (L) are classified.
4.2. Metrics: In this paper, we compared proposed method to
four popular methods used for arrhythmia classification interms of
accuracy (Acc), Sensitivity (Se), Specificity (Sp) [16].
Accuracy is defined as the ratio of correctly classified patterns to
the total no of patterns classified.
TP + TN
Accuracy(Acc) = (7)
TP + TN + FP + FN
Sensitivity is defined as the rate of correctly classified events among
all events.
TP
Sensitivity(Sen) = = (8)
TP + FN
Specificity is defined as the rate of correctly classified non events
among all non events.
TP + TN
Specificity(Spe) = (9)
TN + FP
Positive-Predictivity is defined as the rate of correctly classified
events in all detected events.
TP
Positive_predctivity(Ppr) = (10)
TP + FP
where TP, TN, FP, FN are true positive, true negatuve, flase
positive, false negative respectively which can be calculated from
the confusion matrix.
Table 1 indicates the relative performance of proposed work
with the recent works on ECG arrhythmia classification based on
physionet database.The disadvantage of Chazal et al. technique is
that fixed classification technique doesn’t take any variation in ECG
pattern caused by personal or environmental differences. Chazal et
al. are used AAMI standard five heart beat types and only they
used 44 files for the experimental study with classification accuracy
85.90%. In [17] the authors used lyapunov exponents,wavelet
coefficients and they consider power levels of power spectral
density (PSD) values of the Electrocardiogram signal as features
for classifying four types of ECG beats of MIT-BIH database. In
the reported work [6] experimental study conducted on very small
data and DWT which lacks the property of shift invariance due to
the down sampling operation at each stage of DWT implementation.
Due to these resons classification accuracy achieved only 93.90%.
The diagonal elements of the confusion matrix specifies the
correctly classiifed instances corresponding to their individual
classes. From Table 2, it is clear that 197 N arrhythmia beats,
398 V arrhythmia beats, 67 P arrhythmia beats, 310 L arrhythmia
beats, 310 R arrhythmia beats are misclassified. Fig.5 represents
predicted patterns of five types of arrhythmias.V arrhythmia beat is
very important in clinical diagnosis for cardiac arrhythmia patient.
Compared to the previous techniques random forest classified V
beat with better accuracy.The proposed method classifies N,P,L,R,V
with sensitivity of 99.74%, 99.05%, 96.16%, 95.88%, 94.42%
respectively. The proposed technique provides best overall accuracy
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Table 1 Summary of the techniques on ECG arrhythmia classification using MIT-BIH database
Literature Features Classifier Classes Accuracy (%)
De Chazal et al. Morphology and heart beat interval Linear discriminant 5 85.90
Ubeyli Lyapunov exponents and wavelet coefficients ANN classifier 4 93.90
Hu et al. Time domain features Mixture of experts 2 94.00
Manu Thomas et al. DTCWT features ANN classifier 5 94.64
Proposed method DTCWT features Random forest 5 98.78

R arrhythmia beat detection shows an accuracy of 99.70%,

of 98.78% compared to the all other classifiers. The proposed sensitivity of 95.88%, specificity of 99.99% and positive
technique with random classifier gives higher true positive rate predictivity of 99.86%. F-score is calculated based on precision
(TPR) than false positive rate (FPR) [18]. and recall. F-score provides the most realistic measure of classifier
In [11] M.Thomas et al. selected a window of 128 samples performance.
from right and left of the R-peak of the ECG signal.The final
feature vector consists of an extracted feature set from DTCWT and
four other temporal features.The authors proposed multilayer back
propogation neural network is proposed to classify the five types
of ECG arrhythmias. Multilayer back propogation neural network
is very much sensitive to the hidden layer neurons. When hidden
layer neurons are less,then MLP leads to underfitting. If the hidden
layer neurons are many then it leads to over fitting so that the
fitting curve takes uncontrolled oscillations.Network dysfunction
happens once the weights are adjusted to terribly massive values.
It has the following disadvantages (i) A fixed handcrafted feature
extraction method may not be suitable for extracting features when
classifying beats of a particular person (ii) Complexity in the
structure of this technique imposes difficulty in implementation.
DTCWT is a promising technique even though because of multi
layer back propogation drawbacks final classification accuracy
decreased. These drawbacks can be over come by random forest Figure 5: Patterns classification plot of N, V, P, L, R arrhythmias
algorithm to get better accuracy [19].
Table 3 represents the performance perameters of the classifier
Precision and recall values are calculated using confusion matrix
like accuracy (Acc), sensitivity (Sen), specificity (Spe), positive-
represented in Table 2. Precision is defined as the fraction of
predictivity (Ppr) [20]. All 48 files including four files of paced
instances correctly classified as positive out of all the instances
beats also included for the performance evaluation of the classifier.
the algorithm classified as positive, whereas recall is the fraction
For 48 files the N arrhythmia beat detection shows an accuracy of
of elements correctly classified as positive out of all the positive
98.93% , sensitivity of 99.74%, specificity of 96.85% and positive
elements [21].
predictivity of 98.78%, V arrhythmia beat detection shows an
accuracy of 99.39% , sensitivity of 94.42%, specificity of 99.76% 2 ∗ TP
and positive predictivity of 96.63%, P arrhythmia beat detection F − score(F) = (11)
2 ∗ TP + FP + FN
shows an accuracy of 99.90% , sensitivity of 99.05%, specificity
of 99.96% and positive predictivity of 99.51%. L arrhythmia beat The overall F-score of a classifier calculated as 98.24 by using
detection shows an accuracy of 99.63% , sensitivity of 96.16%, precision and recall values.
specificity of 99.93% and positive predictivity of 99.11%.
Table 4 True Posive, False positive rates & Roc area of Individual Classes
Class TP Rate FP Rate ROC Area
Table 2 Classification results of MIT-BIH arrhythmia database N 0.997 0.031 0.999
V 0.944 0.002 0.999
Class Confusion matrix [DTCWT] P 0.990 0.000 1.000
N V P L R L 0.962 0.001 0.999
N 74788 142 9 42 4 R 0.959 0.000 0.999
V 357 6730 21 17 3
P 43 23 6953 1 0
L 250 54 3 7759 3 ROC area is used to evoluate the performance of the classifier
R 272 16 1 10 6952 [22]. An area of 1.000, 0.500 represents the perfect test and test
fail respectively. Table 4 shows the ROC area of individual five
arrhythmia classes. For all classes ROC area is above 0.9. The
results shows that Random forest classifier works efficiently for the
Table 3 Classification performance of RF with DTCWT features
arrhythmia classification [23].
Performance matrix
Method Class
Acc (%) Sen (%) Spe (%) Ppr (%) 5. Conclusion: In this letter, an automatic classification
N 98.93 99.74 96.85 98.78 approach is proposed to classify the ECG arrhythmia types of
V 99.39 94.42 99.76 96.63 Paced (P), Premature ventricular contraction (V), Normal (N),
Proposed
P 99.90 99.05 99.96 99.51 Right bundle branch block (R) and Left bundle branch block
Method
L 99.63 96.16 99.93 99.11 (L). The experiments are conducted on the standard MIT-BIH
R 99.70 95.88 99.99 99.86 standard physionet dataset [24]. In this work Feature extraction

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