{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:23:25Z","timestamp":1788665005469,"version":"build-2803163510"},"reference-count":34,"publisher":"The Royal Society","issue":"89","license":[{"start":{"date-parts":[[2013,12,6]],"date-time":"2013-12-06T00:00:00Z","timestamp":1386288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/royalsociety.org\/journals\/ethics-policies\/data-sharing-mining\/"}],"content-domain":{"domain":["royalsocietypublishing.org"],"crossmark-restriction":true},"short-container-title":["J. R. Soc. Interface."],"published-print":{"date-parts":[[2013,12,6]]},"abstract":"<jats:p>Fragmented QRS (f-QRS) has been proven to be an efficient biomarker for several diseases, including remote and acute myocardial infarction, cardiac sarcoidosis, non-ischaemic cardiomyopathy, etc. It has also been shown to have higher sensitivity and\/or specificity values than the conventional markers (e.g. Q-wave, ST-elevation, etc.) which may even regress or disappear with time. Patients with such diseases have to undergo expensive and sometimes invasive tests for diagnosis. Automated detection of f-QRS followed by identification of its various morphologies in addition to the conventional ECG feature (e.g. P, QRS, T amplitude and duration, etc.) extraction will lead to a more reliable diagnosis, therapy and disease prognosis than the state-of-the-art approaches and thereby will be of significant clinical importance for both hospital-based and emerging remote health monitoring environments as well as for implanted ICD devices. An automated algorithm for detection of f-QRS from the ECG and identification of its various morphologies is proposed in this work which, to the best of our knowledge, is the first work of its kind. Using our recently proposed time\u2013domain morphology and gradient-based ECG feature extraction algorithm, the QRS complex is extracted and discrete wavelet transform (DWT) with one level of decomposition, using the \u2018Haar\u2019 wavelet, is applied on it to detect the presence of fragmentation. Detailed DWT coefficients were observed to hypothesize the postulates of detection of all types of morphologies as reported in the literature. To model and verify the algorithm, PhysioNet's PTB database was used. Forty patients were randomly selected from the database and their ECG were examined by two experienced cardiologists and the results were compared with those obtained from the algorithm. Out of 40 patients, 31 were considered appropriate for comparison by two cardiologists, and it is shown that 334 out of 372 (89.8%) leads from the chosen 31 patients complied favourably with our proposed algorithm. The sensitivity and specificity values obtained for the detection of f-QRS were 0.897 and 0.899, respectively. Automation will speed up the detection of fragmentation, reducing the human error involved and will allow it to be implemented for hospital-based remote monitoring and ICD devices.<\/jats:p>","DOI":"10.1098\/rsif.2013.0761","type":"journal-article","created":{"date-parts":[[2013,10,16]],"date-time":"2013-10-16T05:16:10Z","timestamp":1381900570000},"page":"20130761","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":35,"title":["An automated algorithm for online detection of fragmented QRS and identification of its various morphologies"],"prefix":"10.1098","volume":"10","author":[{"given":"Sidharth","family":"Maheshwari","sequence":"first","affiliation":[{"name":"Department of Electronics and Electrical Engineering, Indian Institute of Technology Guwahati, Guwahati, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Acharyya","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Emilio","family":"Puddu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos B.","family":"Mazomenos","sequence":"additional","affiliation":[{"name":"School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gourav","family":"Leekha","sequence":"additional","affiliation":[{"name":"Department of Electronics and Communication Engineering, The LNM Institute of Information Technology, Jaipur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koushik","family":"Maharatna","sequence":"additional","affiliation":[{"name":"School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Schiariti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2013,12,6]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1253\/jcj.63.25"},{"key":"e_1_3_3_3_2","first-page":"2495","article-title":"Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease","volume":"113","author":"Das MK","year":"2006","journal-title":","},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2006.00094.x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2007.05.003"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.763284"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.10.019"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.03.063"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-12-44"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2009.00320.x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.770917"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","first-page":"A9485","DOI":"10.1161\/circ.124.suppl_21.A9485","article-title":"Fragmented QRS complexes, conduction disorder, and ST segment abnormality on twelve-lead electrocardiography predict severe cardiac manifestation in sarcoidosis","volume":"124","author":"Nagao S","year":"2011","journal-title":"Circulation"},{"key":"e_1_3_3_13_2","first-page":"A20836","article-title":"Prevalence of fragmented QRS complexes in non-ischemic dilated cardiomyopathy patients and long term prognosis","volume":"122","author":"Vanga SR","year":"2010","journal-title":"Circulation"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2010.00353.x"},{"key":"e_1_3_3_15_2","first-page":"A15244","article-title":"Fragmented wide QRS on a 12-lead electrocardiogram increases the risk of ventricular arrhythmias in patients with severe systolic dysfunction","volume":"124","author":"Refaat MM","year":"2011","journal-title":"Circulation"},{"key":"e_1_3_3_16_2","first-page":"II_512","article-title":"Fragmented QRS on a 12-lead ECG is a sign of acute or recent myocardial infarction","volume":"114","author":"Michael MA","year":"2006","journal-title":"Circulation"},{"key":"e_1_3_3_17_2","first-page":"117","article-title":"A time-domain morphology and gradient based algorithm for ECG feature extraction","author":"Mazomenos EB","year":"2012","journal-title":"In 2012 IEEE Int. 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