{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T05:08:40Z","timestamp":1778389720336,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"PRIN","award":["MUR 20228ARNXS"],"award-info":[{"award-number":["MUR 20228ARNXS"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Background: Adaptive deep brain stimulation (aDBS) for Parkinson\u2019s disease (PD) relies on accurate detection of beta oscillatory activity. However, electrocardiographic (ECG) artifacts frequently contaminate local field potentials (LFPs), compromising control algorithms. While offline cleaning methods exist, their feasibility for real-time operation within the strict timing constraints of current sensing-enabled devices remains unknown. Methods: We evaluated four ECG removal algorithms, template subtraction (TS), singular value decomposition (SVD), extended SVD (eSVD), and the Perceive toolbox (PR), on simulated datasets (contaminated at \u221230 to +20 dB) and clinical recordings from 20 PD patients. Algorithms were assessed for artifact removal quality (beta power preservation, signal-to-noise ratio) and real-time feasibility (99th percentile processing latency\u2014P99 &lt; 50 ms). Results: Only TS and standard SVD met the real-time feasibility threshold, with TS achieving superior timing consistency (P99 \u2248 10 ms). eSVD and PR proved incompatible with closed-loop requirements (P99 &gt; 90 ms). While eSVD yielded the highest artifact suppression at extreme contamination, it suffered from poor signal preservation at moderate levels. TS demonstrated the best balance, maintaining beta power accuracy within \u00b112% across clinically relevant contamination levels. Conclusions: TS is the recommended method for real-time aDBS applications, offering a safety-critical balance of computational efficiency and biomarker fidelity.<\/jats:p>","DOI":"10.3390\/s26092673","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:12:31Z","timestamp":1777363951000},"page":"2673","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-Time ECG Artifact Removal for Adaptive Deep Brain Stimulation: A Comparative Study"],"prefix":"10.3390","volume":"26","author":[{"given":"Lucrezia","family":"Silvi","sequence":"first","affiliation":[{"name":"Biomedical Engineering Research to Advance and Innovate Translational Neuroscience (BRAIN Unit), Department of Neuroscience, University of Padova, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5898-0967","authenticated-orcid":false,"given":"Valentina","family":"D\u2019Onofrio","sequence":"additional","affiliation":[{"name":"Padova Neuroscience Center (PNC), University of Padova, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Cauzzo","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Research to Advance and Innovate Translational Neuroscience (BRAIN Unit), Department of Neuroscience, University of Padova, 35122 Padua, Italy"},{"name":"Padova Neuroscience Center (PNC), University of Padova, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1040-2807","authenticated-orcid":false,"given":"Angelo","family":"Antonini","sequence":"additional","affiliation":[{"name":"Padova Neuroscience Center (PNC), University of Padova, 35122 Padua, Italy"},{"name":"Department of Neuroscience, University of Padova, 35122 Padua, Italy"},{"name":"Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Camillo Hospital, 30126 Venice, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6601-4964","authenticated-orcid":false,"given":"Andrea","family":"Guerra","sequence":"additional","affiliation":[{"name":"Padova Neuroscience Center (PNC), University of Padova, 35122 Padua, Italy"},{"name":"Department of Neuroscience, University of Padova, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4847-163X","authenticated-orcid":false,"given":"Camillo","family":"Porcaro","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Research to Advance and Innovate Translational Neuroscience (BRAIN Unit), Department of Neuroscience, University of Padova, 35122 Padua, Italy"},{"name":"Padova Neuroscience Center (PNC), University of Padova, 35122 Padua, Italy"},{"name":"Institute of Cognitive Sciences and Technologies (ISTC), National Research Council (CNR), 00185 Rome, Italy"},{"name":"Center of Human Brain Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1056\/NEJMoa060281","article-title":"A Randomized Trial of Deep-Brain Stimulation for Parkinson\u2019s Disease A BS TR AC T","volume":"355","author":"Deuschl","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/jama.2008.929","article-title":"Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients with Advanced Parkinson Disease: A Randomized Controlled Trial","volume":"301","author":"Weaver","year":"2009","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1111\/j.1460-9568.2006.04717.x","article-title":"Reduction in Subthalamic 8\u201335 Hz Oscillatory Activity Correlates with Clinical Improvement in Parkinson\u2019s Disease","volume":"23","author":"Kupsch","year":"2006","journal-title":"Eur. J. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6165","DOI":"10.1523\/JNEUROSCI.0282-08.2008","article-title":"High-Frequency Stimulation of the Subthalamic Nucleus Suppresses Oscillatory \u03b2 Activity in Patients with Parkinson\u2019s Disease in Parallel with Improvement in Motor Performance","volume":"28","author":"Kempf","year":"2008","journal-title":"J. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"042002","DOI":"10.1088\/1741-2552\/ac1d5b","article-title":"Towards Adaptive Deep Brain Stimulation: Clinical and Technical Notes on a Novel Commercial Device for Chronic Brain Sensing","volume":"18","author":"Thenaisie","year":"2021","journal-title":"J. Neural Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1093\/brain\/awx252","article-title":"Beta Burst Dynamics in Parkinson\u2019s Disease off and on Dopaminergic Medication","volume":"140","author":"Tinkhauser","year":"2017","journal-title":"Brain"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tinkhauser, G., and Moraud, E.M. (2021). Controlling Clinical States Governed by Different Temporal Dynamics with Closed-Loop Deep Brain Stimulation: A Principled Framework. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.734186"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.nbd.2018.06.007","article-title":"Beta Burst Coupling across the Motor Circuit in Parkinson\u2019s Disease","volume":"117","author":"Tinkhauser","year":"2018","journal-title":"Neurobiol. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.expneurol.2012.09.013","article-title":"Adaptive Deep Brain Stimulation (ADBS) Controlled by Local Field Potential Oscillations","volume":"245","author":"Priori","year":"2013","journal-title":"Exp. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/ana.23951","article-title":"Adaptive Deep Brain Stimulation in Advanced Parkinson Disease","volume":"74","author":"Little","year":"2013","journal-title":"Ann. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/s41531-022-00350-7","article-title":"Diurnal Modulation of Subthalamic Beta Oscillatory Power in Parkinson\u2019s Disease Patients during Deep Brain Stimulation","volume":"8","author":"Feldmann","year":"2022","journal-title":"npj Park. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e971","DOI":"10.1212\/WNL.0000000000005121","article-title":"Eight-Hours Adaptive Deep Brain Stimulation in Patients with Parkinson Disease","volume":"90","author":"Arlotti","year":"2018","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"012001","DOI":"10.1088\/1741-2552\/ad1dc3","article-title":"Neural Signal Data Collection and Analysis of PerceptTM PC BrainSense Recordings for Thalamic Stimulation in Epilepsy","volume":"21","author":"Sanger","year":"2024","journal-title":"J. Neural Eng."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1038\/s41531-024-00772-5","article-title":"Sensing Data and Methodology from the Adaptive DBS Algorithm for Personalized Therapy in Parkinson\u2019s Disease (ADAPT-PD) Clinical Trial","volume":"10","author":"Stanslaski","year":"2024","journal-title":"npj Park. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1001\/jamaneurol.2025.2781","article-title":"Long-Term Personalized Adaptive Deep Brain Stimulation in Parkinson Disease","volume":"82","author":"Beudel","year":"2025","journal-title":"JAMA Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wilkins, K.B., Melbourne, J.A., Akella, P., and Bronte-Stewart, H.M. (2023). Unraveling the Complexities of Programming Neural Adaptive Deep Brain Stimulation in Parkinson\u2019s Disease. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1310393"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1038\/s41531-025-01124-7","article-title":"Chronic Adaptive Deep Brain Stimulation for Parkinson\u2019s Disease: Clinical Outcomes and Programming Strategies","volume":"11","author":"Busch","year":"2025","journal-title":"npj Park. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.brs.2021.08.016","article-title":"The Sensitivity of ECG Contamination to Surgical Implantation Site in Brain Computer Interfaces","volume":"14","author":"Neumann","year":"2021","journal-title":"Brain Stimul."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.clinph.2022.11.011","article-title":"A Comparison of Methods to Suppress Electrocardiographic Artifacts in Local Field Potential Recordings","volume":"146","author":"Stam","year":"2022","journal-title":"Clin. Neurophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1159\/000521431","article-title":"Artifact Characterization and a Multipurpose Template-Based Offline Removal Solution for a Sensing-Enabled Deep Brain Stimulation Device","volume":"100","author":"Hammer","year":"2022","journal-title":"Ster. Funct. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"014001","DOI":"10.1088\/1741-2552\/adaeee","article-title":"Pitfalls and Practical Suggestions for Using Local Field Potential Recordings in DBS Clinical Practice and Research","volume":"22","author":"Swinnen","year":"2025","journal-title":"J. Neural Eng."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Chen, Y., Ma, B., Hao, H., and Li, L. (2021). Removal of Electrocardiogram Artifacts From Local Field Potentials Recorded by Sensing-Enabled Neurostimulator. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.637274"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/brain\/awx010","article-title":"The Modulatory Effect of Adaptive Deep Brain Stimulation on Beta Bursts in Parkinson\u2019s Disease","volume":"140","author":"Tinkhauser","year":"2017","journal-title":"Brain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1016\/j.brs.2020.09.006","article-title":"Gait-Related Frequency Modulation of Beta Oscillatory Activity in the Subthalamic Nucleus of Parkinsonian Patients","volume":"13","author":"Canessa","year":"2020","journal-title":"Brain Stimul."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1109\/TAU.1967.1161901","article-title":"The Use of Fast Fourier Transform for the Estimation of Power Spectra: A Method Based on Time Averaging over Short, Modified Periodograms","volume":"15","author":"Welch","year":"1967","journal-title":"IEEE Trans. Audio Electroacoust."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1038\/s41593-020-00744-x","article-title":"Parameterizing Neural Power Spectra into Periodic and Aperiodic Components","volume":"23","author":"Donoghue","year":"2020","journal-title":"Nat. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Afshar, P., Khambhati, A., Stanslaski, S., Carlson, D., Jensen, R., Linde, D., Dani, S., Lazarewicz, M., Cong, P., and Giftakis, J. (2013). A Translational Platform for Prototyping Closed-Loop Neuromodulation Systems. Front. Neural Circuits, 6.","DOI":"10.3389\/fncir.2012.00117"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Rodriguez-Zurrunero, R., Araujo, A., and Lowery, M.M. (2021). Methods for Lowering the Power Consumption of OS-Based Adaptive Deep Brain Stimulation Controllers. Sensors, 21.","DOI":"10.3390\/s21072349"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cummins, D.D., Kochanski, R.B., Gilron, R., Swann, N.C., Little, S., Hammer, L.H., and Starr, P.A. (2021). Chronic Sensing of Subthalamic Local Field Potentials: Comparison of First and Second Generation Implantable Bidirectional Systems Within a Single Subject. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.725797"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1038\/s41587-021-00897-5","article-title":"Long-Term Wireless Streaming of Neural Recordings for Circuit Discovery and Adaptive Stimulation in Individuals with Parkinson\u2019s Disease","volume":"39","author":"Gilron","year":"2021","journal-title":"Nat. Biotechnol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1016\/j.clinph.2017.08.028","article-title":"Long Term Correlation of Subthalamic Beta Band Activity with Motor Impairment in Patients with Parkinson\u2019s Disease","volume":"128","author":"Neumann","year":"2017","journal-title":"Clin. Neurophysiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/mds.27996","article-title":"Debugging Adaptive Deep Brain Stimulation for Parkinson\u2019s Disease","volume":"35","author":"Little","year":"2020","journal-title":"Mov. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s13311-018-00705-0","article-title":"Toward Electrophysiology-Based Intelligent Adaptive Deep Brain Stimulation for Movement Disorders","volume":"16","author":"Neumann","year":"2019","journal-title":"Neurotherapeutics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1111\/ene.14801","article-title":"Subthalamic Beta Band Suppression Reflects Effective Neuromodulation in Chronic Recordings","volume":"28","author":"Feldmann","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1749-6632.2012.06650.x","article-title":"What Brain Signals Are Suitable for Feedback Controzl of Deep Brain Stimulation in Parkinson\u2019s Disease?","volume":"1265","author":"Little","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/9\/2673\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T04:15:02Z","timestamp":1778386502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/9\/2673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["s26092673"],"URL":"https:\/\/doi.org\/10.3390\/s26092673","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]}}}