Patent Application: US-201113293632-A

Abstract:
various embodiments are directed to signal processing . in accordance with example embodiments , methods and apparatuses involve using at least two electrodes that sense an ecg signal . a denoising module is communicatively coupled to the at least two electrodes , and receives the ecg signal sensed by the sensing electrodes . the denoising module includes circuitry that conditions and digitizes the ecg signal , and a computing circuit that processes the digitized ecg signal to denoise the ecg signal . a communications circuit generates a communication including the denoised ecg signal for access by a remote device .

Description:
various example embodiments of the present invention relate to an active lead for sensing an ecg at or near the surface of the body of a subject , removing in - band noise from the sensed ecg , and providing a denoised output signal similar in amplitude to the sensed ecg signal . the active ecg sensing lead with denoising capability , which is the subject invention , can be used with a large installed base of ambulatory monitoring devices already in existence and can be substituted for commonly used passive sensing leads . while the present invention is not necessarily limited to such applications , various aspects of the invention may be appreciated through a discussion of examples using this context . certain embodiments of the present invention describe the use of multi - domain filtering ( mdf ). the term mdf is used herein to refer to embodiments that use multi - domain signal processing ( mdsp ) to denoise an ecg signal . various embodiments of the present invention are directed to denoising ecg signals sensed at the surface of the body of a human being or animal in the context of this invention , denoising refers to removing in - band noise , or noise present within the bandwidth of the ecg signal . in the following discussion , reference is made to cited references listed in a numbered order near the end of this document , which are fully incorporated herein by reference . these references may assist in providing general information regarding a variety of fields that may relate to one or more embodiments of the present invention , and further may provide specific information regarding the application of one or more such embodiments . according to an example embodiment , and referring to fig1 , skin electrodes 103 are positioned on the chest of a body surface of a subject to be monitored , sense an ecg signal and are electrically connected to conductive wires via snaps 101 . in this embodiment , there are three skin electrodes used to provide two ecg signals ( two channels ). in an alternate embodiment , two electrodes are placed on the skin of the patient to provide a single channel ecg signal . in yet other alternate embodiments , additional skin electrodes and corresponding conductive wires can be added to provide additional ecg signal channels . the conductive wires extend from each snap to a point of convergence where they consolidate into a lead body that connects to denoising module 100 . denoising module 100 outputs a low - level analog signal of an amplitude similar to the ecg signal sensed by skin electrodes 103 . the output signal is conductively communicated by lead body 104 to connector 105 that plugs into ambulatory monitoring device 102 worn by the subject . in this embodiment , ambulatory monitoring device 102 is suspended from lanyard 106 worn around the neck of the monitored subject . in alternate embodiments , skin electrodes may be adhesive backed electrodes such as 3m ( st . paul , minn .) red dot electrodes . alternately , the skin electrodes may be dry electrodes in direct contact with surface tissue and incorporated into an elastic strap worn around the subject &# 39 ; s thorax , such as from polar electro ( kempele , finland ). alternately , the skin electrodes may be dry electrodes positioned or woven into the fabric of a garment worn by the subject and designed to be in contact with the subject &# 39 ; s skin such as is available from textronic , inc . ( wilmington , del .). in one embodiment , a garment has multiple ecg electrodes incorporated into the fabric , each electrically connected to the denoising module . the denoising module could be incorporated into a small pouch in the fabric with a lead body extending from the denoising module for connection to an ambulatory monitoring device . in some embodiments the denoising module can be wirelessly connected to a monitoring device such as a heart rate monitor . alternately , the skin electrodes may be capacitive sensing electrodes such as those described in [ 1 ]. in an embodiment that employs capacitive sensing electrodes , additional signal conditioning circuitry can be used to convert the capacitance modulated signal to a voltage representing the ecg signal for input to denoising module 100 . referring to fig2 , skin electrodes 201 are conductively connected to denoising module 200 by snaps 202 attached to lead wires . signal conditioning and defibrillation protection circuits 209 protect the electronics from damage in the event the patient is defibrillated as well as amplify the sensed ecg signal . in some embodiments , the circuits 209 may include an anti - aliasing filter that removes energy from the signal outside the band of the frequencies contained in the ecg signal . in one embodiment , the device shown in fig2 is implemented for monitoring a human ecg , and the amplifier circuits in 209 increase the amplitude of the sensed ecg by a factor of 1 , 000 from 2 . 5 mv to 2 . 5 volts peak - to - peak and will pass frequencies from 0 . 05 hz to 100 hz . in another embodiment , the device shown in fig2 is used to monitor other species , and the gain and filter settings are different than those used for a human ecg . the conditioned ecg signal is digitized using an analog - to - digital converter ( adc ) 216 in microprocessor chip 210 . in one embodiment , chip 210 is a texas instruments ( dallas , tex .) msp - 430 microcontroller . a 16 - bit risc processor executes algorithms to remove in - band noise . the denoised ecg signal is converted to an analog signal via digital - to - analog converter ( dac ) 218 incorporated in chip 210 . in some embodiments , adc 216 and dac 218 may be separate from microprocessor chip 210 . the analog output signal is conditioned in circuit 211 to provide filtering and any signal level adjustments necessary to provide compatibility with ambulatory monitoring device 215 . the analog output signal is conductively communicated to connector 213 via lead body 212 . connector 213 mates with connector 214 of ambulatory monitoring device 215 . in one embodiment of the present invention , and referring to fig2 , an automatic amplitude control ( aac ) function can be implemented in chip 210 . the aac attempts to maintain relatively constant qrs complex amplitude . this approach is useful , for example , when used with ambulatory monitoring devices 215 having limitations in qrs detection algorithm where changes in amplitude can be detrimental to performance . in some embodiments , ambulatory monitoring device 215 is configured to evaluate the integrity of the conductive coupling between skin electrodes 201 and the skin of the subject . this is performed by circuits within device 215 that measure impedance between skin electrodes 201 . when an impedance level indicative of poor coupling is detected , device 215 may notify the subject of a problem via an alarm . it is therefore useful for this active sensing lead to detect poor quality ecg signals and modulate an impedance measured by device 215 when poor quality ecg signals are detected . in some embodiments , an algorithm implemented by microprocessor 210 monitors the quality of the signal sensed by skin electrodes 201 . if skin electrodes 201 are not making adequate contact with the skin or the skin has not been properly prepared , or the electrodes have not been properly positioned , the signal quality may be poor . when the microprocessor 210 detects that signal quality is unacceptable , it sends a logic level signal to circuit 211 via digital output port 217 to modulate an impedance that is evaluated by ambulatory monitoring device 215 . the impedance can be modulated , for example , by switching a high - value resistor in series with an analog signal line carrying the denoised ecg signal to ambulatory monitoring device 215 . the switch used to insert the series resistor is activated by a logic - level signal provided from chip 210 via digital output port 217 when the algorithm has detected a poor quality signal . in some embodiments , denoising module 200 is powered by a primary cell battery that can be replaced via an access in the housing of module . in some embodiments , denoising module 200 is contained in a sealed housing . this may be useful in preventing ingress of moisture that may negatively impact the reliability of the denoising module . for embodiments where the housing of denoising module 200 is sealed , it is useful to use a rechargeable battery such as lithium ion battery or thin film battery . in this embodiment , battery 207 is recharged by recharging circuit 206 . circuit 206 includes inductor 205 to receive a varying magnetic field induced by inductor 204 . circuit 206 processes the alternating voltage produced by inductor 205 and converts it to a direct current suitable for charging battery 207 . recharging field generator circuit 203 provides a varying voltage to inductor 204 to produce the varying magnetic field . it is anticipated that inductor 204 will be placed near or directly adjacent to the location of inductor 205 in order to facilitate a faster charge time for battery 207 . in some embodiments , it is anticipated that the charge time for battery 207 will be a few hours and that charging will be required every 1 to 4 weeks . power regulation circuits 208 regulate the voltage to circuits 209 and 211 and to microprocessor 210 . in another embodiment a supercapacitor capable of storing a large amount of charge is used to power the denoising module 200 ( e . g ., as an alternative to the battery 207 ). referring to fig3 , the sensed ecg signal from electrodes 301 is conditioned by circuits 302 as described herein . the microprocessor 303 executes an algorithm to remove noise from the input ecg signal . each input channel of the conditioned ecg signal is digitized by an analog - to - digital converter incorporated on the texas instruments ( dallas , tex .) msp - 430 microcontroller chip . in some embodiments , and referring to fig4 , the digitized signal 401 is first processed to remove power line noise ( e . g . either 60 hz or 50 hz , depending upon power line frequency used in individual country ) using notch filter 402 . in one embodiment , notch filter 402 is implemented using infinite impulse response ( iir ) filtering techniques . in other embodiments , power line noise is removed by the denoising process executed by microprocessor 303 in process 403 or 405 . in one embodiment , referring to fig4 , the possible algorithms used for denoising depends upon the number of channels in the ecg signal . if there is only one channel , denoising is directed by decision point 407 to process 405 and is accomplished using one of adaptive filtering , decomposition and thresholding , and multi - domain signal processing ( mdsp ). if there is more than one channel , denoising is directed by decision point 407 to process 403 and is accomplished using one of principal component analysis , adaptive filtering , decomposition and thresholding , and multi - domain signal processing ( mdsp ). following denoising the signal is converted to an analog signal using a digital - to - analog converter at 404 . in one embodiment , and referring to fig5 , the digitized ecg signal 502 is denoised using adaptive filtering techniques [ 4 , 5 ]. the input ecg signal 502 is composed of a desired signal s 1 that is corrupted with noise n 1 . signal 502 is preprocessed to extract a noise reference signal n 2 using reference generator 501 . noise reference signal n 2 is correlated with noise signal n 1 . the adaptive filter algorithm estimates and updates the parameters of adaptive multiplier 503 to minimize the least squared error between the output y of adaptive multiplier 503 and input signal 502 . summation node 504 computes the difference between the input signal 502 and the output of adaptive multiplier 503 . the resulting difference signal e is an estimate of the desired signal s 1 when the least squared error between the output y of 503 and input signal 502 is minimized . in another embodiment reference signal n 2 is acquired independently by a skin electrode , separate from the skin electrodes that produced input signal 502 , rather than generating a reference signal from the input signal 502 . when the reference signal n 2 is a sensed ecg signal s 1 is extracted by minimizing mean square error between input signal 502 and the reference signal n 2 . examples of techniques that minimize mean square error include least - mean squares , normalized least mean squares , recursive least squares , adaptive recurrent filter , fast affine projection , and fast euclidean direction [ 6 ]. in the process 505 , the output signal y of adaptive multiplier 503 is used as an estimate of noise for computing noise power and the denoised signal e output from summation node 504 is used to compute signal power . the snr is then computed in process 505 according to formula : snr db = 10 ⁢ log 10 ⁡ ( p signal p noise ) ( 1 ) where p signal and p noise are respective signal and noise energy . snr is used to evaluate input signal quality . for example , if a skin electrode is not properly attached , the quality will be poor and would result in a low snr value . snr is evaluated relative to a predetermined threshold t 1 in decision point 507 . a logic - level 0 signal is generated in process 508 if snr & lt ; t 1 to signal to circuit 211 of fig2 that a resistor should be inserted into the analog signal line in communication with ambulatory monitoring device 215 . insertion of the resistor effectively increases source impedance in the ecg signal line to ambulatory monitoring device 215 , thereby emulating the situation of an increase in source impedance that would occur if a skin electrode of a passive lead were to have come loose . if the ambulatory monitoring device incorporates a mechanism based upon source impedance to signal to the subject that a lead has come loose , it will generate an alarm signal to that effect , as described herein . ecg signals are reconstructed at 506 . in another embodiment , and referring to fig6 , the digitized ecg signal 601 is denoised using principal component analysis ( pca ). in this embodiment the multi - channel ecg signal is projected onto the domain of its principal components [ 7 ]. the principal components are computed in process 602 by performing eigenvalue or singular value decomposition of the spatial covariance matrix computed from ecg signals . the projection of ecg signals onto the domain of their principal components is performed in process 603 by multiplying the ecg signals by the extracted unitary matrix of eigenvectors or singular vectors . this linear projection results in new signals that are uncorrelated with normalized variance . geometrically , the projection involves rotation and scaling of the data in order to orthogonalize signal components . among the orthogonalized components , the ones with low signal power are often associated with noise and can be removed to achieve denoising . the data are filtered by zeroing the principal components associated with smaller eigenvalues in process 604 . in one embodiment the filtered data can be projected back onto the original domain at 605 using the unitary matrix of eigenvectors to retain original signal morphology . in one embodiment pca is performed in combination with independent component analysis technique ( ica ) [ 8 ] for denoising . in this embodiment , pca is performed as a preliminary step to decorrelate the signals prior to applying ica for noise removal . in various embodiments involving the use of an ica technique for denoising the signal , noise sources are separated by achieving their mutual independence . in one embodiment the problem of maximizing independence of ecg recording from contaminating noise is found as a solution of an optimization problem that maximizes independence between the signal sources . for example , ica techniques can use either higher - order statistics of signal components [ 9 , 10 ] or information - theoretic criteria to maximize independence . information - theoretic criteria that can be applied include maximization of negentropy or its approximation [ 11 ], minimization of mutual information [ 11 ], maximum likelihood estimation [ 12 , 13 ], maximum a posteriori probability [ 14 ], or expectation — maximization of gaussian mixture models of sources [ 15 ]. these solutions can be approximated via efficient numerical methods , such as fastica [ 16 ] and jade [ 11 ] algorithms . in some embodiments , it is useful to compute signal - to - noise ratio ( snr ) of the input signal 601 when denoising using pca . the parameters required in formula 1 , p signal and p noise , can be computed as a byproduct of the pca denoising process . p signal can be estimated as the sum of the eigenvalues of the retained principal components in process 604 . likewise , p noise can be estimated as the sum of the eigenvalues of the principal components removed in process 604 . in another embodiment , and referring to fig7 , the digitized ecg signal 701 is denoised using a signal decomposition and thresholding technique ( sdtt ), in accordance with another example embodiment of the present invention . in process 702 input signal 701 is decomposed into subcomponents in a second domain of larger dimension than the first domain . the dimension of the first domain is defined by the number of observed , or captured , signal channels . the dimension of the second domain is defined by the number of channels multiplied by the number of subcomponents in each channel . decomposition step 702 is performed using one of a variety of transforms that result in a small signal reconstruction error . such transforms may include , for example , a discrete cosine transform [ 17 ], a wavelet related transform [ 19 ], a karhunen - loeve transform [ 21 ], a fourier transform [ 18 ], a gabor transform [ 20 ], or a filter bank [ 19 ]. in one embodiment , denoising is facilitated by a decomposition whereby signal energy is concentrated in a small number of large subcomponent coefficients , while noise is spread out across either many decomposition levels or decomposition levels corresponding to higher frequency and is represented by small coefficients . in process 705 , the signal quality is enhanced by discarding subcomponents below a threshold computed in process 703 . the energy in the discarded subcomponents is used to estimate noise energy in process 705 . signal energy , for computing snr in process 705 is estimated using the residual subcomponents representing the denoised ecg signal . snr is computed from noise energy and signal energy estimates as described herein . in some implementations , instead of discarding subcomponents below a threshold , those subcomponents above a threshold ( the residual subcomponents above ) can be positively identified and used to estimate the signal energy , with the remaining energy being noise . techniques similar to soft or hard thresholding [ 23 ] can be used to remove this noise in process 704 . examples of a threshold selection rule used to compute the noise threshold in process 703 include adaptive threshold selection using the principle of stein &# 39 ; s unbiased risk estimate and fixed threshold based on signal statistics such as sd * sqrt ( 2 * log ( length ( x )), where sd is standard deviation and x is a vector of subcomponents [ 22 ]. the residual subcomponents are combined in process 706 to reconstruct an ecg signal using the inverse of the transform used for signal decomposition in process 702 . referring to fig8 , the digitized ecg is denoised using an mdsp embodiment . input signal 801 is decomposed in process 802 from a first domain into largely uncorrelated subcomponents in a second domain of higher dimension . decomposition in process 802 is accomplished using one of a discrete cosine transform , a karhunen - loeve transform , a fourier transform , a gabor transform , and a filter bank . in another embodiment , decomposition is accomplished using a wavelet - related transform and the decomposition levels correspond to wavelet scales . in another embodiment , decomposition is achieved by representing the observed signals as a linear combination of basis functions . signal decomposition embodiments and the use of subcomponents derived from the decomposition for denoising ( removal of at least some of the in - band noise contained in the signal ), extraction of information from the signal , and evaluation of the accuracy of extracted information is referred to as multi - domain signal processing ( mdsp ) by way of example , in the discussion herein . use of mdsp techniques for removal of in - band noise from a signal is referred to as multi - domain filtering ( mdf ). the dimension of the first domain is defined by the number of ecg channels . the dimension of the second domain is defined by the number of channels multiplied by the number of subcomponents in each channel . following decomposition , signal flow is directed to either process 804 or 805 by decision point 803 , depending upon the number of channels in the signal . if the ecg signal has only one channel , signal flow is directed to process 805 , where either spatially selective filtering ( ssf ) [ 24 , 28 , 29 ] or periodic component analysis [ 25 , 26 ] are used alone or in combination to identify subcomponents that contain more noise energy than signal energy . if the ecg signal has more than one channel , signal flow is directed to process 804 , where either spatially selective filtering , principal component analysis [ 27 ], independent component analysis , or periodic component analysis are used either alone or in combination to identify subcomponents that contain more noise energy than signal energy . a subcomponent that contains more noise than signal energy is said to be associated with noise . conversely , a subcomponent that contains more signal energy than noise energy is said to be associated with a signal . in some embodiments , processes 804 and 805 result in separation of subcomponents into two groups , one associated with noise and the other associated with the ecg signal . determining whether a subcomponent is associated with noise or ecg signal within a targeted interval of time is accomplished by using one or more of principal component analysis ( pca ), independent component analysis ( ica ), periodic component analysis ( πca ) and spatially selective filtering ( ssf ). pca and ica are applicable to multi - lead ecg , while πca and ssf can be applied to either multi - lead or single - lead ecg . the pca technique [ 7 , 27 ] employed in processes 804 and 805 uses subcomponent covariance information to orthogonalize subcomponents . the orthogonalized subcomponents with low signal power are often associated with noise and can be removed to achieve denoising . pca can be used as a preliminary step prior to applying an ica technique . the ica technique further separates signal and noise sources [ 8 ] as a solution of an optimization problem that maximizes independence between them . the πca technique computes and jointly diagonalizes covariance and autocorrelation matrices of subcomponents to separate them based on their periodicity or quasi - periodicity [ 25 , 26 ]. the πca technique extracts most periodic subcomponents corresponding to ecg rhythm and , since noise is not generally periodic , it is left behind . ssf techniques [ 24 , 28 , 29 ] employed in processes 804 and 805 detect one or more signal - related features ( e . g ., qrs complex ) and pass them across the subcomponents while blocking features inherent to noise . the technique relies on the differences of noise and signal distributions across decomposition levels . in one embodiment , spatially selective filtering is facilitated by a decomposition whereby signal energy is concentrated in a small number of large subcomponent coefficients while noise is spread out across many decomposition levels and is represented by small coefficients . techniques similar to wavelet thresholding [ 23 ] can be used to remove this noise . in another embodiment of process 804 and 805 , a spatially selective filtering approach exploits the fact that most noise subcomponents are confined to decomposition levels that represent high frequencies . in this embodiment the locations of signal features are identified by examining subcomponents corresponding to lower frequency . for example , a qrs wave location can be identified as high amplitude changes in peaks and valleys that occur simultaneously across multiple subcomponents associated with lower frequencies . to avoid signal distortion , the subcomponents associated with high frequency are preserved within the time window surrounding the identified peaks and valleys , and are zeroed at other times . by zeroing out the subcomponents or time segments within subcomponents associated with noise , and reconstructing the ecg signal using those subcomponents associated with the ecg signal , the in - band noise level in the ecg is reduced , or “ denoised ”, to create a denoised ecg . the subcomponents identified as associated with noise in processes 804 and 805 are removed and the residual subcomponents are used to reconstruct a denoised ecg signal for each ecg channel in process 806 using the inverse of the transform used to decompose the ecg in process 802 . in some implementations , instead of removing subcomponents that are associated with noise , subcomponents associated with signal energy are identified ( the residual subcomponents above ) and used to estimate the signal energy , with the remaining energy being noise . in some embodiments involving an mdsp - based approach , a signal - to - noise ratio ( dsnr ) is computed as the ratio of the energies in signal and noise subcomponents . in one embodiment , referring to fig8 , following separation of subcomponents into two groups , as described herein in processes 804 and 805 , the power in each of the groups , p signal and p noise , is independently computed and used to compute snr as per formula 1 . referring to fig9 , an example of a two channel ecg signal denoised by an mdsp embodiment is provided . input signals 901 and 902 are recordings of a human ambulatory ecg and were obtained from the mit - bih database . output ecg traces 903 and 904 are shown for each channel . the improvement in snr in this example is approximately 8 db and noise amplitude is reduced by about 85 % with no noticeable distortion . in some embodiments , and referring to fig1 , signal - to - noise ratio is computed for evaluating signal quality . as described herein , a measure of signal quality can be useful to change the effective source impedance of the ecg signal communicated to the ambulatory monitoring device when the device is configured to detect unusually high source impedance as an indicator that an ecg sensing electrode is in poor contact with the skin . in process 1001 , signal and noise are separated . some embodiments for separating signal and noise , described herein , include adaptive filtering , decomposition and thresholding , principal component analysis , and mdsp denoising embodiments . in process 1002 , separated noise and signal are used to estimate signal energy and noise energy . snr is computed in process 1003 , as described herein . the approach used in process 1001 to separate signal and noise would typically match the process technique used for denoising , as the signal and noise values can be computed as a byproduct of the denoising process . hence the technique used in 1001 will depend upon the method of denoising . various embodiments as described herein can be used in connection with ambulatory monitoring devices . for instance , devices as discussed herein can be used as a substitute for existing passive ecg leads used with ambulatory monitoring devices , such as holter monitors , event recorders , and mobile cardiac outpatient telemetry devices . such devices may be used , for example , to improve performance of these devices in one or more of a variety of manners . in some embodiments , denoising module 200 includes a wireless communication link to communicate the denoised ecg to a location away from the body of the subject from which the ecg is obtained . the various computing components , circuits and signal processing methods described herein can be implemented using a variety of devices and methods . for example , computing , logic or processing circuits can be implemented using one or more of : discrete logic circuitry , fully - programmable and semi - programmable circuits such as plas ( programmable logic arrays ), specialized processors or general purpose processors that are specially programmed . combinations of these and other circuit components are also possible and within the scope of various embodiments , including those discussed above . for example , the various components and processes shown in the figures can be implemented in a variety of circuit - based forms , such as through the use of data processing circuit modules . such systems are exemplified by implementation in high - speed programmable computer / processor circuits , or in combination with discrete and or semi - programmable circuitry ( e . g ., as field - programmable gate arrays , programmable logic devices / arrays ). for general information regarding a variety of fields that may relate to one or more embodiments of the present invention , and for specific information regarding the application of one or more such embodiments , reference may be made to the following documents , which are fully incorporated herein by reference . various ones of these references are further cited above via corresponding numerals , and may be implemented as such . 1 . akinori ueno , et al . capacitive sensing of electrocardiographic potential through cloth from the dorsal surface of the body in a supine position : a preliminary study . ieee transactions on biomedical engineering , vol . 54 , no . 4 , april 2007 , pp 759 - 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( 1995 ), “ de - noising by soft - thresholding ,” ieee trans . on inf . theory , 41 , 3 , pp . 613 - 627 . 24 . xu , yansun , et . al . wavelet transform domain filters : a spatially selective noise filtration technique , ieee transactions on image processing 1994 , vol . 3 , no 6 , pp . 747 - 758 25 . l . k . saul and j . b . allen , “ periodic component analysis : an eigenvalue method for representing periodic structure in speech .,” in nips , [ online ] 2000 , pp . 807 - 813 . available : http :// www . cs . cmu . edu / groups / nips / 00papers - pub - on - web / saulallen . pdf 26 . r sameni , et . al . multichannel electrocardiogram decomposition using periodic component analysis . ieee transactions on biomedical engineering , 2008 vol 55 , no 8 pp 1935 - 1940 27 . aminghafari , m . ; cheze , n . ; poggi , j - m . ( 2006 ), “ multivariate de - noising using wavelets and principal component analysis ,” computational statistics & amp ; data analysis , 50 , pp . 2381 - 2398 28 . mallat , s . g ., hwang , w . l ., singularity detection and processing with wavelets , ieee transactions on information technology ( 38 ), 1991 , pp . 617 - 643 . 29 . pan q ., zhang l . dai g . and et al . two denoising methods by wavelet transform . ieee trans . on sp ., 1999 , 47 ( 12 ): 3401 - 3406 based upon the above discussion and illustrations , those skilled in the art will readily recognize that various modifications and changes may be made to the present invention without strictly following the exemplary embodiments and applications illustrated and described herein . for exam , various aspects are directed to signal processing such as denoising using one or more approaches as described in one or more of the priority documents referenced above and incorporated herein . one such aspect involves the denoising of an ecg signal using one or more approaches described in connection with multi - domain signal processing as described in these documents . such modifications and changes may include , for example , incorporating one or more aspects described in the above references and / or applying one or more embodiments thereto , or combining embodiments . these and other modifications do not depart from the true spirit and scope of the present invention , including that set forth in the following claims .