Comparative Evaluation of Methodologies for T-Wave Alternans Mapping in Electrograms

Electrograms (EGM) recorded from the surface of the myocardium are becoming more and more accessible. T-wave alternans (TWA) is associated with increased vulnerability to ventricular tachycardia/fibrillation and it occurs before the onset of ventricular arrhythmias. Thus, accurate methodologies for...

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Bibliographic Details
Published in:IEEE transactions on biomedical engineering Vol. 61; no. 2; pp. 308 - 316
Main Authors: Orini, Michele, Hanson, Ben, Monasterio, Violeta, Martinez, Juan Pablo, Hayward, Martin, Taggart, Peter, Lambiase, Pier
Format: Journal Article
Language:English
Published: United States IEEE 01.02.2014
The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
Subjects:
Accuracy
Cardiac arrhythmia
Computer Simulation
Coronary Artery Disease - physiopathology
Electrocardiography - methods
Electrodes
Electrograms (EGM)
Estimation
Heart beat
Humans
intracardiac ECG
Models, Cardiovascular
Morphology
Noise
Pericardium - physiopathology
repolarization
Respiration
Signal Processing, Computer-Assisted
T-wave alternans
Temporal distribution
ventricular arrhythmia
ISSN:0018-9294, 1558-2531, 1558-2531
Online Access:Get full text
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Summary:Electrograms (EGM) recorded from the surface of the myocardium are becoming more and more accessible. T-wave alternans (TWA) is associated with increased vulnerability to ventricular tachycardia/fibrillation and it occurs before the onset of ventricular arrhythmias. Thus, accurate methodologies for time-varying alternans estimation/detection in EGM are needed. In this paper, we perform a simulation study based on epicardial EGM recorded in vivo in humans to compare the accuracy of four methodologies: the spectral method (SM), modified moving average method, laplacian likelihood ratio method (LLR), and a novel method based on time-frequency distributions. A variety of effects are considered, which include the presence of wide band noise, respiration, and impulse artifacts. We found that 1) EGM-TWA can be detected accurately when the standard deviation of wide-band noise is equal or smaller than ten times the magnitude of EGM-TWA. 2) Respiration can be critical for EGM-TWA analysis, even at typical respiratory rates. 3) Impulse noise strongly reduces the accuracy of all methods, except LLR. 4) If depolarization time is used as a fiducial point, the localization of the T-wave is not critical for the accuracy of EGM-TWA detection. 5) According to this study, all methodologies provided accurate EGM-TWA detection/quantification in ideal conditions, while LLR was the most robust, providing better detection-rates in noisy conditions. Application on epicardial mapping of the in vivo human heart shows that EGM-TWA has heterogeneous spatio-temporal distribution.
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ISSN:0018-9294
1558-2531
1558-2531
DOI:10.1109/TBME.2013.2289304