Dynamic Tracking of Cardiac Vulnerability by Complex Demodulation of the T Wave

Nearing, Bruce D.; Huang, Alice H.; Verrier, Richard L.

doi:10.1126/science.2017682

Cited by 298 publications

(153 citation statements)

References 22 publications

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“…Several methods exist to automatically detect and estimate TWA. 12 Two commercially available techniques are the spectral method (SM) 23,26 and the modified moving average method 22 ; alternative techniques are the complex demodulation method 20 and the Laplacian likelihood ratio method (LLR). 11,13 A major limitation of these methods is their poor sensitivity to low-amplitude alternans 12,19 due to a lack of robustness to noise.…”

Section: Introductionmentioning

confidence: 99%

A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG

et al. 2010

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Abstract-T-wave alternans (TWA) is a cardiac phenomenon that appears in the electrocardiogram (ECG) and is associated with the mechanisms leading to sudden cardiac death (SCD). In this study, we propose the use of a multilead TWA analysis scheme that combines the Laplacian likelihood ratio (LLR) method and periodic component analysis (pCA), an eigenvalue decomposition technique whose aim is to extract the most periodic sources of the signal. The proposed scheme is evaluated in different scenarios-from synthetic signals to stress test ECGs-and is compared to other reported schemes based on the LLR method. Results demonstrate that the pCA-based scheme provides a superior ability to detect TWA than previously reported schemes, and has the potential to improve the prognostic value of testing for TWA.

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Section: Introductionmentioning

confidence: 99%

A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG

et al. 2010

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“…[1][2][3][4][5] The transition from concordant to discordant action potential duration (APD) alternans is also a harbinger of vulnerability to ventricular fibrillation. 6 -10 Recent optical mapping studies by Pastore et al 9 linked these 2 findings by demonstrating that with increasing pacing rate, APD first alternates concordantly throughout the tissue (causing T-wave alternans) and then becomes spatially discordant, with areas of long-short APD alternation adjacent to areas with short-long APD alternation (causing both QRS and T-wave alternans).…”

mentioning

confidence: 99%

Mechanisms of Discordant Alternans and Induction of Reentry in Simulated Cardiac Tissue

Qu¹,

et al. 2000

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Background-T-wave alternans, which is associated with the genesis of cardiac fibrillation, has recently been related to discordant action potential duration (APD) alternans. However, the cellular electrophysiological mechanisms responsible for discordant alternans are poorly understood. Methods and Results-We simulated a 2D sheet of cardiac tissue using phase 1 of the Luo-Rudy cardiac action potential model. A steep (slope Ͼ1) APD restitution curve promoted concordant APD alternans and T-wave alternans without QRS alternans. When pacing was from a single site, discordant APD alternans occurred only when the pacing rate was fast enough to engage conduction velocity (CV) restitution, producing both QRS and T-wave alternans. Tissue heterogeneity was not required for this effect. Discordant alternans markedly increases dispersion of refractoriness and increases the ability of a premature stimulus to cause localized wavebreak and induce reentry. In the absence of steep APD restitution and of CV restitution, sustained discordant alternans did not occur, but reentry could be induced if there was marked electrophysiological heterogeneity. Both discordant APD alternans and preexisting APD heterogeneity facilitate reentry by causing the waveback to propagate slowly. Conclusion-Discordant alternans arises dynamically from APD and CV restitution properties and markedly increases dispersion of refractoriness. Preexisting and dynamically induced (via restitution) dispersion of refractoriness independently increase vulnerability to reentrant arrhythmias. Reduction of dynamically induced dispersion by appropriate alteration of electrical restitution has promise as an antiarrhythmic strategy. (Circulation.

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“…They have defined a unified methodological framework of TWA analysis to compare 12 methods with one other, including complex demodulation [9], KL transform [10], Poincaré mapping [11], periodicity transforms [12], the Laplacian likelihood ratio [13], the correlation method [14], and the capon filtering method [15].…”

Section: Previous Research On Quantification Of T-wave Alternansmentioning

confidence: 99%

Fractal-Dimension-Based Method for Quantification of T-Wave Alternans Using Short Time Series

Sakai¹

2013

J Comput Sci Syst Biol

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The presence of T-Wave Alternans (TWA) in an electrocardiogram (ECG) has been certified as an important predictor for the risk of sudden cardiac death (SCD). TWA is a beat-to-beat change in the amplitude of a T-wave, but is rarely visible to the naked eye. Thus, automatic detection and quantification of TWA are desirable. While several automatic algorithms, such as the periodogram method or the modified moving average method (MMA), have been developed to detect or quantify TWA, most conventional methods do not effectively measure short-duration TWA (SDTWA) (<16 beats). In this paper, we proposed a fractal dimension based SDTWA quantification method, and evaluated it with simulated ECG signals with SDTWA episodes (<16 beats) based on the European ST-T database. In the evaluation, the proposed method was applied to ECG signals with TWA amplitude of 5, 15, 30, 45, 60 and 75 μV. Sensitivity and positive predictivity of over or closed to 90% were obtained except for the 5 μV SDTWA episodes. Even for 5 μV SDTWA episodes, the sensitivity reached 75%. We believe that proposed s fractal dimension based method is a promising method for SDTWA analysis.

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Dynamic Tracking of Cardiac Vulnerability by Complex Demodulation of the T Wave

Cited by 298 publications

References 22 publications

A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG

A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG

Mechanisms of Discordant Alternans and Induction of Reentry in Simulated Cardiac Tissue

Fractal-Dimension-Based Method for Quantification of T-Wave Alternans Using Short Time Series

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