Detection of T-wave alternans in fetal magnetocardiography using the generalized likelihood ratio test

T-wave alternans (TWA) is an indicator of cardiac instability and is associated with life-threatening ventricular arrhythmias. Detection of TWA in the adult has been widely investigated and is used routinely for cardiac risk assessment. Detection of TWA in the fetus, however, is much more difficult due to the low amplitude and variable configuration of the signal, the presence of strong interferences, and the brevity of fetal TWA episodes. In this paper, we present a statistical detector based on the generalized likelihood ratio test that is designed for detection of TWA in the fetus. The performance of the detector is evaluated by constructing receiver-operator characteristic curves, using simulated data and real data from subjects with macroscopic TWA. The detector is capable of detecting TWA episodes as brief as 20 beats. The detection performance is improved significantly by modeling the fetal T-wave as a low-rank, low bandwidth signal, and using maximum likelihood estimation to estimate the model parameters. This approach enables all of the data to be used to estimate the noise statistics, providing highly effective suppression of interference, including maternal interference. The method is suitable for routine use because it can be applied to raw, unprocessed recordings, allowing automated analysis of extended fetal magnetocardiography recordings.