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Importance of over-reading ambulatory ECG-based microvolt T-wave alternans to eliminate three main sources of

Nobuhiro Takasugi1, Hiroko Matsuno1, Mieko Takasugi2

  • 1Gifu University Hospital, Gifu, Japan.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|June 27, 2019
PubMed
Abstract

Insights

Automated microvolt T-wave alternans (TWA) measurements can be inaccurate due to non-alternans T-wave changes. Identifying these errors improves the detection of true repolarization alternans during ambulatory ECG monitoring.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Signal Processing

Background:

  • Ambulatory electrocardiogram (ECG)-based microvolt T-wave alternans (TWA) measured by the modified moving average method (MMA-TWA) can be disrupted by T-wave changes mimicking true repolarization alternans.
  • Accurate TWA measurement is crucial for assessing cardiac repolarization abnormalities.

Purpose of the Study:

  • To investigate potential sources of measurement error in automated MMA-TWA.
  • To differentiate true TWA from T-wave changes that mimic TWA.

Main Methods:

  • Studied 19 healthy subjects undergoing 24-hr continuous 12-lead ECG monitoring.
  • Investigated causes of automated MMA-TWA episodes ≥42 µV through visual inspection.
  • Classified TWA measurement errors into artifact, positional changes, and postextrasystolic changes.

Main Results:

  • A total of 2,189 automated MMA-TWA episodes ≥42 µV were observed.
  • The majority of these episodes were identified as measurement errors (99.9%) due to T-wave deformation lacking a repeating pattern.
  • Identified causes included artifact (72.6%), positional T-wave changes (25.5%), and postextrasystolic T-wave changes (1.9%).

Conclusions:

  • Relying solely on automated MMA-TWA values can lead to incorrect TWA measurements.
  • Findings can help reduce false-positive TWA results and improve the detection of true repolarization alternans.
Keywords:
continuous 12-lead electrocardiographyhealthy subjectmicrovolt T-wave alternansmodified moving average method

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