Electrocardiographic Alternans: A New Approach

Marcantoni, Ilaria; Calabrese, Dalila; Chiriatti, Giorgia; Melchionda, Roberta; Pambianco, Benedetta; Rafaiani, Giulia; Scardecchia, Eleonora; Sbrollini, Agnese; Morettini, Micaela; Burattini, Laura

doi:10.1007/978-3-030-31635-8_19

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…Various methods exist and have been tested to measure MTWA (Burattini et al, 2008;Martínez, 2005;Verrier et al, 2011;You et al, 2021), not limited to the spectral method (Smith et al, 1988) and modified moving average method (Nearing & Verrier, 2002), which are integrated into commercial ambulatory ECG monitors or exercise testing workstations. Differences among MTWA measures obtained by different methods are well known in the literature (Bini & Burattini, 2013;Burattini et al, 2009Burattini et al, , 2011Marcantoni et al, 2020). Herewith, we described the possibility of measuring MTWA more conveniently from shorter data signals acquired from portable ECG systems, using the novel EAMF algorithm, in line with the upcoming trend of utilizing digital devices in arrhythmia detection guidelines (Marcantoni et al, 2021;Nurmaini et al, 2021;Svennberg et al, 2022).…”

Section: Discussionmentioning

confidence: 92%

Microvolt T‐wave alternans in early repolarization syndrome associated with ventricular arrhythmias: A case report

Tondas¹,

Batubara²,

Sari³

et al. 2022

Noninvasive Electrocardiol

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Despite early repolarization (ER) syndrome being usually considered benign, its association with severe/malignant ventricular arrhythmias (VA) was also reported.Microvolt T-wave alternans (MTWA) is an electrocardiographic marker for the development of VA, but its role in ER syndrome remains unknown. A 90-second 6-lead electrocardiogram from an ER syndrome patient, acquired with the Kardia recorder, was analyzed by the enhanced adaptive matched filter for MTWA quantification. On V, higher than what was previously observed on healthy subjects using the same method. In our ER syndrome patient, MTWA plays a potential role in VA development in ER syndrome. early repolarization syndrome, electrocardiogram, implantable cardioverter defibrillator, sudden cardiac death, T-wave alternans, ventricular arrhythmias | TONDAS ET AL.also performed a treadmill test while the ECG was being recorded.The initial ECG (Figure 1) showed sinus rhythm and a normal QTc elevation in leads II, III, and aVF. However, during the maximum load of exercise testing, she reported no chest pain, but, suddenly, she felt dizziness and fell into presyncope so that the test was interrupted.Analysis of the ECG (Figure 2) highlighted a wide QRS-complex tachycardia episode that lasted less than 1 minute and terminated spontaneously; afterward, no ST-segment changes occurred.Then, the patient was referred to the tertiary hospital for further workup. The standard 12-lead ECG examination was performed and indicated a peculiar ER pattern in the inferior leads. A 6-lead Alivecor, Inc.) and analyzed for detection using the enhanced adaptive matched filter (EAMF) method (Marcantoni et al., 2021).V for leads I, aVR, and aVL, respectively. MTWA was not measurable in leads II, III, and aVF due to the presence of artifacts. Coronary angiography was also performed to exclude ischemic precursors: Nonsignificant coronary artery disease resulted, with only 20% of distal stenosis in the right coronary artery. Eventually, the negative provocative acetylcholine test and flecainide test ruled out vasospastic angina and Brugada

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Section: Discussionmentioning

confidence: 92%

Microvolt T‐wave alternans in early repolarization syndrome associated with ventricular arrhythmias: A case report

Tondas¹,

Batubara²,

Sari³

et al. 2022

Noninvasive Electrocardiol

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“…This study evaluated ECGA at rest on a patient with MB by using the AMF in order to contribute to have more insight on the relationship of MB with an increased cardiovascular risk due to ECGA. The AMF method was chosen because of its ability to detect time variability of alternans and its versatility in detecting all possible types of alternans [15].…”

Section: Discussionmentioning

confidence: 99%

“…The filtered ECG window is a pseudosinusoid the amplitude of which is zero if ECGA is not present or greater than zero otherwise. PWA, QRSA and TWA amplitudes (µV) were computed as twice the pseudosinusoid amplitude in correspondence of the P wave, the QRS complex and the T wave, respectively [15]. Eventually, PWA, QRSA and TWA areas (PWAA, QRSAA, TWAA; µV×s) were computed as the product of PWA amplitude and P-wave width, of QRSA amplitude and QRS width, and of TWA amplitude and T-wave width, respectively.…”

Section: Automatic Electrocardiographic Alternans Detectionmentioning

confidence: 99%

“…However, a complete vision of possible electrical instability affecting any part of the heart and any phase of the cardiac cycle, thus reflecting into P-wave alternans (PWA) and/or QRS alternans (QRSA), could be very useful [13,14]. Therefore, ECG alternans (ECGA), defined as the prevalent alternans affecting ECG [15], should be considered. Among all computerized methods specifically designed for automatic TWA detection [16][17] there is the adaptive match filter (AMF) method [18].…”

Section: Introductionmentioning

confidence: 99%

“…Among all computerized methods specifically designed for automatic TWA detection [16][17] there is the adaptive match filter (AMF) method [18]. Recently, it was adapted also for PWA and QRSA detection, to achieve a comprehensive investigation of ECGA [15]. This study aims to evaluate ECGA at rest on a patient with MB by using the AMF in order to contribute to the knowledge of the relationship of MB with the predisposition to develop electrical cardiac anomalies.…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic Alternans in Myocardial Bridge: A Case Report

Marcantoni¹,

Menna²,

Rossini³

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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Myocardial bridge (MB) is a congenital heart condition in which a "bridge" of myocardium is overlying a "tunneled" coronary artery. MB can be associated with a series of critical cardiac events. Aim of this study was to evaluate electrocardiographic alternans (ECGA) on a MB patient, being ECGA a cardiac electrical risk index defined as beat-to-beat alternation of electrocardiographic P-wave, QRS-complex and Twave morphology at stable heart rate. ECGA analysis was performed in a 1-hour 12-lead electrocardiographic recording of a 54 years-old MB male patient at rest by application of the heart-rate adaptive match filter method. Areas of P-wave, QRS and T-wave alternans (PWAA, QRSAA, TWAA) were measured, evaluating also the prevalent among the three. Results showed the prevalent alternans was T-wave alternans, being TWAA on average equal to 6.3 µV×s (PWAA=4.7 µV×s, QRSAA=4.3 µV×s); TWAA prevalence occurrence rate was 94% (PWAA: 5%, QRSAA:1%). TWAA was also found to be significantly correlated (ρ=0.72, p<10 -2 ) with heart rate. Eventually, TWAA was at least twice higher than in previously analyzed male healthy subjects. Thus, MB seems to be associated to a higher cardiac electrical risk, possibly especially while performing physical activity at high heart rate.

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