Nonlinear trend estimation of the ventricular repolarization segment for T-wave alternans detection.

Repolarization alternans or T-wave alternans (TWA) is a subject of great interest as it has been shown as a risk stratifier for sudden cardiac death. As TWA consists of subtle and nonvisible variations of the ST-T complex, its detection may become more difficult in noisy environments, such as stress testing or Holter recordings. In this paper, a technique based on the empirical-mode decomposition (EMD) to separate the useful information of the ST-T complex from noise and artifacts is proposed. The identification of the useful part of the signal is based on the study of complexity in the EMD domain by means of the Hjorth descriptors. As a result, a robust technique to extract the trend of the ST-T complex has been achieved. The evaluation of the method is carried out with the spectral method (SM) over several public domain databases with ECGs sampled at different frequencies. The results show that the SM with the proposed technique outperforms the traditional SM by more than 2 dB. Also, the robustness of this technique is guaranteed as it does not introduce any additional distortion to the detector in noiseless conditions.