T wave alternans evaluation using adaptive time-frequency signal analysis and non-negative matrix factorization.

Each year 400,000 North Americans die from sudden cardiac death (SCD). Identifying those patients at risk of SCD remains a formidable challenge. T wave alternans (TWA) evaluation is emerging as an important tool to risk stratify patients with heart diseases. TWA is a heart rate dependent phenomenon that manifests on the surface electrocardiogram (ECG) as a change in the shape or amplitude of the T wave every second heart beat. The presence of large magnitude TWA often presages lethal ventricular arrhythmias. Because the TWA signal is typically in the microvolt range, accurate detection algorithms are required to control for confounding noise and changing physiological conditions (i.e. data nonstationarity). In this study, we address the limitations of two common TWA estimation methods, spectral method (SM) and modified moving average (MMA). To overcome their limitations, we propose a modified TWA quantification framework, called Adaptive SM, that uses non-linear time-frequency distribution (TFD). In order to increase the robustness of TWA detection in ambulatory ECGs, we also propose a new technique, called non-negative matrix factorization (NMF)-Adaptive SM. We present the analytical background of these methods, and evaluate their accuracy in detecting synthetic TWA signal in simulated and real-world ambulatory ECG recordings under conditions of noise and data non-stationarity. The results of the numerical simulations support the effectiveness of the proposed approaches for TWA analysis, which may ultimately improve SCD risk assessment.