Detection of T wave beta-to-beat variations prior to ventricular arrythmias onset in ICD-stored intracardiac electrograms: the endocardial T-wave alternans study (ETWAS)

Autor: Philippe, Maury, Chao, Lin, Jean-Luc, Pasquié, Frank, Raczka, Lionel, Beck, Jérôme, Taieb, Corinne, Mailhes, Jean-Yves, Tourneret, Anne, Rollin, Alexandre, Duparc, Pierre, Mondoly, Pierre, Winum, Philippe, Rolland, Francis, Castanié, Benoit, Hallier
Přispěvatelé: CHU Toulouse [Toulouse], Signal et Communications (IRIT-SC), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées, Télécommunications Spatiales et Aéronautiques - Telecommunications for Space ant Aeronautics (TéSA), Laboratoire de recherche coopératif dans les télécommunications spatiales et aéronautiques (TESA), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier du Pays d'Aix, CoMputational imagINg anD viSion (IRIT-MINDS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), St Jude Medical, St. Jude Medical International, Inc., Zaventem, Belgium
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Zdroj: Pacing and Clinical Electrophysiology
Pacing and Clinical Electrophysiology, Wiley, 2014, 37 (11), pp.1510--1519. ⟨10.1111/pace.12453⟩
ISSN: 0147-8389
1540-8159
DOI: 10.1111/pace.12453⟩
Popis: International audience; Background: The aim of the Endocardial T-Wave Alternans Study was to prospectively assess thepresence of T-wave alternans (TWA) or beat-to-beat repolarization changes on implantable cardioverter-defibrillator (ICD)-stored electrograms (EGMs) immediately preceding the onset of spontaneous ventriculartachycardia (VT) or fibrillation (VF). Methods: Thirty-seven VT/VF episodes were compared to 116 baseline reference EGMs from the same57 patients. A Bayesian model was used to estimate the T-wave waveform in each cardiac beat and a setof 10 parameters was selected to segment each detected T wave. Beat-by-beat differences in each T-waveparameter were computed using the absolute value of the difference between each beat and the followingone. Fisher criterion was used for determining the most discriminant T-wave parameters, then top-Mranked parameters yielding a normalized cumulative Fisher score>95% were selected, and analysis wasapplied on these selected parameters. Simulated TWA EGMs were used to validate the algorithm. Results: In the simulation study, TWA was detectable even in the case of the smallest simulatedalternans of 25μV. In 13 of the 37 episodes (35%) occurring in nine of 16 patients, significant largerbeat-to-beat variations before arrhythmia onset were detected compared to their respective references(median one positive episode per patient). Parameters including the T-wave apex amplitude seem themore discriminant parameters.Conclusions:Detection of beat-by-beat repolarization variations in ICD-stored EGMs is feasible ina significant subset of cases and may be used for predicting the onset of ventricular arrhythmias.
Databáze: OpenAIRE
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