Amplitude of dominant T-wave alternans assessment on ECGs obtained from a biophysical model

The Amplitude of Dominant T-Wave Alternans (ADTWA) is a recently introduced index which quantifies the presence of microvolt T Wave Alternans (TWA) on surface ECG recordings. In this paper we investigate the reliability of ADTWA and its robustness against broadband noise. At this regard, we generated synthetic 12-leads ECG recordings through a forward electrophysiological model and we added TWA, at different extent, by modulating the variation of the repolarization times of transmembrane action potentials across even and odd beats. Using a stochastic model, we derived an analytical relationship between the repolarization variation injected into the model and TWA at the surface, thus offering a strategy to evaluate lead sensitivity. In terms of robustness, the results of the simulations show that ADTWA correctly measured the amplitude of synthetic TWA with an average error of 3.3% ± 5.8% in absence of noise. When a 100 μV peak-to-peak broadband noise is present, its effects on estimation errors were kept limited by singular value decomposition on which ADTWA builds.