QRS complex duration enhancement as ventricular late potential indicator by signal-averaged ECG using time-amplitude alignments

Ventricular late potentials (VLPs) are small-amplitude waves with a short duration that appear at the end part of the QRS complex, making a QRS complex duration larger. The signal-averaged electrocardiography (ECG) technique enhances VLPs and beats, assuming noise as the only random variable. However, ECG signals are not completely stationary and different elongations appear in both time and amplitude in each beat. This research proposes to use piecewise linear approximation to segment each beat and performs the alignment of the beats using the technique known as derivative dynamic time-warping to have beats better aligned and consequently enhance the presence of VLPs. We recorded high-resolution ECGs (HRECGs) from 50 subjects in supine position with no heart-stroke antecedents. VLPs were created synthetically and added to the HRECGs. Two cases were evaluated: (i) duration of the QRS complexes with VLPs without beats alignment, and (ii) duration of QRS complexes with VLPs using beats alignment in time and amplitude. Considering QRS duration as an indicative of VLP presence, results show that when using beats alignment in time and amplitude it is possible to reach a sensitivity of 0.96 and a specificity of 0.52, as opposed to 0.72 and 0.40, respectively, when using only averaging without beats alignment in time and amplitude.