T-Wave Alternans in Nonpathological Preterm Infants

Ann Noninvasive Electrocardiol. 2020 Jul;25(4):e12745. doi: 10.1111/anec.12745. Epub 2020 Jan 27.


Background: Sudden infant death syndrome is more frequent in preterm infants (PTI) than term infants and may be due to cardiac repolarization instability, which may manifest as T-wave alternans (TWA) on the electrocardiogram (ECG). Therefore, the aim of the present work was to analyze TWA in nonpathological PTI and to open an issue on its physiological interpretation.

Methods: Clinical population consisted of ten nonpathological PTI (gestational age ranging from 29 37 to 34 27 weeks; birth weight ranging from 0.84 to 2.10 kg) from whom ECG recordings were obtained ("Preterm infant cardio-respiratory signals database" by Physionet). TWA was identified through the heart-rate adapting match filter method and characterized in terms of mean amplitude values (TWAA). TWA correlation with several other clinical and ECG features, among which gestational age-birth weight ratio, RR interval, heart-rate variability, and QT interval, was also performed.

Results: TWA was variable among infants (TWAA = 26 ± 11 µV). Significant correlations were found between TWAA versus birth weight (ρ = -0.72, p = .02), TWAA versus gestational age-birth weight ratio (ρ = 0.76, p = .02) and TWAA versus heart-rate variability (ρ = -0.71, p = .02).

Conclusions: Our preliminary retrospective study suggests that nonpathological PTI show TWA of few tens of µV, the interpretation of which is still an open issue but could indicate a condition of cardiac risk possibly related to the low development status of the infant. Further investigations are needed to solve this issue.

Keywords: T-wave alternans; arrhythmias-risk index; heart-developing marker; heart-rate adaptive match filter; preterm infant; sudden infant death syndrome.

MeSH terms

  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / physiopathology*
  • Electrocardiography / methods*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Male
  • Retrospective Studies