Trajectory analysis of ECG motif dynamics in the run-up to sudden cardiac arrest

Nivedita Bijlani1 and Mauricio Villarroel2
1The Podium Institute for Sports Medicine and Technology, University of Oxford, 2University of Oxford


Abstract

Early warning signatures of sudden cardiac arrest (SCA) remain poorly characterised in long-duration ECG. We quantified pre-event changes in ECG morphology using a motif-based trajectory framework. Holter ECGs from 23 patients with annotated SCA were analysed over non-overlapping 10 s windows. Window-level motifs were extracted to quantify trajectories of instability, consistency, dispersion, heterogeneity, and personalised-baseline distance. Each trajectory was normalised to an early baseline using z-scores and aligned to ventricular fibrillation (VF) onset. Abnormal burden was defined as the proportion of windows with z>=3 within a rolling 10-minute window. Median sustained abnormal burden onset occurred 5.8-8.4 h before VF across morphological metrics. Motif dispersion showed the most consistent long-horizon detection, with sustained abnormal burden >=1 h before VF in 100% of patients and >=2 h in 89%. Motif consistency showed the strongest late-stage change, with 70% median abnormal burden in the final 10 min. Peak morphological deviation occurred ~2h prior to VF. Our label-free framework transforms longitudinal ECG analysis from an event detection approach towards a continuous characterisation of evolving cardiac change, enabling a personalised early warning of SCA, well suited to long-duration wearable ECG monitoring.