Body Surface Potential Distribution Research Articles

The Role of Transmural Repolarization Gradient in the Inversion of Cardiac Electric Field: Model Study of ECG in Hypothermia.

The changes in ventricular repolarization gradients lead to significant alterations of the electrocardiographic body surface T waves up to the T wave inversion. However, the contribution of a specific gradient remains to be elucidated. The objective of the present investigation was to study the role of the transmural repolarization gradient in the inversion of the body surface T wave with a mathematical model of the hypothermia-induced changes of ventricular repolarization. By means of mathematical simulation, we set the hypothermic action potential duration (APD) distribution on the rabbit ventricular epicardium as it was previously experimentally documented. Then the parameters of the body surface potential distribution were tested with the introduction of different scenarios of the endocardial and epicardial APD behavior in hypothermia resulting in the unchanged, reversed or enlarged transmural repolarization gradient. The reversal of epicardial repolarization gradients (apicobasal, anterior-posterior and interventricular) caused the inversion of the T waves regardless of the direction of the transmural repolarization gradient. However, the most realistic body surface potentials were obtained when the endocardial APDs were not changed under hypothermia while the epicardial APDs prolonged. This produced the reversed and increased transmural repolarization gradient in absolute magnitude. The body surface potentials simulated under the unchanged transmural gradient were reduced in comparison to those simulated under the reversed transmural gradient. The simulations demonstrated that the transmural repolarization gradient did not play a crucial role in the cardiac electric field inversion under hypothermia, but its magnitude and direction contribute to the T wave amplitude.

Forward Problem of Electrocardiography

The relationship between epicardial and body surface potentials defines the forward problem of electrocardiography. A robust formulation of the forward problem is instrumental to solving the inverse problem, in which epicardial potentials are computed from known body surface potentials. Here, the accuracy of different forward models has been evaluated experimentally. Body surface and epicardial potentials were recorded simultaneously in anesthetized closed-chest pigs (n=5) during sinus rhythm, and epicardial and endocardial ventricular pacing (65 records in total). Body surface potentials were simulated from epicardial recordings using experiment-specific volume conductor models constructed from magnetic resonance imaging. Results for homogeneous (isotropic electric properties) and inhomogeneous (incorporating lungs, anisotropic skeletal muscle, and subcutaneous fat) forward models were compared with measured body surface potentials. Correlation coefficients were 0.85±0.08 across all animals and activation sequences with no significant difference between homogeneous and inhomogeneous solutions (P=0.85). Despite this, there was considerable variance between simulated and measured body surface potential distributions. Differences between the body surface potential extrema predicted with homogeneous forward models were 55% to 78% greater than observed (P<0.05) and attenuation of potentials adjacent to extrema were 10% to 171% greater (P<0.03). The length and orientation of the vector between potential extrema were also significantly different. Inclusion of inhomogeneous electric properties in the forward model reduced, but did not eliminate these differences. These results demonstrate that homogeneous volume conductor models introduce substantial spatial inaccuracies in forward problem solutions. This probably affects the precision of inverse reconstructions of cardiac potentials, in which this assumption is made.

Action potential duration gradients in the heart ventricles and the cardiac electric field during ventricular repolarization (a model study)

BackgroundWe simulated contributions of transmural, apicobasal, anteroposterior and interventricular action potential duration (APD) gradients to the body surface potential distribution (BSPD) with constant or varied magnitudes of the transmural and apicobasal gradients. MethodsSimulations were done in the framework of the discrete computer model of the rabbit heart ventricles on the basis of realistic activation sequence and APDs. The APD gradients were set constant at 20ms or varied in the range of ±80ms. ResultsThe apicobasal, transmural and interventricular APD gradients of 20ms produced similar BSPDs, whereas the BSPD inversion was caused by the inverted apicobasal or transmural 80ms gradients. The transmural APD gradient produced transversal and mainly apicobasal T-wave vectors due to wall curvature and cancellation effects. The “normal” transversal and apicobasal repolarization gradients were decreased and increased by activation sequence, respectively. ConclusionThe different APD gradients contributed consistently to the development of BSPD.

Diagnosis of multiple infarcts from complex electrocardiograms during normal rhythm, left bundle-branch block, and ventricular pacing

IntroductionBecause of better treatment of chronic coronary artery disease, patients with multiple ischemic insults are living longer and requiring long-term management. Electrocardiograms (ECGs) in patients with multiple myocardial infarctions (MMIs) are a challenge to the clinician or cardiologist. This is because second myocardial infarctions (MIs) often modify or obscure the ECG effects of the first MI and vice versa. This can result in complex tracings, which are difficult to interpret and predict the locations of damaged regions. It is important to identify MMI because, additively, they can result in poor ventricular function. MethodsNew criteria for the diagnosis of MMI were derived from studies in which ECGs and body surface potential distribution maps were correlated with epicardial and intramural depolarization in animal studies of MI and in patients at the time of coronary artery bypass graft and with the pathologic anatomy in a few patients. The initial criteria were fine tuned by correlations between ECGs and independent data obtained from catheterization and other imaging modalities (ultrasound and radionuclide single photon emission computed tomography). ResultsOften 2 or more MIs are concealed according to classical Q- and R-wave criteria. Myocardial infarctions located in opposing walls (180°), that is, inferior-superior, anterior-posterior, are the most difficult to identify. Two MIs that are not opposing (90°) are usually readily detectable. The pathologic Q waves produced by each separate MI, when opposing, are replaced by multiple QRS deflections or baseline crossings, which are referred to as M and W complexes. These waveforms replace Q waves and are equally weighted in a scoring system to improve diagnostic accuracy of ECG interpretation. These new criteria can also be used to predict MIs in left bundle-branch block, intraventricular conduction delay, and ventricular pacing. ConclusionMultiple myocardial infarctions modify the ECG because they eliminate Q waves and result in confusing, splintered QRS waveforms, referred to as M and W complexes. New criteria are presented to diagnose the presence and locations of these MMIs, which predict reduced left ventricular function, in normal sinus rhythm, left bundle-branch block, and ventricular pacing.

The contribution of ventricular apicobasal and transmural repolarization patterns to the development of the T wave body surface potentials in frogs ( Rana temporaria) and pike ( Esox lucius)

The study aimed at the simultaneous determination of the transmural and apicobasal differences in the repolarization timing and the comparison of the contributions of these two repolarization gradients to the development of the body surface T wave potentials in animals with the single heart ventricle (fishes and amphibians). Unipolar potentials were measured on the body surface, epicardium and in the intramural (subepicardial, Epi; midmyocardial; and subendocardial, Endo) ventricular layers of 9 pike and 8 frogs. Activation times, repolarization times and activation–recovery intervals were determined. A transmural gradient in repolarization durations in frogs (Endo > Epi, P < 0.024) corresponds to the gradient in repolarization times. No significant transmural difference in repolarization duration is observed in pike that produces a repolarization sequence from Endo to Epi (Endo < Epi, P < 0.02) according to the activation sequence. On the apicobasal axis in both species, the repolarization sequence proceeds from apex to base (P < 0.024) which is expressed in similar body surface potential distributions during the T wave in spite of the opposite transmural repolarization patterns. The present study suggests that the apicobasal repolarization gradient provides the major contribution to the development of the T wave potentials on the body surface in pike and frogs.

Origin of the Electrocardiographic U Wave: Effects of M Cells and Dynamic Gap Junction Coupling

The electrophysiological basis underlying the genesis of the U wave remains uncertain. Previous U wave modeling studies have generally been restricted to 1-D or 2-D geometries, and it is not clear whether the U waves generated by these models would match clinically observed U wave body surface potential distributions (BSPDs). We investigated the role of M cells and transmural dispersion of repolarization (TDR) in a 2-D, fully ionic heart tissue slice model and a realistic 3-D heart/torso model. In the 2-D model, while a U wave was present in the ECG with dynamic gap junction conductivity, the ECG with static gap junctions did not exhibit a U wave. In the 3-D model, TDR was necessary to account for the clinically observed potential minimum in the right shoulder area during the U wave peak. Peak T wave simulations were also run. Consistent with at least some clinical findings, the U wave body surface maximum was shifted to the right compared to the T wave maximum. We conclude that TDR can account for the clinically observed U wave BSPD, and that dynamic gap junction conductivity can result in realistic U waves generated by M cells.

Development of a High Precision Body Surface Electrocardiogram

In the 12-lead electrocardiograph currently being used general medical practice, electrodes are positioned at 6 locations in the chest region and the cardiac potential is measured. This research increases the number of electrode to 124 at evenly-spaced intervals over the body surface of the chest, side and back. The commonly used band elimination filter is not used as a countermeasure for exclusion of the noise from such electrodes, and a body surface electrocardiograph has been developed that makes it possible to perform high-speed sampling of the cardiac potential at 80-100 times the conventional rate. From the sampling data obtained with high spatial resolution, maps and animations of the body surface potential distribution are created and displayed from the 1dimension waveform as well as from the 2dimensions/3dimensions waveforms.

Eigenleads: ECG Leads for Maximizing Information Capture and Improving SNR

There is currently much interest in exploring new ways to optimize ECG acquisition. In the current study, we have investigated optimal configurations of ECG leads with respect to: 1) best signal magnitude (maximal signal variance) and 2) best reconstruction of the total body surface potential distribution and the 12-lead ECG. Principal component analysis was applied to a set of 117-lead body surface potential maps (BSPMs) recorded from 559 subjects. Three bipolar leads, referred to as "eigenleads," were identified from the extrema on the resulting eigenvectors. Recording sites for the three leads were largely located in the precordial region. The magnitude of the signals recorded from the eigenleads was calculated on a set of 185 unseen subjects. The accuracy of the eigenleads in the reconstruction of BSPMs and the 12-lead ECG was also assessed for each subject. These results were compared to existing limited lead systems. It was found that, when compared to conventional leads, eigenleads could be used to increase signal strength (rms voltage) by 27.9%, 39.0%, and 20.3% for P-waves, QRS segments, and STT segments, respectively. Although the eigenleads were not able to reconstruct total body surface information as well as the 12-lead ECG (24.4 mu V versus 20.2 mu V), the eigenleads did perform comparably with other limited lead systems in the estimation of the 12-lead ECG. In particular, the eigenleads performed well in the reconstruction of precordial leads in comparison to the EASI lead system and a limited lead system made up of a subset of precordial leads. The proposed leads are a suitable alternative limited leads system, and can be used to improve SNR. More work is needed to test the practicality of such leads.

Ventricular repolarization pattern under heart cooling in the rabbit

Prolongation of ventricular repolarization is characteristic of myocardial cooling. In the present study, we investigated whether this prolongation is uniform or not throughout ventricular epicardium and how these hypothermia-induced changes express in the body surface potential distribution. Epicardial and body surface potential mapping from 64 unipolar leads was carried out in 18 anaesthetized adult rabbits. Mild hypothermia documented by lowering the mediastinal and rectal temperature from 38 to 32 degrees C was elicited by perfusion of the mediastinum with cooled saline. Activation times, repolarization times and activation-recovery intervals were determined in each epicardial lead. Baseline activation-recovery intervals distributed non-uniformly on the ventricular epicardium, increasing progressively from the apex to the base and from the left ventricular (LV) sites to the right ventricular (RV) sites (P < 0.05), governing the repolarization sequence of ventricular epicardium. Heart cooling from 38 to 32 degrees C produced the heterogeneous prolongation of activation-recovery intervals which was more pronounced at the apex than at the base, and in the LV areas compared to the RV areas (P < 0.05). These nonuniform changes in local repolarization durations resulted in the development of base-to-apex repolarization sequence and inversion of the body surface potential distribution during the T wave. Thus, under cooling the rabbit heart from 38 to 32 degrees C, the nonuniform prolongation of local repolarization durations resulted in the reversal of ventricular epicardial repolarization sequence which, in turn, was responsible for the inversion in the body surface potential distribution during the T wave.

P-Wave body surface isointegral maps in children and in young adults

Only limited data are available on body surface potential distribution during atrial activation. The aim of this study was to establish the distributions and to analyze chosen quantitative parameters of atrial isointegral maps recorded using a limited 24-lead system in a young healthy population. A total of 166 subjects underwent a procedure of body surface potential mapping. Isointegral maps during the P wave were constructed and qualitatively and quantitatively evaluated. Three types of atrial activation in individual maps were found according to the different shape of the zero isointegral line and to mutual positions of extrema. The most frequently occurring type resembled the group mean maps and was in good agreement with published data obtained from full lead systems. The highest extrema were found in the young men group, while, surprisingly, the lowest values in the young women group. All minima and the majority of maxima were recorded outside the ranges of standard chest leads. The usefulness of the limited lead system to record isointegral P wave maps was shown and new data were presented that can be useful in noninvasive evaluation of atrial pathologies.

The effect of psychoemotional load on ventricular repolarization reflected in integral body surface potential maps

The aim of the present study was to investigate the reflection of psychoemotional stress in the body surface potential distribution as documented by isointegral maps of cardiac activation and recovery. In 72 young men (18.3+/- 7.3 y.) with no cardiovascular history body surface potential maps (BSPMs) at rest and during the test of mental arithmetic were recorded. The digitalized data for each point of the QRS, STT and QRST integral maps, for each subject in both situations, were processed and evaluated by methods of univariate as well as spatial mathematical and statistical modeling. The results showed during MA a significant decrease of repolarization integral values over the sternum and right precordium, which contributed to analogically localized decrements also in the QRST BSM. The decrease occurred in more than 2/3 of lead points. The most pronounced changes were observed in the right precordial area, where potentials decreased in more than in 70 % of subjects. In conclusion, the discriminative power of the difference STT and QRST integral maps was strong enough to distinguish the mental arithmetic induced changes in the superficial cardiac electric field. These adrenergic transient alterations in ventricular recovery may be of importance in subjects at risk for ventricular arrhythmias.

P-wave body surface potential distribution in rats

The aim of this study was to investigate body surface potential distribution during the P wave in Wistar rats. We performed body surface potential mapping by means of a 64-channel synchronous electrocardiotopography. The positive area covered the caudal part of the thorax, and the negative one covered the cranial part of the thorax. During the P wave, we observed 1 maximum and 1 minimum on the body surface. The dynamics of the P-wave body surface potential distribution in rats was characterized by minor movement of the positive and negative areas, and a counterclockwise shift of the extrema on the ventral body surface. The obtained results are discussed in comparison with those in dogs and humans.

Features of the Heart Electric Field In Children With Long QT Syndrome

Anomalies in the ventricular repolarization process in patients (pts) with congenital long QT syndrome (LQTS) were discussed repeatedly but in no way - anomalies in their ventricular depolarization process. to estimate the features of body surface potential distributions QRS complex and ST-T interval in children with LQTS of different types. body surface potential mapping (BSPM) was carried out in 27 children with congenital LQTS (age - 12,7±3,4; 15 girls, 12 boys). The family history, course of disease, results of clinical tests and genetic analysis (in 15 cases) were the reasons for determining the type of LQTS. 15 pts were attributed to LQT1, 9 pts to LQT2, 1 pt to LQT3, LQT5 and LQT7 accordingly. Cardiag System (Czech Republic) with simultaneous ECG registration in 80 unipolar chest leads was used for BSM at rest. Isopotential and isointegral maps of the QRS complex, ST-T interval and QRST were observed. 5 of 15 pts (33%) with LQT1 revealed accessory negative extrema in the potential distributions during ventricular depolarization (in the middle of ventricular septum and anterior wall of LV projections). The potential distributions during ventricular repolarization in pts with LQT1 had no features. 4 of 9 pts (44%) with LQT2 revealed the wide zone of negative depolarization potentials on the anterior chest surface extending through the anterior wall of RV, top and middle of ventricular septum, whole of anterior wall of LV. 8 of 9 pts (88%) with LQT2 had the extensive zone of negative repolarization potentials on the right and middle chest surface extending to the left up to V6. Pts with LQT3 and LQT5 had no visual features of body surface maps in comparison with normal distributions. The distribution of heart electric field in pt with LQT7 was changed significantly as at de- as at repolarization. The maps of the QRS complex had an extensive negative zone on the anterior chest surface similarly to LQT2, the maps of the ST-T interval presented an extensive negative zone on the back and left chest. Our results testify to the presence of anomalies of both depolarization and repolarization processes in the heart of child with congenital LQTS. Body surface potential distributions in QRS complex and ST-T interval reveal characteristic features of the different localization in children with LQTS1 and LQTS2.

Mining for diagnostic information in body surface potential maps: A comparison of feature selection techniques

BackgroundIn body surface potential mapping, increased spatial sampling is used to allow more accurate detection of a cardiac abnormality. Although diagnostically superior to more conventional electrocardiographic techniques, the perceived complexity of the Body Surface Potential Map (BSPM) acquisition process has prohibited its acceptance in clinical practice. For this reason there is an interest in striking a compromise between the minimum number of electrocardiographic recording sites required to sample the maximum electrocardiographic information.MethodsIn the current study, several techniques widely used in the domains of data mining and knowledge discovery have been employed to mine for diagnostic information in 192 lead BSPMs. In particular, the Single Variable Classifier (SVC) based filter and Sequential Forward Selection (SFS) based wrapper approaches to feature selection have been implemented and evaluated. Using a set of recordings from 116 subjects, the diagnostic ability of subsets of 3, 6, 9, 12, 24 and 32 electrocardiographic recording sites have been evaluated based on their ability to correctly asses the presence or absence of Myocardial Infarction (MI).ResultsIt was observed that the wrapper approach, using sequential forward selection and a 5 nearest neighbour classifier, was capable of choosing a set of 24 recording sites that could correctly classify 82.8% of BSPMs. Although the filter method performed slightly less favourably, the performance was comparable with a classification accuracy of 79.3%. In addition, experiments were conducted to show how (a) features chosen using the wrapper approach were specific to the classifier used in the selection model, and (b) lead subsets chosen were not necessarily unique.ConclusionIt was concluded that both the filter and wrapper approaches adopted were suitable for guiding the choice of recording sites useful for determining the presence of MI. It should be noted however that in this study recording sites have been suggested on their ability to detect disease and such sites may not be optimal for estimating body surface potential distributions.

Depolarization pattern of ventricular epicardium in two‐kidney one‐clip hypertensive rats

The present study is the first attempt to examine the effect of left ventricular hypertrophy (LVH) on the excitation pattern of the ventricular epicardium in experimental hypertensive rats. The left renal artery was clipped in Wistar rats (n = 8; 6-8 months old; weight, 174-295 g) to produce two-kidney one-clip (2K1C) hypertension. After 4 weeks, blood pressure was measured, and epicardial potential mapping was performed under sinus rhythm from 64 unipolar electrodes regularly distributed over the ventricular epicardium. Systolic blood pressure was approximately 40% higher in the rats with a clipped renal artery (162 +/- 14 mmHg, mean +/- s.d.) than in the normotensive rats (115 +/- 3 mmHg). LVH (approximately 23% increase in the ratio of the left ventricular weight to the body weight, P < 0.05) was observed in the 2K1C hypertensive rats. The depolarization pattern of the ventricular epicardium in the normotensive rats was similar to that in the rats with 2K1C hypertensive LVH. The duration of ventricular epicardial activation was shown to increase (approximately 35%, P < 0.05) in the hypertensive rats as compared to the normotensive animals. This study provides an explanation for alterations of the body surface potential distribution in hypertensive patients with LVH.

Changes in body surface potential distributions induced by isoproterenol and Na channel blockers in patients with the Brugada syndrome

Background: The characteristics of unique ECG findings in the Brugada syndrome have not been well explained. Methods: To clarify their characteristics and mechanisms, body surface maps (BSM) were recorded from patients with the Brugada syndrome (13 cases; a mean age of 48 years) before and after administration of isoproterenol (ISP) or Na channel blockers (12 cases). Results: ST elevation in V1–V3 was decreased by 0.1 mV or more after ISP infusion in 8 of 11 cases and elevated after Na channel blockers in 8 of 12. In ventricular activation time (VAT) isochronal map, delayed conduction was noted on upper anterior chest in 11 and on anterior left chest in two. Delayed conduction areas were decreased by ISP and expanded by Na channel blockers. QRST isointegral map showed normal findings in baseline with minimal changes after ISP or Na channel blockers. Activation recovery interval (ARI) isochronal map showed prolonged area on upper anterior chest in baseline, being reduced by ISP and expanded by Na channel blockers. ARI dispersion (ARI-d), defined as difference between the maximum and minimum value of ARI, was larger in Brugada patients than that of normal subjects in baseline, and decreased after ISP and increased after Na channel blockers. Conclusion: ST elevation in the Brugada syndrome is primarily caused by abnormality in depolarization rather than in repolarization. BSM can provide better information to clarify a mechanism of ECG changes adding its diagnostic value for this unique syndrome.

Derivation of an optimal lead set for measuring ectopic atrial activation from the pulmonary veins by using body surface mapping

Atrial fibrillation is often initiated by atrial premature beats originating in the pulmonary veins. Non-invasive localization of these ectopic beats would be of significant value in guiding therapy. Body surface potential mapping was performed in nine patients undergoing invasive electrophysiologic study. Signals were recorded from 62 electrodes during pace mapping from each of the pulmonary veins. Optimal electrodes for localizing pulmonary vein activation were sequentially chosen. Seven optimal electrodes (6 anterior, 1 posterior) for recording ectopic atrial activation originating in the pulmonary veins were selected. The seven optimal elctrode set performed better than the standard 9 electrode ECG at estimating the full body surface map (correlation 97 vs. 95.7%; p<0.05). Seven optimally selected electrodes can estimate the body surface potential distribution during ectopic atrial activation orignating from the pulmonary veins. The ability of this electrode configuration to discriminate the site of origin of ectopic atrial beats requires prospective evaluation

The effects of inhomogeneities and anisotropies on electrocardiographic fields: a 3-D finite-element study.

The aim of this study was to quantify the effects of selected inhomogeneities and anisotropies on computed electric potential fields associated with the electrocardiographic forward problem. The model construction was based on the Utah Torso model and included geometry for major anatomical structures such as subcutaneous fat, skeletal muscle, and lungs, as well as for epicardial fatpads, major arteries and veins, and the sternum, ribs, spine, and clavicles. Measured epicardial potentials served as the electrical source for solutions to the electrocardiographic forward problems computed using the finite element method (FEM). The geometry of the torso model for each simulation was constant, but different combinations of conductivities were assigned to individual organs or tissues. Comparisons of different conductivity combinations followed one of two basic schemes: 1) a homogeneous torso served as the reference against which we compared simulations with a single organ or tissue and assigned its nominal conductivity, or 2) a fully inhomogeneous torso served as the reference and we removed the effect of individual organs or tissues by assigning it the homogeneous conductivity value. When single inhomogeneities were added to an otherwise homogeneous isotropic model, anisotropic skeletal muscle (at a 15:1 anisotropy ratio) and the right and left lung had larger average effects (12.8, 12.7, and 12.1% relative error (RE), respectively) than the other inhomogeneities tested. Our results for removing single inhomogeneities show that the subcutaneous fat, the anisotropic skeletal muscle (with the degree of anisotropy equal to 7:1), and the lungs have larger average impacts on the body surface potential distributions than other elements of the model (with values of 14.9, 12.6, and 11.7% RE, respectively). The results also show that the size of the effect depended strongly on the distribution of epicardial potentials. The results of this study suggest that accurate representation of tissue inhomogeneity has a significant effect on the accuracy of the forward solution, with regions near the torso surface playing a larger role, in general, than those near the heart.

A computer heart model incorporating anisotropic propagation: III. Simulation of ectopic beats

With the advent of catheter ablation procedures, it has become an important goal to predict noninvasively the site of origin of ventricular tachycardia. Site classifications based on the observed body surface potential maps (BSPMs) during ventricular endocardial pacing, as well as on the patterns of the QRS integrals of these maps, have been suggested. The goals of this study were to verify these maps and their QRS integral patterns via simulation using a computer heart model with realistic geometry and to determine whether the model could improve clinical understanding of these ectopic patterns. Simulation was achieved by initiating excitation of the heart model at different endocardial sites and their overlying epicardial counterparts. This excitation propagated in anisotropic fashion in the myocardium. Retrograde excitation of the model's His-Purkinje conduction system was necessary to obtain realistic activation durations. Simulated BSPMs, computed by placing the heart model inside a numerical torso model, and their QRS integrals were close to those observed clinically. Small differences in QRS integral map patterns and in the positions of the QRS integral map extrema were noted for endocardial sites in the left septal and anteroseptal regions. The simulated BSPMs during early QRS for an endocardial site and its epicardial counterpart tended to be mirror images about the zero isopotential contour, exchanging positive and negative map regions. The simulation results attest to the model's ability to reproduce accurately clinically recorded body surface potential distributions obtained following endocardial stimulation. The QRS integral maps from endocardial sites in the left septal and anteroseptal regions were the most labile, owing to considerable cancelation effects. Conventional BSPMs can be useful to help distinguish between endocardial and epicardial ectopic sites.

A computer heart model incorporating anisotropic propagation: IV. Simulation of regional myocardial ischemia

The main goal of this study was to simulate clinical body surface potential maps, recorded during percutaneous transluminal coronary angioplasty protocols, using a realistic geometry computer heart model. Other objectives were to address the question of reciprocal ST-segment changes observed in the 12-lead electrocardiogram during ischemia and to verify the hypothesis that the shortening of the QRS duration observed in left anterior descending (LAD) coronary artery occlusion may be explained by conduction delay in the septal His-Purkinje system. Simulation was achieved by first introducing into the heart model three transmural zones of mild, moderate, and severe ischemia for assumed occlusions in the LAD, left circumflex, and right coronary arteries. The heart model was then excited, in turn, with these three zones present for assumed occlusions in the LAD, left circumflex, and right coronary arteries. Myocardial conduction velocities in the regions of moderate and severe ischemia were assumed to be reduced to 75 and 50% of normal, respectively. Model action potentials in the mild, moderate, and severely ischemic zones were also altered to reflect known ischemic changes in these action potentials. Body surface potential maps and electrocardiograms were computed by placing the heart model inside a numerical torso model. Simulated map patterns during both ST-segment and QRS were qualitatively similar to clinical maps. Reciprocal ST-segment depression was observed for all three occlusions in remote leads that did not overlie the ischemic zones. QRS shortening due to septal His-Purkinje conduction delay was verified. The simulation results attest to the model's ability to reproduce body surface potential distributions recorded following percutaneous transluminal coronary angioplasty protocols. The simulations also showed that reciprocal ST-segment changes occur as a natural consequence of the primary ischemic region and that there is no need to invoke a second region of ischemia. Finally, the model demonstrated that QRS shortening can occur in LAD occlusion despite a slowing of conduction down the septal His-Purkinje system.