QRS complex waveform indicators of ventricular activation slowing: Simulation studies.

Diffuse or regional activation slowing in ventricular myocardium can result from different cardiac pathologies, such as left ventricular hypertrophy, ischemia or fibrosis. Altered ventricular activation sequence leads to deformations of the activation front and consequently to the changes in the QRS complex. Using a computer model we simulated the effect of slowed ventricular activation on the QRS waveform with a special interest in ECG changes which reproduce the ECG criteria of left ventricular hypertrophy (ECG-LVH).

The effect of conduction velocity slowing in left ventricular midwall on the QRS complex morphology: A simulation study.

Unlabelled: Midwall fibrosis is a frequent finding in different types of left ventricular hypertrophy. Fibrosis presents a local conduction block that can create a substrate for ventricular arrhythmias and lead to the continuous generation of reentry. Having also impact on the sequence of ventricular activation it can modify the shape of QRS complex.

Imaging QRS complex and ST segment in myocardial infarction.

Background: Acute myocardial infarction creates regions of altered electrical properties of myocardium resulting in typical QRS patterns (pathological Q waves) and ST segment deviations observed in leads related to the MI location. The aim of this study was to present a graphical method for imaging the changes in the sequence of depolarization and the ST segment deviations in myocardial infarction using the Dipolar ElectroCARdioTOpography (DECARTO) method.

Material And Methods: Simulated ECG data corresponding to intramural, electrically inactive areas encircled by transmural areas with slowed impulse propagation velocity in anteroseptal and inferior locations were used for imaging the altered sequence of depolarization and the ST vector.

QRS complex and ST segment manifestations of ventricular ischemia: the effect of regional slowing of ventricular activation.

Objective: Reduction or interruption of the blood supply to myocardium due to occlusion of coronary artery and consequent ischemia leads to changes of electrogenesis: changes in morphology and duration of action potentials and slowing of conduction velocity in the affected area. In this study we simulated the effects of localized changes in depolarization sequence on the QRS and ST segment patterns, using computer modeling.

Methods: The model defines the geometry of cardiac ventricles analytically as parts of ellipsoids and allows changing the velocity of impulse propagation in the myocardium.

Computer simulation of ECG manifestations of left ventricular electrical remodeling.

An increased QRS voltage is considered to be specific for the electrocardiogram (ECG) diagnosis of left ventricular hypertrophy (LVH). However, the QRS-complex patterns in patients with LVH cover a broader spectrum: increased QRS voltage, prolonged QRS duration, left axis deviation, and left anterior fascicular block- and left bundle branch block-like patterns, as well as pseudo-normal QRS patterns. The classical interpretation of the QRS patterns in LVH relates these changes to increased left ventricular mass (LVM) per se, while tending to neglect the modified active and passive electrical properties of the myocardium.

Electrocardiographic patterns of left bundle-branch block caused by intraventricular conduction impairment in working myocardium: a model study.

Unlabelled: By definition, the electrocardiographic (ECG) patterns of left bundle-branch block (LBBB) represent distinctive changes in duration and shape of the QRS complex caused by intraventricular conduction delay in the left ventricle (LV) due to structural abnormalities in the His-Purkinje conduction system and/or ventricular myocardium. However, impaired conduction in the working myocardium is not taken into consideration in the practical ECG diagnosis. Because the degree of LV myocardium impairment could be of importance for clinical evaluation of patients, we studied the effects of blocked and of delayed onsets of activation in the LV to simulate complete and incomplete LBBBs and slowed conduction in the LV myocardium by applying an analytical computer model.

Secondary and primary repolarization changes in left ventricular hypertrophy: a model study.

The contributions of reduced conduction velocity (CV) and prolonged action potential duration (APD) to QT interval prolongation and T wave and T vector loop morphology in left ventricular hypertrophy (LVH) were studied using an analytical computer model. Three types of anatomic LVH were simulated: concentric and eccentric hypertrophy, and left ventricular dilatation. In each LVH type, depolarization changes were simulated by CV slowing and primary repolarization changes by APD prolongation.

Spontaneous variability and reactive postural beat-to-beat changes of integral ECG body surface potential maps.

There is virtually no information on spontaneous variability of ECG body surface potential maps (BSPMs) and on dynamics of their reactive changes in healthy subjects. This study evaluated quantitatively the depolarization (QRS) and repolarization (QRST) parameters derived from the respective integral BSPMs, constructed beat-to-beat, from continual body surface ECG records in 9 healthy men resting supine, during head-up tilting and sitting. Spontaneous variability of the BSPMs parameters, both at rest and during postural reactions, was characterized by significant respiratory and low frequency oscillations, more pronounced when related to repolarization.

Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study.

Unlabelled: The increased QRS voltage is considered to be a specific electrocardiogram (ECG) sign of left ventricular hypertrophy (LVH), and it is expected that the QRS voltage reflects the increase in left ventricular mass (LVM). However, the increased QRS voltage is only one of QRS patterns observed in patients with LVH. According to the solid angle theory, the resultant QRS voltage is influenced not only by spatial (anatomic) but also by nonspatial (electrophysiologic) determinants.

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.

Computer model study of electrocardiologic manifestations in asymmetric left ventricular hypertrophy.

Electrocardiologic criteria of left ventricular enlargement do not take into consideration the eventuality of asymmetric hypertrophy. Since experimental techniques for production of this condition are not available, computer modeling was utilized to study its electrocardiologic manifestations. A computer model of human ventricles with analytically defined geometry, consisting of 142,000 elements (1.

Effect of different sources of ventricular repolarization heterogeneity on the resultant cardiac vectors. A model study.

The computer model of ventricular activation was used to study the effects of eventual differences in the repolarization pattern between the right and the left ventricle, as well as between the apical and the basal parts of the ventricles. All changes in model action potential durations (APDs) were performed in the range corresponding to the APD variability measured in myocytes. The vectorcar-diographical spatial T loop was very sensitive on the changes in the right to left ventricular gradient of APD, while the similar changes in the apico-basal gradient of APD influenced the T loop minimally.

Information on heart repolarization changes obtained from body surface ECG potentials.

Possibility to obtain information about local changes of heart repolarization from body surface potentials was studied on a model. Activation-recovery intervals (ARI) in surface ECG leads were tested as indicators of changed repolarization in the underlying myocardium. ECG signals corresponding to activation of myocardium with normal and changed action potential duration were simulated on the surface of a realistic inhomogeneous torso.

Analysis of the effect of apex-base wall curvature on the vectorial representation of ventricular depolarization: a model study.

A computer model of propagated activation study is presented to investigate the possible effect of the ventricular wall curvature on the vectorial representation of its activation. The shape of the ventricle is changed by gradually decreasing the value of the input parameter determining the relative apex-base curvature of the ventricular wall (rvc) from 1.0 to 0.

Modelling developmental changes of human cardiac electric field in early postnatal period.

In early postnatal life, human cardiac electric field undergoes dramatic changes resulting from the adaptation of the heart to new hemodynamic conditions. For the study of the effect of changes in ventricular geometry as well as in spatial orientation of the heart occurring in this period of life, on the resultant heart vectors, our computer model of propagated activation was used. This model allows to change both mentioned characteristics of ventricles so that they reflect the developmental changes in the human heart.

Role of left ventricular geometry in the alteration of initial QRS vectors due to concentric ventricular hypertrophy.

The relation between serial magnitudes of instantaneous spatial vectors, obtained throughout ventricular depolarization, and echocardiographically estimated left ventricular (LV) mass was investigated in 64 patients with congenital aortic stenosis and in 16 patients with coarctation of the aorta. While the correlation was positive between LV mass and vector magnitudes at 50 and 60 ms after QRS onset (r = .530 and .

Computer simulation of propagated activation in different types of left ventricular enlargement.

An increase of the left ventricular mass does not always have an unambiguous effect on the electro- or vectorcardiographic image of ventricular activation. To analyse this phenomenon, three types of left ventricular enlargement were simulated by a computer model of propagated activation in cardiac ventricles. These were obtained from the reference (normal) left ventricle by an increase of its wall thickness either centripetally or centrifugally, as well as by increase of the ventricular cavity dimensions (dilatation).

An interactive computer model of propagated activation with analytically defined geometry of ventricles.

A computer model of propagated activation in cardiac ventricles was developed for simulation experiments in an interactive regime on personal computers. In the model, the geometry of ventricles is defined by parts of "compound quasi-ellipsoids". The parameters specifying these ellipsoids as well as their spatial positions are derived from input data characterizing the heart geometry.

[Vectorcardiography of variations in localization of specific conduction systems in the left ventricle].

A realistic computer model of propagation of ventricular activation was used to study the effects of varying the position of specific conduction system terminations in the left ventricle and the septum, representing the sites of initial activation, on the resulting simulated spatial heart vectors. Three differently localized foci of initial activation, each of them represented by one model element, were considered: in the central part of the left septal surface, posteriorly at about one third of the distance from the apex to the base, and in the upper part of the anterior free wall. During the model experiments, the positions of the initial activation were shifted +/- 5 model units (ca 5 mm) in the vertical and lateral direction either separately or in different mutual combinations.

[New results in computer simulation of the spread of excitation in the myocardium].

The paper presents the results from three series of simulation experiments performed by means of a realistic computer model of activation propagation in the myocardium. Simulation of two types of hypertrophy showed that hypertrophy of the ventricles without their simultaneous dilatation leaves the parameters of the cardioelectric field virtually unchanged. Change in the activation rate in the layer of elements formed by the intraventricular surface of the cavities, compared to the rate in the other elements of the heart, considerably affects the magnitude and orientation of cardiac vectors during the middle and terminal phase of activation.

Physically corrected orthogonal electrocardiographic lead systems in macaques and baboons.

The adequacy of various physically corrected electrocardiographic lead systems for lower primates was compared with the aid of physical models of the cardiac electrical field. Electrolytic tanks fashioned from plaster casts of the thorax of young adult male and female macaques and baboons were used. A dipole source situated at different points in the heart region simulated the electrical activity of the heart.

Etalon (standard) for surface potential distribution produced by electric activity of the heart.

The authors submit etalon (standard) equipotential maps as an aid in the evaluation of maps of surface potential distributions in living subjects. They were obtained by measuring potentials on the surface of an electrolytic tank shaped like the thorax. The individual etalon maps were determined in such a way that the parameters of the physical dipole forming the source of the electric field in the tank corresponded to the mean vectorcardiographic parameters measured in a healthy population sample.