Anisotropic mechanisms for multiphasic unipolar electrograms: simulation studies and experimental recordings.

The origin of the multiple, complex morphologies observed in unipolar epicardial electrograms, and their relationships with myocardial architecture, have not been fully elucidated. To clarify this problem we simulated electrograms (EGs) with a model representing the heart as an anisotropic bidomain with unequal anisotropy ratio, ellipsoidal ventricular geometry, transmural fiber rotation, epi-endocardial obliqueness of fiber direction and a simplified Purkinje network. The EGs were compared with those directly recorded from isolated dog hearts immersed in a conducting medium during ventricular excitation initiated by epicardial stimulation. The simulated EGs share the same multiphasic character of the recorded EGs. The origin of the multiple waves, especially those appearing in the EGs for sites reached by excitation wave fronts spreading across fibers, can be better understood after splitting the current sources, the potential distributions and the EGs into an axial and a conormal component and after taking also into account the effect of the reference or drift component. The split model provides an explanation of humps and spikes that appear in the QRS (the initial part of the ventricular EG) wave forms, in terms of the interaction between the geometry and direction of propagation of the wave front and the architecture of the fibers through which excitation is spreading.