A simulation study of the effects of torso inhomogeneities on electrocardiographic potentials, using realistic heart and torso models.

The effects of torso inhomogeneities on electrocardiographic potentials were investigated via computer stimulation, using a 23-dipole heart model placed within a realistically shaped human torso model. The transfer coefficients relating the individual dipoles to the torso surface potentials, as well as the body surface potential maps, the vectorcardiogram, and the 12-lead electrocardiogram resulting due to normal activation of the heart model, were calculated for each of the following torso conditions: homogeneous, homogeneous + skeletal muscle layer, homogeneous + muscle layer + lungs, and homogeneous + muscle layer + lungs + intraventricular blood masses. The effects of each inhomogeneity were deduced by comparing results before and after its inclusion. For individual dipole transfer coefficients we confirm the validity of the "Brody effect," whereby the high conductivity blood masses augment radially oriented dipoles and diminish tangentially oriented ones. With regard to the vectorcardiogram , the electrocardiogram, and the body surface potential maps, the major qualitative effects were an augmentation of the head-to-foot component of the vectorcardiogram due to the lungs, and a smoothening of notches in the electrocardiogram (temporal filtering) and of isopotential contours in the body surface potential maps (spatial filtering) with a consequent loss of information, due to the blood masses, muscle layer, and, to a lesser extent, the lungs. Besides the above qualitative effects of the inhomogeneities, there were also large quantitative effects on the surface potentials, namely, magnitude increases due to the blood masses and magnitude decreases due to the muscle layer, that--if unaccounted for--could compromise the inverse solution of these potentials for the cardiac dipole sources.