Multiple components in the unipolar electrogram: a simulation study in a three-dimensional model of ventricular myocardium.

Abstract

INTRODUCTION: For many decades, the interpretation of unipolar electrograms (EGs) and ECGs was based on simple models of the heart as a current generator, e.g., the uniform dipole layer, and, more recently, the "oblique dipole layer." However, a number of recent and old experimental data are inconsistent with the predictions of these models. To address this problem, we implemented a numerical model simulating the spread of excitation through a parallelepipedal myocardial slab, with a view to identifying the factors that affect the shape, amplitude, and polarity of unipolar EGs generated by the spreading wavefront. METHODS AND RESULTS: The numerical model represents a portion of the left ventricular wall as a parallelepipedal slab (6.5 x 6.5 x 1 cm); the myocardial tissue is represented as an anisotropic bidomain with epi-endocardial rotation of fiber direction and unequal anisotropy ratio. Following point stimulation, excitation times in the entire volume are computed by using an eikonal formulation. Potential distributions are computed by assigning a fixed shape to the action potential profile. EGs at multiple sites in the volume are computed from the time varying potential distributions. The simulations show that the unipolar QRS waveforms are the sum of a "field" component, representing the effect of an approaching or receding wavefront on the potential recorded by a unipolar electrode, and a previously unrecognized "reference" component, which reflects the drift, during the spread of excitation, of the reference potential, which moves from near the positive to near the negative extreme of the potential distribution during the spread of excitation. CONCLUSION: The drift of the reference potential explains the inconsistencies between the predictions of the models and the actual shapes of the EGs. The drift modifies the slopes of EG waveforms during excitation and recovery and can be expected to affect the assessment of excitation and recovery times and QRS and ST-T areas. Removing the drift reestablishes consistency between potential distributions and electrographic waveforms.