An in-silico analysis of the effect of heart position and orientation on the ECG morphology and vectorcardiogram parameters in patients with heart failure and intraventricular conduction defects

J Electrocardiol. 2015 Jul-Aug;48(4):617-25. doi: 10.1016/j.jelectrocard.2015.05.004. Epub 2015 May 8.

Abstract

Aim: The aim of this study was to investigate the influence of geometrical factors on the ECG morphology and vectorcardiogram (VCG) parameters.

Methods: Patient-tailored models based on five heart-failure patients with intraventricular conduction defects (IVCDs) were created. The heart was shifted up to 6 cm to the left, right, up, and down and rotated ±30° around the anteroposterior axis. Precordial electrodes were shifted 3 cm down.

Results: Geometry modifications strongly altered ECG notching/slurring and intrinsicoid deflection time. Maximum VCG parameter changes were small for QRS duration (-6% to +10%) and QRS-T angle (-6% to +3%), but considerable for QRS amplitude (-36% to +59%), QRS area (-37% to +42%), T-wave amplitude (-41% to +36%), and T-wave area (-42% to +33%).

Conclusion: The position of the heart with respect to the electrodes is an important factor determining notching/slurring and voltage-dependent parameters and therefore must be considered for accurate diagnosis of IVCDs.

Keywords: Computer simulation; ECG morphology; Geometry; VCG.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / physiopathology*
  • Computer Simulation
  • Diagnosis, Computer-Assisted / methods
  • Electrocardiography / methods
  • Female
  • Heart Conduction System / physiopathology*
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Models, Cardiovascular*
  • Patient Positioning / methods*
  • Patient-Specific Modeling
  • Posture
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Vectorcardiography / methods*