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This contribution demonstrates some applications of the most recent release of ECGSIM, an interactive simulation program that enables the user to study the relationship between the electric current sources of the heart and the resulting electrocardiographic signals on the body surface as well as those on the surface of the heart. It aims to serve as an educational tool as well as a research tool. The examples are drawn from the topics discussed by the participants of the Magnetic Anatomic and eLectrical Technology meeting in Maastricht, the Netherlands (February 2011), reports of which are to be found in the current issue of the Journal of Electrocardiology. These examples include simulation of the atrial electrocardiogram, improved accessibility of endocardial source locations, and an explanation of ST elevations accompanying true TQ depressions., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Discussion about the selection of diagnostic features of the ECG and their possible interpretation would benefit from a model of the genesis of these signals that has a sound basis in electrophysiology as well as in physics. Recent advances in computer technology have made it possible to build a simulation package whereby the genesis of ECG signals can be studied interactively., Design: A numerical method was developed for computing ECG signals on the thorax, as well as electrograms on both endocardium and epicardium. The source representation of the myocardial electric activity is the equivalent double layer. The transfer factors between the electric sources and the resulting potentials on the heart surface as well as on the body surface were computed using a realistic thorax model., Results and Conclusion: The resulting transfer factors were implemented in a simulation program. The program allows the user to make interactive changes in the timing of depolarisation and repolarisation on the ventricular surface, as well as changing the local source strength, and to inspect or document the effect of such changes instantaneously on electrograms and body surface potentials, visualised by waveforms as well as by potential maps and movies. The entire simulation package can be installed free of charge from www.ecgsim.org.

In this study, we investigated the accuracy of an algorithm to identify the spatial single equivalent moving dipole parameters in a realistic anatomic geometry torso model from potentials at the body surface. Specifically we investigated the effect of measurement noise, and dipole position and orientation in the accuracy of the algorithm. The boundary element method was used to calculate the forward potential distribution at 64 electrode positions on the body surface due to a point dipole. The mean and standard deviation of the distance of the true (obtained in the forward potential calculation) minus the estimated dipole location (obtained from the inverse algorithm) was estimated for each of the above three cases. Our results indicate that the dipole position has the most significant influence on the accuracy of our inverse algorithm.

The pathways along which the electrical currents generated by the fetal heart are conducted to the surface of the maternal abdomen are not known. As a consequence, in recording the fetal electrocardiogram (FECG) it is hard to predict where electrodes should be placed in order to obtain an optimal signal. The amplitude of the FECG varies with gestation, and there is a large interindividual variability in the amplitude of the FECG and in the optimal recording site among subjects within the same gestational age. Attempts have been made to explain these phenomena in terms of volume conduction. In this research the complete potential distribution on the maternal abdomen is studied in connection with the geometrical configuration of the electrical source (fetal heart) and the volume conductor (surrounding tissues). For a small group of pregnant women the abdominal FECG is recorded simultaneously in 32 leads during a period of about one minute, once every two weeks from 20 weeks of gestation onwards. A spatial filtering technique which combines information of all 32 leads is used to provide a trigger of the fetal QRS complexes. Using this trigger, an average fetal complex is constructed for each lead by time coherent averaging, after subtraction of the maternal contribution. These average fetal complexes are combined to plot the complete potential distribution generated by the fetal heart at the maternal abdomen (fetal body surface map, FBSM) at any given time instant during the fetal cardiac cycle. At these recording sessions the geometry is carefully quantified by making transverse scans every 2 cm with a compound echo scanner. The contours of fetal head and body, the placenta and the uterus are manually drawn on hardcopies of the video display images. Real time echoscopy is used to support the identification of the geometry. The contours are fed into a computer using a graphics tablet. The three dimensional surfaces of fetus, placenta and uterus are separately represented by a triangulation of the respective contour lines. Figures 5 and 6 show an example of the triangulated representation of the recorded geometry. Figure 7 shows the average fetal complexes of an individual at 26 weeks of gestation, plotted at the site where they have been recorded.(ABSTRACT TRUNCATED AT 400 WORDS)