Effects of heart position on the body-surface electrocardiogram

Previous studies have examined the influence of body position, respiration, and habitus on body surface potentials. However, the authors could only estimate the sources of the effects they documented. Among the proposed origin of changes in body surface potentials from those studies were the position of the heart, alterations in autonomic tone, differences in ventricular blood volume, and variations in torso resistivity. The goal of this study was to investigate specifically the role of geometric factors in altering body surface potentials and the electrocardiogram. For this, we used experiments with an isolated, perfused dog heart suspended in a realistically shaped electrolytic torso tank. The experimental preparation allowed us to measure epicardial and tank surface potentials simultaneously, and then reconstruct the geometry of both surfaces. Our results mimicked some of the features described by previous investigators. However, our results also showed differences that included considerably larger changes in the peak QRS and T-wave amplitudes with heart movement than those reported in human studies. We detected smaller values of root-mean-squared variability from heart movements than those reported in a human study comparing body surface potentials during change in inspiration and body position. There was better agreement with relative variability, which in these studies ranged from 0.11 to 0.42, agreeing well with an estimate from human studies of 0.40. Our results suggest that the isolated heart/torso tank preparation is a valuable tool for investigating the effects of geometric variation. Furthermore, the geometric position of the heart appears to be a large source of variation in body surface potentials. The size of these variations easily exceeded thresholds used to distinguish pathologic conditions and thus such variations could have important implications on the interpretation of the standard electrocardiogram.