Genesis of the P wave: atrial signals as generated by the equivalent double layer source model

To assess the effectiveness of the equivalent surface source model in the simulation of atrial signals as observed in ECG leads.

P waves were extracted from 64-lead ECGs recorded in healthy subjects. The geometries of torso, lungs, heart, and blood cavities of a healthy subject, derived from magnetic resonance imaging, were used to position a detailed, thick-walled 3D model of the atria consisting of a set of 800,000 units representing the activity of all atrial myocytes. The ion-kinetics of the units was based on the formulation of Courtemanche et al. The simulated transmembrane potentials following a normal sinus beat, as well as those during atrial fibrillation, were projected on the 1297 nodes of the surface encapsulating all atrial myocytes (endocardium and epicardium). The transmembrane potentials at these nodes formed the source strengths of the elements of the equivalent generator, which were used to compute body surface potentials.

After invoking slight adaptations of the timing of depolarization of the transmembrane potentials, the simulated signals during the P wave closely corresponded to recorded ones. The correspondence during the entire PR interval improved markedly after the inclusion of early repolarization effects in the interval between the end of the P wave and onset of QRS. This demanded a shortening of the mean action potential duration generated by the Courtemanche model. The simulated ECGs related to atrial fibrillation demonstrated the characteristic features of those clinically observed.

The equivalent double layer is a useful source model for the genesis of atrial signals observed on the thorax. The interval from the end of the P wave to onset of QRS is not iso-electric. The Courtemanche model of the ion-kinetics of atrial cells needs to be adapted when applied to represent the activity of healthy, 'common' atrial myocytes.