Nondipolar content of T wave derived from a myocardial source simulation with increased repolarization inhomogeneity

Several conditions with repolarization disturbances are associated with increased level of nondipolar components of the T wave. The nondipolar content has been proposed as a measure of repolarization inhomogeneity. This computer simulation study examines the link between increased nondipolar components and increased repolarization inhomogeneity in an established model.

The simulation was performed with Ecgsim software that uses the equivalent double-layer source model. In the model, the shape of transmembrane potential is derived from biological recordings. Increased repolarization inhomogeneity was simulated globally by increasing the variance in action potential duration and locally by introducing changes mimicking acute myocardial infarction. We synthesized surface ECG recordings with 12, 18, and 300 leads. The T-wave residue was calculated by singular value decomposition. The study examined the effects of the number of ECG leads, changes in definition of end of T wave and random noise added to the signal.

Normal myocardial source gave a low level of nondipolar content. Increased nondipolar content was observed in the two types of increased repolarization inhomogeneity. Noise gave a large increase in the nondipolar content. The sensitivity of the result to noise increased when a higher number of principal components were used in the computation.

The nondipolar content of the T wave was associated with repolarization inhomogeneity in the computer model. The measure was very sensitive to noise, especially when principal components of high order were included in the computations. Increased number of ECG leads resulted in an increased signal-to-noise ratio.