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Electrical current paths in acute pericarditis

B S Teh¹, J Walsh, A J Bell

¹Department of Medicine, University of Tasmania, Hobart, Australia.

Journal of Electrocardiology

|October 1, 1993

Summary

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Electrocardiogram (ECG) ST elevation in pericarditis is caused by current flowing outward from the epicardium. This current returns to the heart via the great vessels and atria, as shown by body surface potential mapping.

Area of Science:

Cardiology
Electrophysiology
Medical Imaging

Background:

Pericarditis commonly presents with ST elevation on a 12-lead electrocardiogram (ECG).
The underlying mechanism for this ST elevation is attributed to local epicardial inflammation.
A proposed current pathway involves flow from the epicardium back into the endocardium via great vessels and atria.

Purpose of the Study:

To investigate the epicardial current flow patterns during pericarditis.
To test the hypothesis of current returning to the heart through great vessels and atria.

Main Methods:

Body surface potential mapping was performed on 18 patients with pericarditis.
Inverse epicardial potential distributions were computed.
Maps were compared to normal subjects and patients with acute anterior myocardial infarction.

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Main Results:

Epicardial maps revealed a consistent pattern of current flow into the heart over the great vessels and atria in all pericarditis patients.
This specific current flow pattern was absent in normal subjects and myocardial infarction patients.
The findings support the proposed current return pathway.

Conclusions:

The study confirms that ST elevation in pericarditis results from epicardial current flowing outward and returning via the great vessels and atria.
This mechanism explains the characteristic ECG findings in pericarditis.
Body surface potential mapping provides valuable insights into cardiac electrophysiology during inflammatory conditions.