Computer simulation of the precordial QRS complex: effects of simulated changes in ventricular wall thickness and...

The cardiac electric field generated by depolarization of the human ventricle is simulated with a computer model which utilizes 1,500 dipoles. The configuration of the ventricles utilized in the model assumed that the cross-sectional shape of the left ventricle was circular and the right ventricular free wall was a portion of an ellipse. The torso was assumed to be homogeneous and infinite. The activation sequence was based on the measurements of Durrer. The depolarizational wave was simulated by dipole layers. The output of the model is presented as a standard multilead precordial ECG. The ECG complexes generated by the model closely resemble the precordial QRS complexes of normal man. Simulated increases in wall thickness (1 to 2.2 X control) were associated with changes in the calculated precordial QRS complexes which were characteristic of left ventricular hypertrophy. Voltage (R in V5 or V6 and S in V1) and QRS duration increased linearly as a function of calculated left ventricular mass. Increases in ventricular activation time were related nonlinearly to changes in left ventricular mass and did not occur in the absence of a simulated increase in wall thickness. The effects of simulated changes in left ventricular volume (0.6 to 3.0 X control) on the QRS complex were mainly dependent on the resultant increase in left ventricular mass. This model may be useful in simulating the precordial QRS complexes that result from isolated or combined changes in ventricular volume or wall thickness or other disorders of the heart. Furthermore, it may be useful whenever a simulation of a QRS generator is needed.