title: An in-silico analysis of the effect of heart position and orientation on the ECG morphology and vectorcardiogram parameters in patients with heart failure and intraventricular conduction defects.
abstract: OBJECTIVE
  The aim of this study was to investigate the influence of geometrical factors on the ECG morphology and vectorcardiogram (VCG) parameters.
  
  
  METHODS
  Patient-tailored models based on five heart-failure patients with intraventricular conduction defects (IVCDs) were created. The heart was shifted up to 6 cm to the left, right, up, and down and rotated ±30° around the anteroposterior axis. Precordial electrodes were shifted 3 cm down.
  
  
  RESULTS
  Geometry modifications strongly altered ECG notching/slurring and intrinsicoid deflection time. Maximum VCG parameter changes were small for QRS duration (-6% to +10%) and QRS-T angle (-6% to +3%), but considerable for QRS amplitude (-36% to +59%), QRS area (-37% to +42%), T-wave amplitude (-41% to +36%), and T-wave area (-42% to +33%).
  
  
  CONCLUSIONS
  The position of the heart with respect to the electrodes is an important factor determining notching/slurring and voltage-dependent parameters and therefore must be considered for accurate diagnosis of IVCDs.
authors.affiliation: Faculty of Medicine, Maastricht University, Maastricht, the Netherlands.
authors.forename: Uyên Châu
authors.initials: UC
authors.lastname: Nguyên
authors.affiliation: Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland. Electronic address: mark@potse.nl.
authors.forename: Mark
authors.initials: M
authors.lastname: Potse
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Maria Luce
authors.initials: ML
authors.lastname: Caputo
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Romina
authors.initials: R
authors.lastname: Murzilli
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Muzzarelli
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
authors.forename: Enrico G
authors.initials: EG
authors.lastname: Caiani
authors.affiliation: Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.affiliation: Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Krause
authors.affiliation: Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland; Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D056888:Patient Positioning / Q000379:methods*; D066230:Patient-Specific Modeling; D011187:Posture; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014672:Vectorcardiography / Q000379:methods*
keywords: Computer simulation; ECG morphology; Geometry; VCG