Medical & Biological Engineering & Computing

, Volume 47, Issue 1, pp 11–20 | Cite as

Application of the fastest route algorithm in the interactive simulation of the effect of local ischemia on the ECG

  • Peter M. van DamEmail author
  • Thom F. Oostendorp
  • Adriaan van Oosterom
Original Article


A method is described to determine the effect on the ECG of a reduced propagation velocity within an ischemic zone. The method was designed to change the activation sequence throughout the ventricles interactively, i.e. with a response time in the order of a second. The timing of ventricular ischemic activation was computed by using the fastest route algorithm, based on locally reduced values of the propagation velocities derived from a standard, normal activation sequence. The effect of these local reductions of the velocities on the total activation sequence, as well as the changes in the electrocardiogram that these produce, are presented.


Shortest path algorithm Isochrones of depolarization wave Ischemia Heart ECG ECGSIM 



The authors would like to thank Geertjan Huiskamp for providing us with the tools to simulate the normal activation sequence in the anisotropic model of the (canine) ventricle, and Prof. P. Hunter of the University of Auckland for making the canine heart model (set A) publicly available. The authors express their appreciation to the reviewers whose suggestions helped to improve the manuscript.


  1. 1.
    Bronson R (1982) Network analysis. In: Theory and problems of operations research. McGraw-Hill, Inc, New York, pp 169–172Google Scholar
  2. 2.
    Carmeliet E (1999) Cardiac ionic currents and acute ischemia: from channels to arrhythmias. Physiol Rev 79(3):917–1017Google Scholar
  3. 3.
    Coronel R, Casini S, Koopmann TT, Wilms-Schopman FJG, Verkerk AO, de Groot JR et al (2005) Right ventricular fibrosis and conduction delay in a patient with clinical signs of brugada syndrome: a combined electrophysiological, genetic, histopathologic, and computational study. Circulation 112(18):2769–2777. doi: 10.1161/CIRCULATIONAHA.105.532614 CrossRefGoogle Scholar
  4. 4.
    Demoulin JC, Kulbertus HE (1972) Histopathological examination of concept of left hemiblock. Br Heart J 34(8):807–814. doi: 10.1136/hrt.34.8.807 CrossRefGoogle Scholar
  5. 5.
    Dubé B, Gulrajani RM, Lorange M, LeBlanc AR, Nasmith J, Nadeau RA (1996) A computer model incorporating anisotropic propagation. IV Simulation of regional myocardial ischemia. J Electrocardiol 29:91–103. doi: 10.1016/S0022-0736(96)80118-X CrossRefGoogle Scholar
  6. 6.
    Durrer D, van Dam RT, Freud GE, Janse MJ, Meijler FL, Arzbaecher RC (1970) Total excitation of the isolated human heart. Circulation 41:899–912Google Scholar
  7. 7.
    Elharrar V, Zipes DP (1977) Cardiac electrophysiologic alterations during myocardial ischemia. Am J Physiol Heart Circ Physiol 233(3):H329–H345Google Scholar
  8. 8.
    Hooft van Huysduynen B, Swenne CA, Draaisma HHM, Antoni LL, van der Wall EE, Schalij MJ (2005) Validation of ECG indices of ventricular repolarization heterogeneity. J Cardiovasc Electrophysiol 16:1097–1103. doi: 10.1111/j.1540-8167.2005.40758.x CrossRefGoogle Scholar
  9. 9.
    Huelsing DJ, Spitzer KW, Cordeiro JM, Pollard AE (1998) Conduction between isolated rabbit Purkinje and ventricular myocytes coupled by a variable resistance. Am J Physiol Heart Circ Physiol 274(4):H1163–H1173Google Scholar
  10. 10.
    Huiskamp GJM (1998) Simulation of depolarization and repolarization in a membrane equations based model of the anisotropic ventricle. IEEE Trans Biomed Eng BME 45(7):847–855. doi: 10.1109/10.686792 CrossRefGoogle Scholar
  11. 11.
    Hunter PJ, Nielsen PM, Smaill BH, LeGrice IJ, Hunter IW (1992) An anatomical heart model with applications to myocardial activation and ventricular mechanic. CRC Crit Rev Biomed Eng 20:403–426Google Scholar
  12. 12.
    Janse MJ, Wit AL (1989) Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiol Rev 69(4):1049–1169Google Scholar
  13. 13.
    Kleber AG, Janse MJ, Wilms-Schopmann FJ, Wilde AA, Coronel R (1986) Changes in conduction velocity during acute ischemia in ventricular myocardium of the isolated porcine heart. Circulation 73(1):189–198Google Scholar
  14. 14.
    Kleber AG, Rudy Y (2004) Basic Mechanisms of Cardiac Impulse Propagation and Associated Arrhythmias. Physiol Rev 84(2):431–488. doi: 10.1152/physrev.00025.2003 CrossRefGoogle Scholar
  15. 15.
    Oosthoek PW, Viragh S, Lamers WH, Moorman AF (1993) Immunohistochemical delineation of the conduction system II: the atrioventricular node and Purkinje fibers. Circ Res 73(3):482–491Google Scholar
  16. 16.
    Potse M, Coronel R, LeBlanc AR, Vinet A (2007) The role of extracellular potassium transport in computer models of the ischemic zone. Med Biol Eng Comput 45(12):1187–1199. doi: 10.1007/s11517-007-0276-9 CrossRefGoogle Scholar
  17. 17.
    Potse M, Dumé B, Richer J, Vinet A, Gulrajani RM (2006) A comparison of monodomain and bidomain reaction–diffusion models for action potential propagation in the human heart. IEEE Trans Biomed Eng 53(12):2425–2435. doi: 10.1109/TBME.2006.880875 CrossRefGoogle Scholar
  18. 18.
    Press WH, Flannery BP, Teukolski SA, Vetterling WT (1988) Numerical recipes in C. The art of scientific computing. Cambridge University Press, CambridgezbMATHGoogle Scholar
  19. 19.
    Pressler ML, Münster PN, Huang XD (1995) Gap juction distribution in the heart: functional relevance in Cardiac Electrophysilogy. In: Zipes DP, Jalife J (eds) From cell to bedside. Saunders, London, pp 144–151Google Scholar
  20. 20.
    Roberts D, Hersh L, Scher A (1979) Influence of cardiac fiber orientation on wavefront voltage, conduction velocity, and tissue resistivity in the dog. Circ Res 44:701–712Google Scholar
  21. 21.
    Sano T, Takayama N, Shimamoto T (1959) Directional differences of conduction velocity in the cardiac ventricular syncytium studied by microelectrodes. Circ Res VII:262–267Google Scholar
  22. 22.
    Spach MS, Dolber PC (1986) Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res 58(3):356–371Google Scholar
  23. 23.
    Svendsen M, Oostendorp TF, Berbari E (2007) Evaluation of auto-regressive modeling procedures for the detection of abnormal intra-QRS potentials using a boundary element electrocardiogram model in computers in cardiology. In: Murray A (ed) Computers in cardiology, vol 34. Durham, NC, pp 289–292Google Scholar
  24. 24.
    van Dam PM, van Oosterom A (2003) Atrial excitation assuming uniform propagation. J Cardiovasc Electrophysiol 14(s10):S166–S171. doi: 10.1046/j.1540.8167.90307.x CrossRefGoogle Scholar
  25. 25.
    van Dam PM, van Oosterom A (2005) Volume conductor effects involved in the genesis of the P wave. Europace 7:S30–S38. doi: 10.1016/j.eupc.2005.03.013 Google Scholar
  26. 26.
    van Oosterom A (2001) Genesis of the T wave as based on an equivalent surface source model. J Electrocardiogr 34(Supplement 2001):217–227. doi: 10.1054/jelc.2001.28896 CrossRefGoogle Scholar
  27. 27.
    van Oosterom A (2002) Solidifying the solid angle. J Electrocardiol 35S:181–192. doi: 10.1054/jelc.2002.37176 CrossRefGoogle Scholar
  28. 28.
    van Oosterom A, Oostendorp TF (2004) ECGSIM: an interactive tool for studying the genesis of QRST waveforms. Heart 90(2):165–168. doi: 10.1136/hrt.2003.014662 CrossRefGoogle Scholar
  29. 29.
    van Oosterom A, van Dam PM (2005) The intra-myocardial distance function as used in the inverse computation of the timing of depolarization and repolarization. Comput Cardiol 32:567–570. doi: 10.1109/CIC.2005.1588164 CrossRefGoogle Scholar
  30. 30.
    Wellens HJJ, Conover MB (2006) The ECG in emergency decision making. Saunders/Elsevier, St LouisGoogle Scholar
  31. 31.
    Wilson RJ (1975) Introduction to graph theory. Longman, LondonGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2008

Authors and Affiliations

  • Peter M. van Dam
    • 1
    Email author
  • Thom F. Oostendorp
    • 2
  • Adriaan van Oosterom
    • 3
  1. 1.Research, Medtronic SQDMArnhemThe Netherlands
  2. 2.Department of Cognitive NeuroscienceUniversity Medical Center St. RadboudNijmegenThe Netherlands
  3. 3.Department of CardiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

Personalised recommendations