Generation Of ECG

Of the millions of individual cells in the heart that depolarize during a cardiac
cycle, only groups of cells in the myocardium depolarize at any given instant.
Each group of cells which is simultaneously depolarizing may be represented as
an equivalent current dipole source to which a vector is associated, describing
the dipole's time-varying position, orientation, and magnitude. The related
vectors of all these groups can be summed to give a "dominant" vector which
describes the main direction of the electrical impulse, see Figure 6.3.

Figure. 6.3 The vector associated with each group of cells in the myocardium,
during both depolarization and repolarization, can be summed into a dominant
vector describing the main direction of the electrical impulse.
The dipole/vector representation has proven very useful for understanding how
the waves of the ECG are generated as recorded by electrodes attached to the
body surface. 1 Figure 6.4 illustrates the sequence of vectors associated with
different phases of depolarization and repolarization and the related ECG wave,
in this example viewed by an exploring electrode which is positioned on the
chest (known as lead V5, see below). This electrode position primarily reflects
the activity of the left ventricle, although the activity of the atria and the right
ventricle can also be observed.
Before a new heartbeat is initiated by the SA node, all cardiac cells are at rest,
which is reflected by a horizontal line (the isoelectric line) in the ECG which forms
its baseline, see Figure 6.4(a). During atrial depolarization, the dominant vector
is directed downwards toward the AV node. As a result, an atrial wave with
positive polarity is generated in the ECG recorded at the position of the exploring
electrode, see Figure 6.4(b). The amplitude of the resulting wave is low because
the muscle mass of the atria that produces the electrical wavefront is relatively
small.

Once depolarization of the atria has been completed, the ECG returns to the
isoelectric line where it remains until the ventricles become depolarized, see
Figure 6.4(c). Depolarization of the AV node and the His bundle starts toward the
end of the atrial wave but does not produce any visible ECG waves because of
the small muscle masses.
The waves associated with ventricular depolarization are much larger than the
atrial wave since the ventricles have a much larger muscle mass. Ventricular
depolarization begins in the wall between the ventricles (septum) in such a way
that the associated vector is directed away from the exploring electrode, see
Figure 6.4(d); hence, the related ECG wave has negative polarity. Due to the high
conduction velocity of the cells in this part of the heart, the negative wave has a
short duration. During continued ventricular depolarization, the dominant
direction of the vector gradually turns toward the exploring electrode. This
behavior is related to the fact that the wall of the left ventricle is three times
thicker than that of the right ventricle and consequently takes longer to
depolarize, see Figure 6.4(e)-(g).
Depolarization terminates with the dominant vector pointing away from the
electrode, and thus a wave with negative polarity is produced in the ECG, see
Figure 6.4(g). Once ventricular depolarization has been completed, the ECG
returns to the isoelectric line where it remains until ventricular repolarization
occurs. During ventricular repolarization, a similar sequence of dominant vectors
to those during ventricular depolarization appears, and a wave with positive
polarity is produced, see Figure 6.4(h). Since atrial repolarization is concurrent
with ventricular depolarization, the related atrial repolarization wave is masked
by the ventricular waves which have much larger amplitudes.

Figure 6.4: The ECG recorded in by an electrode positioned at the location of

the symbol k-. (a) All cardiac cells at rest, (b) atrial depolarization, (c) the
electrical impulse passing through the AV node, (d)-(g) ventricular depolarization,
(h) ventricular repolarization, and (i) all cardiac cells again at rest.