Kurbel Sven
Department of Physiology, Osijek Medical Faculty, Osijek, Croatia.
Theor Biol Med Model. 2014 Feb 10;11:10. doi: 10.1186/1742-4682-11-10.
Since cell membranes are weak sources of electrostatic fields, this ECG interpretation relies on the analogy between cells and electrets. It is here assumed that cell-bound electric fields unite, reach the body surface and the surrounding space and form the thoracic electric field that consists from two concentric structures: the thoracic wall and the heart. If ECG leads measure differences in electric potentials between skin electrodes, they give scalar values that define position of the electric field center along each lead. Repolarised heart muscle acts as a stable positive electric source, while depolarized heart muscle produces much weaker negative electric field. During T-P, P-R and S-T segments electric field is stable, only subtle changes are detectable by skin electrodes.Diastolic electric field forms after ventricular depolarization (T-P segments in the ECG recording). Telediastolic electric field forms after the atria have been depolarized (P-Q segments in the ECG recording). Systolic electric field forms after the ventricular depolarization (S-T segments in the ECG recording). The three ECG waves (P, QRS and T) can then be described as unbalanced transitions of the heart electric field from one stable configuration to the next and in that process the electric field center is temporarily displaced. In the initial phase of QRS, the rapidly diminishing septal electric field makes measured potentials dependent only on positive charges of the corresponding parts of the left and the right heart that lie within the lead axes. If more positive charges are near the "DOWN" electrode than near the "UP" electrode, a Q wave will be seen, otherwise an R wave is expected. Repolarization of the ventricular muscle is dampened by the early septal muscle repolarization that reduces deflection of T waves. Since the "UP" electrode of most leads is near the usually larger left ventricle muscle, T waves are in these leads positive, although of smaller amplitude and longer duration than the QRS wave in the same lead. The proposed interpretation is applied to bundle branch blocks, fascicular (hemi-) blocks and changes during heart muscle ischemia.
由于细胞膜是静电场的微弱来源，这种心电图解释依赖于细胞与驻极体之间的类比。在此假定，细胞结合电场联合起来，到达体表和周围空间，并形成由两个同心结构组成的胸壁电场：胸壁和心脏。如果心电图导联测量皮肤电极之间的电位差，它们会给出标量值，这些值定义了电场中心沿每个导联的位置。复极化的心肌充当稳定的正电源，而去极化的心肌产生的负电场要弱得多。在T-P、P-R和S-T段期间，电场是稳定的，皮肤电极只能检测到细微变化。舒张期电场在心室去极化后形成（心电图记录中的T-P段）。终末舒张期电场在心房去极化后形成（心电图记录中的P-Q段）。收缩期电场在心室去极化后形成（心电图记录中的S-T段）。然后，三个心电图波（P、QRS和T）可以描述为心脏电场从不稳定构型到下一个稳定构型的不平衡转变，在此过程中电场中心会暂时移位。在QRS波的初始阶段，快速减弱的间隔电场使测量到的电位仅取决于位于导联轴内的左、右心脏相应部分的正电荷。如果“向下”电极附近的正电荷比“向上”电极附近的多，就会看到Q波，否则预期会出现R波。心室肌的复极化受到早期间隔肌复极化的抑制，这会减少T波的偏转。由于大多数导联的“向上”电极靠近通常较大的左心室肌，因此这些导联中的T波为正向，尽管其幅度比同一导联中的QRS波小，持续时间更长。所提出的解释适用于束支传导阻滞、分支（半）传导阻滞以及心肌缺血期间的变化。
