Impedance cardiography: What is the source of the signal?

Impedance cardiography continues to be investigated for various applications. Instruments for its use are available commercially. Almost all of the recent presentations and articles along with commercial advertisements have assumed that aortic volume pulsation is the source of the signal. A review of the literature will reveal that there is no clear evidence for this assumption. Starting with the first paper on impedance cardiography in 1964, which assumed the lung was the source of the signal, the presentation will review many studies in the 60's, 70's and 80's, which suggest the aorta and other vessels as well as atria and again the lung as possible sources. Current studies based on high resolution thoracic models will be presented that show the aorta as contributing only approximately 1% of the total impedance measurement, making it an unlikely candidate for the major contributor to the signal. Combining the results of past studies along with recent work based on models, suggest other vessels and regions as possible sources.