749 research outputs found
Multiple mechanisms of spiral wave breakup in a model of cardiac electrical activity
It has become widely accepted that the most dangerous cardiac arrhythmias are
due to re- entrant waves, i.e., electrical wave(s) that re-circulate repeatedly
throughout the tissue at a higher frequency than the waves produced by the
heart's natural pacemaker (sinoatrial node). However, the complicated structure
of cardiac tissue, as well as the complex ionic currents in the cell, has made
it extremely difficult to pinpoint the detailed mechanisms of these
life-threatening reentrant arrhythmias. A simplified ionic model of the cardiac
action potential (AP), which can be fitted to a wide variety of experimentally
and numerically obtained mesoscopic characteristics of cardiac tissue such as
AP shape and restitution of AP duration and conduction velocity, is used to
explain many different mechanisms of spiral wave breakup which in principle can
occur in cardiac tissue. Some, but not all, of these mechanisms have been
observed before using other models; therefore, the purpose of this paper is to
demonstrate them using just one framework model and to explain the different
parameter regimes or physiological properties necessary for each mechanism
(such as high or low excitability, corresponding to normal or ischemic tissue,
spiral tip trajectory types, and tissue structures such as rotational
anisotropy and periodic boundary conditions). Each mechanism is compared with
data from other ionic models or experiments to illustrate that they are not
model-specific phenomena. The fact that many different breakup mechanisms exist
has important implications for antiarrhythmic drug design and for comparisons
of fibrillation experiments using different species, electromechanical
uncoupling drugs, and initiation protocols.Comment: 128 pages, 42 figures (29 color, 13 b&w
Indeterminacy of Spatiotemporal Cardiac Alternans
Cardiac alternans, a beat-to-beat alternation in action potential duration
(at the cellular level) or in ECG morphology (at the whole heart level), is a
marker of ventricular fibrillation, a fatal heart rhythm that kills hundreds of
thousands of people in the US each year. Investigating cardiac alternans may
lead to a better understanding of the mechanisms of cardiac arrhythmias and
eventually better algorithms for the prediction and prevention of such dreadful
diseases. In paced cardiac tissue, alternans develops under increasingly
shorter pacing period. Existing experimental and theoretical studies adopt the
assumption that alternans in homogeneous cardiac tissue is exclusively
determined by the pacing period. In contrast, we find that, when calcium-driven
alternans develops in cardiac fibers, it may take different spatiotemporal
patterns depending on the pacing history. Because there coexist multiple
alternans solutions for a given pacing period, the alternans pattern on a fiber
becomes unpredictable. Using numerical simulation and theoretical analysis, we
show that the coexistence of multiple alternans patterns is induced by the
interaction between electrotonic coupling and an instability in calcium
cycling.Comment: 20 pages, 10 figures, to be published in Phys. Rev.
Nonlinear physics of electrical wave propagation in the heart: a review
The beating of the heart is a synchronized contraction of muscle cells
(myocytes) that are triggered by a periodic sequence of electrical waves (action
potentials) originating in the sino-atrial node and propagating over the atria and
the ventricles. Cardiac arrhythmias like atrial and ventricular fibrillation (AF,VF)
or ventricular tachycardia (VT) are caused by disruptions and instabilities of these
electrical excitations, that lead to the emergence of rotating waves (VT) and turbulent
wave patterns (AF,VF). Numerous simulation and experimental studies during the
last 20 years have addressed these topics. In this review we focus on the nonlinear
dynamics of wave propagation in the heart with an emphasis on the theory of pulses,
spirals and scroll waves and their instabilities in excitable media and their application
to cardiac modeling. After an introduction into electrophysiological models for action
potential propagation, the modeling and analysis of spatiotemporal alternans, spiral
and scroll meandering, spiral breakup and scroll wave instabilities like negative line
tension and sproing are reviewed in depth and discussed with emphasis on their impact
in cardiac arrhythmias.Peer ReviewedPreprin
Gene Therapy in Cardiac Arrhythmias
Gene therapy has progressed from a dream to a bedside reality in quite a few human diseases. From its first application in adenosine deaminase deficiency, through the years, its application has evolved to vascular angiogenesis and cardiac arrhythmias. Gene based biological pacemakers using viral vectors or mesenchymal cells tested in animal models hold much promise. Induction of pacemaker activity within the left bundle branch can provide stable heart rates. Genetic modification of the AV node mimicking beta blockade can be therapeutic in the management of atrial fibrillation. G protein overexpression to modify the AV node also is experimental. Modification and expression of potassium channel genes altering the delayed rectifier potassium currents may permit better management of congenital long QT syndromes. Arrhythmias in a failing heart are due to abnormal calcium cycling. Potential targets for genetic modulation include the sarcoplasmic reticulum calcium pump, calsequestrin and sodium calcium exchanger.Lastly the ethical concerns need to be addressed
Blockade of sodium‑calcium exchanger via ORM-10962 attenuates cardiac alternans
Repolarization alternans, a periodic oscillation of long-short action potential duration, is an important source of arrhythmogenic substrate, although the mechanisms driving it are insufficiently understood. Despite its relevance as an arrhythmia precursor, there are no successful therapies able to target it specifically. We hypothesized that blockade of the sodium‑calcium exchanger (NCX) could inhibit alternans. The effects of the selective NCX blocker ORM-10962 were evaluated on action potentials measured with microelectrodes from canine papillary muscle preparations, and calcium transients measured using Fluo4-AM from isolated ventricular myocytes paced to evoke alternans. Computer simulations were used to obtain insight into the drug's mechanisms of action. ORM-10962 attenuated cardiac alternans, both in action potential duration and calcium transient amplitude. Three morphological types of alternans were observed, with differential response to ORM-10962 with regards to APD alternans attenuation. Analysis of APD restitution indicates that calcium oscillations underlie alternans formation. Furthermore, ORM-10962 did not markedly alter APD restitution, but increased post-repolarization refractoriness, which may be mediated by indirectly reduced L-type calcium current. Computer simulations reproduced alternans attenuation via ORM-10962, suggesting that it is acts by reducing sarcoplasmic reticulum release refractoriness. This results from the ORM-10962-induced sodium‑calcium exchanger block accompanied by an indirect reduction in L-type calcium current. Using a computer model of a heart failure cell, we furthermore demonstrate that the anti-alternans effect holds also for this disease, in which the risk of alternans is elevated. Targeting NCX may therefore be a useful anti-arrhythmic strategy to specifically prevent calcium driven alternans
CORRELATION BETWEEN ALTERNANS OF EARLY AND LATE PHASES OF VENTRICULAR ACTION POTENTIAL
Several studies suggest that action potential duration (APD) alternans play an important role in initiation of arrhythmias, while less is known about the alternans of early phases of action potential (AP) and phase relation between the two. Transmembrane potentials recorded from swine and canine ventricles were analyzed to determine the correlation and phase relation between alternans of early and late phases of an AP. In both species, for activation intervals ≤ 400 ms, action potential amplitude (APA) alternans occurred≥ 50% of times when APD alternans occurred and vice versa, both were mostly in phase. Also, alternans of APA and APD were mostly in phase with alternans of maximal rate of depolarization. The correlation between alternans in early and later parts of AP, however, was variable between species; APD10 and APD90 alternans were out of phase 81 % versus 34 % in canines and swines. These observations suggest that ionic mechanisms underlying alternans of depolarization and early repolarization phases may be distinct from those underlying later phases of repolarization. Simulations conducted to see the spatiotemporal effect of phase behavior between these alternans show that out of phase behavior suppresses oscillations in wavelength and minimizes the chances of spatial discordance
Regional differences in APD restitution can initiate wavebreak and re-entry in cardiac tissue: A computational study
Background
Regional differences in action potential duration (APD) restitution in the heart favour arrhythmias, but the mechanism is not well understood.
Methods
We simulated a 150 Ă— 150 mm 2D sheet of cardiac ventricular tissue using a simplified computational model. We investigated wavebreak and re-entry initiated by an S1S2S3 stimulus protocol in tissue sheets with two regions, each with different APD restitution. The two regions had a different APD at short diastolic interval (DI), but similar APD at long DI. Simulations were performed twice; once with both regions having steep (slope > 1), and once with both regions having flat (slope < 1) APD restitution.
Results
Wavebreak and re-entry were readily initiated using the S1S2S3 protocol in tissue sheets with two regions having different APD restitution properties. Initiation occurred irrespective of whether the APD restitution slopes were steep or flat. With steep APD restitution, the range of S2S3 intervals resulting in wavebreak increased from 1 ms with S1S2 of 250 ms, to 75 ms (S1S2 180 ms). With flat APD restitution, the range of S2S3 intervals resulting in wavebreak increased from 1 ms (S1S2 250 ms), to 21 ms (S1S2 340 ms) and then 11 ms (S1S2 400 ms).
Conclusion
Regional differences in APD restitution are an arrhythmogenic substrate that can be concealed at normal heart rates. A premature stimulus produces regional differences in repolarisation, and a further premature stimulus can then result in wavebreak and initiate re-entry. This mechanism for initiating re-entry is independent of the steepness of the APD restitution curve
- …