Modelling the effects of disopyramide on short QT syndrome variant 1 in the human ventricles

The short QT syndrome (SQTS) is a recently identified genetic disorder associated with ventricular and/or atrial arrhythmias and increased risk of sudden cardiac death. The SQTS variant 1 (SQT1) N588K mutation to the hERG gene causes a gain-of-function to IKr which shortens the ventricular effective refractory period (ERP), as well as reducing the potency of several drugs which block the hERG channel. This study used computational modelling to assess the effects of disopyramide (DISO), a class 1a anti-arrhythmic agent, on human ventricular electro-physiology in SQT1. The O'Hara Rudy dynamic (ORd) model of the human ventricle action potential (AP) was modified to incorporate a Markov chain model of IKr/hERG including formulations for wild type (WT) and SQT1 N588K mutant hERG channels. The blocking effects of DISO on IKr, INa, ICaL, and Ito were modelled using IC50 and Hill coefficient values from the literature. The ability of DISO to prolong the QT interval was evaluated using a 1D model of human ventricular cells with transmural heterogeneities and the corresponding pseudo-ECG. At a clinically-relevant concentration of 10 μM DISO, the action potential duration (APD) at the single cell level was increased significantly through inhibition of mutant SQT1-hERG channels. The corrected QT interval in tissue was prolonged. This study provides further evidence that DISO is a suitable treatment for hERG-mediated SQTS

Modelling the effects of disopyramide on short QT syndrome variant 1 in the human ventricles

The short QT syndrome (SQTS) is a recently identified genetic disorder associated with ventricular and/or atrial arrhythmias and increased risk of sudden cardiac death. The SQTS variant 1 (SQT1) N588K mutation to the hERG gene causes a gain-of-function to IKr which shortens the ventricular effective refractory period (ERP), as well as reducing the potency of several drugs which block the hERG channel. This study used computational modelling to assess the effects of disopyramide (DISO), a class 1a anti-arrhythmic agent, on human ventricular electro-physiology in SQT1. The O'Hara Rudy dynamic (ORd) model of the human ventricle action potential (AP) was modified to incorporate a Markov chain model of IKr/hERG including formulations for wild type (WT) and SQT1 N588K mutant hERG channels. The blocking effects of DISO on IKr, INa, ICaL, and Ito were modelled using IC50 and Hill coefficient values from the literature. The ability of DISO to prolong the QT interval was evaluated using a 1D model of human ventricular cells with transmural heterogeneities and the corresponding pseudo-ECG. At a clinically-relevant concentration of 10 μM DISO, the action potential duration (APD) at the single cell level was increased significantly through inhibition of mutant SQT1-hERG channels. The corrected QT interval in tissue was prolonged. This study provides further evidence that DISO is a suitable treatment for hERG-mediated SQTS

The Spatial Distribution of Absolute Skeletal Muscle Deoxygenation During Ramp-Incremental Exercise Is Not Influenced by Hypoxia.

Time-resolved near-infrared spectroscopy (TRS-NIRS) allows absolute quantitation of deoxygenated haemoglobin and myoglobin concentration ([HHb]) in skeletal muscle. We recently showed that the spatial distribution of peak [HHb] within the quadriceps during moderate-intensity cycling is reduced with progressive hypoxia and this is associated with impaired aerobic energy provision. We therefore aimed to determine whether reduced spatial distribution of skeletal muscle [HHb] was associated with impaired aerobic energy transfer during exhaustive ramp-incremental exercise in hypoxia. Seven healthy men performed ramp-incremental cycle exercise (20 W/min) to exhaustion at 3 fractional inspired O2 concentrations (FIO2): 0.21, 0.16, 0.12. Pulmonary O2 uptake (VO₂) was measured using a flow meter and gas analyser system. Lactate threshold (LT) was estimated non-invasively. Absolute muscle deoxygenation was quantified by multichannel TRS-NIRS from the rectus femoris and vastus lateralis (proximal and distal regions). VO₂peak and LT were progressively reduced (p < 0.05) with hypoxia. There was a significant effect (p < 0.05) of FIO2 on [HHb] at baseline, LT, and peak. However the spatial variance of [HHb] was not different between FIO2 conditions. Peak total Hb ([Hbtot]) was significantly reduced between FIO2 conditions (p < 0.001). There was no association between reductions in the spatial distribution of skeletal muscle [HHb] and indices of aerobic energy transfer during ramp-incremental exercise in hypoxia. While regional [HHb] quantified by TRS-NIRS at exhaustion was greater in hypoxia, the spatial distribution of [HHb] was unaffected. Interestingly, peak [Hbtot] was reduced at the tolerable limit in hypoxia implying a vasodilatory reserve may exist in conditions with reduced FIO2

Computational Modelling of Cardiac Electrophysiological Changes in Malarial Fever

Cardiac function is impaired in severe malarial fever, and ECGs show changes associated with repolarization. These could contribute to mortality via ventricular arrhythmia. The cardiac effects could be due to the malarial parasite load in the heart, specific cardio-toxic effects of the parasite or cardio-toxic effects of antimalarial agents. We construct a simple 1-dimensional electrophysiological model for the physico-chemical changes clinically observed during malarial fever: with temperature, pH and [ionic]plasma changes. The model can quantitatively reproduce the tachycardia and QTc prolongation seen in the adult, and shortening seen in the child during malarial fever

Investigating Calcium-Mediated Arrhythmias via a Computational Model of a Rabbit Atrial Myocyte

The system of transverse and longitudinal sarcolemmal tubules (T-system) is observed to remodel in atrial fibrillation (AF) and heart failure (HF). The resulting calcium dysregulation has been suggested to underlie disruptions in excitation-contraction coupling, and increase the frequency of arrhythmic events at the cellular scale; however, these mechanisms and their importance are yet to be fully described. A stochastic, 3D, spatiotemporal model of the rabbit atrial myocyte was developed in order to study calcium-mediated arrhythmic phenomena at the cellular scale. Preliminary findings suggest a relationship between the severity of detubulation, and the promotion of spontaneous activity, and provides insight into the conditions required for the emergence of spontaneous activity within atrial myocytes in HF

Self-terminating re-entrant cardiac arrhythmias: quantitative characterization

Atrial and ventricular tachyarrhythmia are often sustained by re-entrant propagation, and explained by deterministic models. A quantitative, stochastic description of self-termination provides an alternative to the current paradigm for re-entrant tachyarrhythmia - that of triggers and a substrate, modelled by parametrically heterogeneous deterministic partial differential equations. Atrial and ventricular data was from recordings obtained during routine clinical monitoring and treatment, either noninvasively or invasively. Atrial and ventricular tachycardia are characterised by their initiation times and durations, re-presented as instantaneous rates, whose means estimate transition probabilities/s for onset and termination. These estimated probabilities range from 10(-9) to 10(-1)/s

Inward Rectifier Current Downregulation Promotes Spontaneous Calcium Release in a Novel Model of Rat Ventricular Electrophysiology

Aberrant intracellular calcium handling, as observed in diseases such as heart failure, promotes lethal ventricular arrhythmias and sudden cardiac death. Recent data from our laboratory suggests that reduced expression of the inward rectifier current in failing rat myocytes increases spontaneous calcium release, however existing computational models are unable to reproduce the underlying stochastic calcium cycling dynamics and so we have been unable to use simulation approaches to explore the cause of this pro-arrhythmic behaviour. Here, we develop a novel model of rat ventricular electrophysiology that reproduces normal spatio-temporal calcium dynamics. Simulations implementing a similar reduction in inward rectifier current to that observed experimentally show that spontaneous calcium release is promoted by action potential prolongation and sarcoplasmic reticulum loading in the presence of a depolarised resting membrane potential. Combined, these effects can result in triggered activity. The model therefore provides insight into arrhythmogenic mechanisms in failing ventricular myocytes and can be utilised to further explore pro-arrhythmic behaviour caused by abnormal calcium handling

Multi-scale approaches for the simulation of cardiac electrophysiology: II - tissue-level structure and function

Computational models of the heart, from cell-level models, through one-, two- and three-dimensional tissue-level simplifications, to biophysically-detailed three-dimensional models of the ventricles, atria or whole heart, allow the simulation of excitation and propagation of this excitation, and have provided remarkable insight into the normal and pathological functioning of the heart. In this article we present equations for modelling cellular excitation (i.e. the cell action potential) from both a phenomenological and a biophysical perspective. Hodgkin-Huxley formalism is discussed, along with the current generation of biophysically-detailed cardiac cell models. Alternative Markovian formulations for modelling ionic currents are also presented. Equations describing propagation of this cellular excitation, through one-, two- and three-dimensional idealised or realistic tissues, are then presented. For all types of model, from cell to tissue, methods for discretisation and integration of the underlying equations are discussed. The article finishes with a discussion of two tissue-level experimental imaging techniques – diffusion tensor magnetic resonance imaging and optical imaging – that can be used to provide data for parameterisation and validation of cell- and tissue-level cardiac models

Carbon Monoxide Effects on Electrophysiological Mechanisms of Ventricular Arrhythmogenesis

Increased dissolved carbon monoxide decreases ICa,L IK1 and IKr, and increases late INa currents in rat and guinea pig patch-clamped isolated ventricular myocytes. Action potentials are prolonged. These effects are reproduced by scaling the currents in the Gattoni et al., 2016 (rat) and Luo and Rudy, 1994 (guinea-pig) cell models. Using the same scaling of currents in the O’Hara-Rudy (2011) models the endo-, mid-myo- and epi-cardial APD90 is prolonged. CO abolishes alternans in endo-, and induces alternans in mid-myo -cardial cell models at cycle lengths < 280ms. In the homogenous human ventricular tissue models these CO effects decrease epi-, endocardial conduction velocities from 0.4 to 0.32m/s, and increase the widths of the vulnerable windows by +9%, +8% . In the ventricular wall model (a third each of endo-, mid-myo- and epicardial) CO increased transmural propagation times from 44 to 55 ms and maximal difference in propagating APD from 68 to 73 ms. The computed effects of CO on human ventricular tissue are pro-arrhythmogenic

Increased SERCA2a sub-cellular heterogeneity in right-ventricular heart failure inhibits excitation-contraction coupling and modulates arrhythmogenic dynamics

The intracellular calcium handling system of cardiomyocytes is responsible for controlling excitation-contraction coupling (ECC) and has been linked to pro-arrhythmogenic cellular phenomena in conditions such as heart failure (HF). SERCA2a, responsible for intracellular uptake, is a primary regulator of calcium homeostasis, and remodelling of its function has been proposed as a causal factor underlying cellular and tissue dysfunction in disease. Whereas adaptations to the global (i.e. whole-cell) expression of SERCA2a have been previously investigated in the context of multiple diseases, the role of its spatial profile in the sub-cellular volume has yet to be elucidated. We present an approach to characterize the sub-cellular heterogeneity of SERCA2a and apply this approach to quantify adaptations to the length-scale of heterogeneity (the distance over which expression is correlated) associated with right-ventricular (RV)-HF. These characterizations informed simulations to predict the functional implications of this heterogeneity, and its remodelling in disease, on ECC, the dynamics of calcium-transient alternans and the emergence of spontaneous triggered activity. Image analysis reveals that RV-HF is associated with an increase in length-scale and its inter-cellular variability; simulations predict that this increase in length-scale can reduce ECC and critically modulate the vulnerability to both alternans and triggered activity