Computational probabilistic quantification of pro-arrhythmic risk from scar and left-to-right heterogeneity in the human ventricles

Abstract

Both scar and left-to-right ventricular (LV/RV) differences in repolarization properties have been implicated as risk factors for lethal arrhythmias. As a possible mechanism for the initiation of re-entry, a recent study has indicated that LV/RV heterogeneities in action potential duration (APD) adaptation can cause a transient increase in APD dispersion following rate acceleration, promoting unidirectional block of conduction at the LV/RV junction. In the presence of an ischemic region and ectopic stimulation, a pathological dispersion in repolarization has been suggested to increase the risk of electrical re-entry. However, the exact location and timing of the ectopic activation play a crucial role in initiation of re-entry, and certain combinations may lead to re-entry even under normal LV/RV dispersion in repolarization. This suggests that the phenomenon needs to be investigated in a quantitative way. In this study we employ a computationally efficient, phenomenological model in order to investigate the proarrhythmic properties of a range of combinations of position and timing of an ectopic activation. This allows us to probabilistically study how increasing interventricular dispersion of repolarization increases arrhythmic risk. Results indicate that a larger LV/RV dispersion in repolarization allows ectopic beats to initiate re-entry during a significantly larger time window and from a greater number of locations compared to the case of smaller LV/RV dispersion