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Electrophysiological and anatomical factors determine arrhythmic risk in acute myocardial ischaemia and its

Hector Martinez-Navarro1, Xin Zhou1, Alfonso Bueno-Orovio1

  • 1Department of Computer Science, British Heart Foundation Centre of Research Excellence, University of Oxford, Parks Road, Oxford OX1 3QD, UK.

Interface Focus
|December 18, 2020
PubMed

Insights

Reduced sodium current availability increases arrhythmia risk during acute myocardial ischemia. This is due to electrophysiological changes and anatomical factors, particularly in the ventricles, highlighting key mechanisms of sudden cardiac death.

Area of Science:

  • Cardiovascular Physiology
  • Computational Biology
  • Medical Simulation

Background:

  • Acute myocardial ischemia is a primary cause of sudden cardiac death.
  • Reduced sodium current availability, from mutations or other factors, is linked to increased arrhythmia risk in ischemic patients, but mechanisms remain unclear.

Purpose of the Study:

  • To investigate arrhythmia mechanisms in acute myocardial ischemia with variable sodium current availability.
  • To utilize high-performance computing simulations for precise control and data transparency.

Main Methods:

  • Employed a human anatomically based torso-biventricular electrophysiological model.
  • Incorporated realistic ventricular anatomy, fiber architecture, and ionic to electrocardiographic properties.
  • Conducted over 300 high-performance computing simulations.

Main Results:

  • Reduced sodium current availability exacerbated arrhythmic risk in acute regional ischemia.
  • Electrophysiological factors (dispersion of refractoriness) and anatomical factors (ventricular asymmetry, conduction block) contributed to risk.
  • Asymmetric ventricular anatomy increased risk for right ventricular and basal ectopic stimuli; increased sodium availability was ineffective for septo-basal excitations.

Conclusions:

  • Human-based multiscale modeling identified key electrophysiological and anatomical determinants of arrhythmic risk in ischemia with altered sodium current.
  • Findings provide insights into mechanisms underlying sudden cardiac death in ischemic heart disease.

Keywords:
Brugada syndromeanti-arrhythmic drugscomputer simulationscoronary artery diseasemyocardial ischaemiasodium block

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