The Role of Infarct Border Zone Remodelling in Ventricular Arrhythmias: Bridging Basic Research and Clinical Applications

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pathophysiology

Background:

• Post-myocardial infarction (MI) patients with ejection fraction <35% are at high risk for sudden cardiac death due to ventricular arrhythmias (VAs).
• Scar tissue expansion and infarct border zone (IBZ) remodeling are key drivers of heart failure progression and VA development.
• Structural changes (fibrosis) and electrophysiological alterations (ion channels, gap junctions, autonomic dysfunction) in the IBZ promote abnormal impulse conduction.

Purpose of the Study:

• To systematically review structural characteristics of ischemic myocardial substrates.
• To summarize current clinical treatment strategies for VAs post-MI.
• To propose novel prevention strategies targeting arrhythmogenic substrate formation.

Main Methods:

• Systematic review of literature on myocardial infarction, ventricular arrhythmias, and cardiac remodeling.
• Analysis of structural and electrophysiological changes in the infarct border zone.
• Evaluation of current pharmacological, device-based, and catheter ablation therapies for VAs.

Main Results:

• Identified critical roles of scar tissue and IBZ in VA pathogenesis.
• Detailed structural and electrophysiological substrate modifications contributing to arrhythmias.
• Summarized established treatment modalities including beta-blockers, amiodarone, ICDs, and ablation.

Conclusions:

• Current VA management relies on treating established arrhythmias.
• Early prevention strategies targeting substrate modification offer a promising innovative approach.
• Mitigating arrhythmogenic substrate formation could reduce VA incidence and sudden cardiac death post-MI.