Dynamics Study of Constant DI and Constant TR Control for Cardiac Alternans Based on a Two Dimensional Cellular Automata Model

As a precursor for cardiac arrhythmias such as atrial and ventricular fibrillations, which could cause sudden cardiac death (SCD), cardiac alternans is essentially an unstable heart rhythm with alternating long and short action potential durations (APD) of cardiac myocytes that usually occurs under fast pacing conditions. In this paper, the constant TR control method based on global pseudo-electrocardiogram (ECG) is studied and compared with the local constant diastolic interval (DI) control method using a 2-dimensional (2-D) cellular automata model (CAM), aiming at preventing or eliminating cardiac alternans before arrhythmias. The results show that both the constant TR and constant DI control methods are effective in stabling the alternans to a smaller basic cycle length (BCL). Also, the efficacy of the two control approaches depends on the “decrease step” Δ in the downsweep protocol, and a smaller Δ could significantly improve their performance. Besides, in general, constant TR control is superior to constant DI control in alternans prevention when a relatively large Δ is adopted.

Stretch-activated current in human atrial myocytes and Na+ current and mechano-gated channels’ current in myofibroblasts alter myocyte mechanical behavior: a computational study

Background The activation of stretch-activated channels (SACs) in cardiac myocytes, which changes the phases of action potential repolarization, is proven to be highly efficient for the conversion of atrial fibrillation. The expression of Na+ current in myofibroblasts (Mfbs) regenerates myocytes’ action potentials, suggesting that Mfbs play an active role in triggering cardiac rhythm disturbances. Moreover, the excitation of mechano-gated channels (MGCs) in Mfbs depolarizes their membrane potential and contributes to the increased risk of post-infarct arrhythmia. Although these electrophysiological mechanisms have been largely known, the roles of these currents in cardiac mechanics are still debated. In this study, we aimed to investigate the mechanical influence of these currents via mathematical modeling. A novel mathematical model was developed by integrating models of human atrial myocyte (including the stretch-activated current, Ca2+–force relation, and mechanical behavior of a single segment) and Mfb (including our formulation of Na+ current and mechano-gated channels’ current). The effects of the changes in basic cycle length, number of coupled Mfbs and intercellular coupling conductance on myocyte mechanical properties were compared. Results Our results indicated that these three currents significantly regulated myocyte mechanical parameters. In isosarcometric contraction, these currents increased segment force by 13.8–36.6% and dropped element length by 12.1–31.5%. In isotonic contraction, there are 2.7–5.9% growth and 0.9–24% reduction. Effects of these currents on the extremum of myocyte mechanical parameters become more significant with the increase of basic cycle length, number of coupled Mfbs and intercellular coupling conductance. Conclusions The results demonstrated that stretch-activated current in myocytes and Na+ current and mechano-gated channels’ current in Mfbs significantly influenced myocyte mechanical behavior and should be considered in future cardiac mechanical mathematical modeling.

Effects of Na+Current and Mechanogated Channels in Myofibroblasts on Myocyte Excitability and Repolarization

Fibrotic remodeling, characterized by fibroblast phenotype switching, is often associated with atrial fibrillation and heart failure. This study aimed to investigate the effects on electrotonic myofibroblast-myocyte (Mfb-M) coupling on cardiac myocytes excitability and repolarization of the voltage-gated sodium channels (VGSCs) and single mechanogated channels (MGCs) in human atrial Mfbs. Mathematical modeling was developed from a combination of (1) models of the human atrial myocyte (including the stretch activated ion channel current,ISAC) and Mfb and (2) our formulation of currents through VGSCs (INa_Mfb) and MGCs (IMGC_Mfb) based upon experimental findings. The effects of changes in the intercellular coupling conductance, the number of coupled Mfbs, and the basic cycle length on the myocyte action potential were simulated. The results demonstrated that the integration ofISAC,INa_Mfb, andIMGC_Mfbreduced the amplitude of the myocyte membrane potential(Vmax)and the action potential duration (APD), increased the depolarization of the resting myocyte membrane potential(Vrest), and made it easy to trigger spontaneous excitement in myocytes. For Mfbs, significant electrotonic depolarizations were exhibited with the addition ofINa_MfbandIMGC_Mfb. Our results indicated thatISAC,INa_Mfb, andIMGC_Mfbsignificantly influenced myocytes and Mfbs properties and should be considered in future cardiac pathological mathematical modeling.

Characterizing Spatial Dynamics of Bifurcation to Alternans in Isolated Whole Rabbit Hearts Based on Alternate Pacing

Sudden cardiac death instigated by ventricular fibrillation (VF) is the largest cause of natural death in the USA. Alternans, a beat-to-beat alternation in the action potential duration, has been implicated as being proarrhythmic. The onset of alternans is mediated via a bifurcation, which may occur through either a smooth or a border-collision mechanism. The objective of this study was to characterize the mechanism of bifurcation to alternans based on experiments in isolated whole rabbit hearts. High resolution optical mapping was performed and the electrical activity was recorded from the left ventricle (LV) epicardial surface of the heart. Each heart was paced using an “alternate pacing protocol,” where the basic cycle length (BCL) was alternatively perturbed by ±δ. Local onset of alternans in the heart,BCLstart, was measured in the absence of perturbations (δ=0) and was defined as the BCL at which 10% of LV exhibited alternans. The influences of perturbation size were investigated at two BCLs: one prior toBCLstart(BCLprior=BCLstart+20 ms) and one precedingBCLprior(BCLfar=BCLstart+40 ms). Our results demonstrate significant spatial correlation of the region exhibiting alternans with smooth bifurcation characteristics, indicating that transition to alternans in isolated rabbit hearts occurs predominantly through smooth bifurcation.

Reduction of fibrosis-related arrhythmias by chronic renin-angiotensin-aldosterone system inhibitors in an aged mouse model

Myocardial fibrosis increases arrhythmia vulnerability of the diseased heart. The renin-angiotensin-aldosterone system (RAAS) governs myocardial collagen synthesis. We hypothesized that reducing cardiac fibrosis by chronic RAAS inhibition would result in reduced arrhythmia vulnerability of the senescent mouse heart. Wild-type mice (52 wk old) were treated for 36 wk: 1) untreated control (C); 2) eplerenone (E); 3) losartan (L); and 4) cotreatment with eplerenone and losartan (EL). Ventricular epicardial activation mapping was performed on Langendorff-perfused hearts. Arrhythmia inducibility was tested by one to three premature stimuli and burst pacing. Longitudinal and transverse conduction velocity and dispersion of conduction were determined during pacing at a basic cycle length of 150 ms. Sirius red staining (collagen) was performed. As a result, in the RV of mice in the E, L, and EL groups, transverse conduction velocity was significantly increased and anisotropic ratio was significantly decreased compared with those values of mice in the C group. Anisotropic reentrant arrhythmias were induced in 52% of untreated mice and significantly reduced to 22%, 26%, and 16% in the E, L, and EL groups, respectively. Interstitial fibrosis was significantly decreased in both the RV and LV of all treated groups. Scattered patches of replacement fibrosis were found in 90% of untreated hearts, which were significantly reduced in the E, L, and EL groups. A strong correlation between the abundance of patchy fibrosis and arrhythmia inducibility was found. In conclusion, chronic RAAS inhibition limited aging-related interstitial fibrosis. The lower arrhythmogeneity of treated mice was directly correlated to the reduced amount of patchy fibrosis.

Cellular and subcellular alternans in the canine left ventricle

Previous studies indicate that action potential duration (APD) alternans is initiated in the endocardial (END) and midmyocardial (MID) regions rather than the epicardium (EPI) in the canine left ventricle (LV). This study examines regional differences in the rate dependence of Ca2+ transient characteristics under conditions that give rise to APD and associated T wave alternans. The role of the sarcoplasmic reticulum (SR) was further evaluated by studying Ca2+ transient characteristics in myocytes isolated from neonates, where an organized SR is poorly developed. All studies were performed in cells and tissues isolated from the canine LV. Isolated canine ENDO, MID, and EPI LV myocytes were either field stimulated or voltage clamped, and Ca2+ transients were measured by confocal microscopy. In LV wedge preparations, increasing the basic cycle length (BCL) from 800 to 250 ms caused alternans to appear mainly in the ENDO and MID region; alternans were not observed in EPI under these conditions. Ca2+ transient alternans developed in response to rapid pacing, appearing in EPI cells at shorter BCL compared with MID and ENDO cells (BCL=428 ± 17 vs. 517 ± 29 and 514 ± 21, respectively, P < 0.05). Further increases in pacing rate resulted in the appearance of subcellular alternans of Ca2+ transient amplitude, which also appeared in EPI at shorter BCL than in ENDO and MID cells. Ca2+ transient alternans was not observed in neonate myocytes. We conclude that 1) there are distinct regional differences in the vulnerability to rate-dependent Ca2+ alternans in dog LV that may be related to regional differences in SR function and Ca2+ cycling; 2) the development of subcellular Ca2+ alternans suggests the presence of intracellular heterogeneities in Ca2+ cycling; and 3) the failure of neonatal cells to develop Ca2+ alternans provides further support that SR Ca2+ cycling is a major component in the development of these phenomena.

Mechanistic enquiry into the effect of increased pacing rate on the upper limit of vulnerability

The goal of this study is to investigate the mechanisms responsible for the increase in the upper limit of vulnerability (ULV; highest shock strength that induces arrhythmia) following the increase in pacing rate. To accomplish this goal, the study employs a three-dimensional bidomain finite element model of a slice through the canine ventricles. The preparation was paced eight times at a basic cycle length (BCL) of either 80 or 150 ms followed by delivery of shocks of various strengths and timings. Our results demonstrate that the shock strength, which induced an arrhythmia 50% of the time, increased 20% for the faster pacing compared to the slower pacing. Analysis of the mechanisms underlying the increased vulnerability revealed that delayed post-shock activations originating in the tissue depths appear as breakthrough activations on the surfaces of the preparation following an isoelectric window (IW). However, the IW duration was consistently shorter in the faster-paced preparation. Consequently, breakthrough activations appeared on the surfaces of this preparation earlier, when the tissue was less recovered, resulting in higher probability of unidirectional block and reentry. This explains why shocks of the same strength were more likely to result in arrhythmia induction when delivered to a preparation that was rapidly paced.

Biventricular hypertrophy in dogs with chronic AV block: effects of cyclosporin A on morphology and electrophysiology

Chronic atrioventricular (AV) block (CAVB) and biventricular hypertrophy in dogs increase susceptibility to drug-induced polymorphic ventricular tachycardia (PVT). In various rodent models, cyclosporin A (CsA) prevented hypertrophy. A similar effect in the CAVB model would allow us to determine whether hypertrophy represents an epiphenomenon, the cause of electrophysiological changes, and/or the anatomic substrate for PVTs. Upon AV node ablation, 6 dogs were studied acutely (AAVB), 25 dogs were kept for 6 (6W) and 12 wk (12W), receiving no treatment [CTL-CAVB-6W ( n = 6) and CTL-CAVB-12W ( n = 7)] or a daily oral dose of 10–20 mg/kg CsA directly ( n = 6, CsA-CAVB-6W) or 6 wk after radio-frequency ablation ( n = 6, CsA-CAVB-12W). For the final study, dogs were anesthetized, and 60 needles were inserted into both ventricles and connected to a multiplexer mapping system. Local effective refractory periods (ERPs) were determined at 56 ± 22 randomly selected sites (extrastimulus technique, basic cycle length = 800 ms). Arrhythmias within 30 min after application of almokalant (0.34 μmol/kg iv) were registered. The hearts were then excised to obtain the heart weight-body weight index (HBWI). Compared with AAVB, CTL-CAVB-6W and CTL-CAVB-12W showed increased HBWI and ERP associated with PVT inducibility in none of six AAVB dogs, four of six CTL-CAVB-6W dogs, and one of seven CTL-CAVB-12W dogs. Compared with CTL-CAVB-6W and CTL-CAVB-12W, CsA-CAVB-6W and CsA-CAVB-12W partially prevented hypertrophy or led to a regression of hypertrophy without reducing ERP prolongation. Despite ERP prolongation, PVTs were no longer inducible with CsA treatment. Thus prolongation of refractoriness seems to provide the trigger, but hypertrophy provides the essential substrate for the induction of PVTs in this model.

Electrical interactions between a rabbit atrial cell and a nodal cell model

Atrial activation involves interactions between cells with automaticity and slow-response action potentials with cells that are intrinsically quiescent with fast-response action potentials. Understanding normal and abnormal atrial activity requires an understanding of this process. We studied interactions of a cell with spontaneous activity, represented by a “real-time” simulation of a model of the rabbit sinoatrial (SA) node cell, simultaneously being electrically coupled via our “coupling clamp” circuit to a real, isolated atrial myocyte with variations in coupling conductance ( G c) or stimulus frequency. The atrial cells were able to be driven at a regular rate by a single SA node model (SAN model) cell. Critical G c for entrainment of the SAN model cell to a nonstimulated atrial cell was 0.55 ± 0.05 nS ( n = 7), and the critical G c that allowed entrainment when the atrial cell was directly paced at a basic cycle length of 300 ms was 0.32 ± 0.01 nS ( n = 7). For each atrial cell we found periodic phenomena of synchronization other than 1:1 entrainment when G c was between 0.1 and 0.3 nS, below the value required for frequency entrainment, when the atrial cell was directly driven at a basic cycle length of either 300 or 600 ms. In conclusion, the high input resistance of the atrial cells allows successful entrainment of nodal and atrial cells at low values of G c, but further uncoupling produces arrhythmic interactions.