Tachycardia in post-infarction hearts: insights from 3D image-based ventricular models.
Tachycardia in post-infarction hearts: insights from 3D image-based ventricular models.
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DOI：
10.1371/journal.pone.0068872
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Trayanova N
中科院分区：
文献类型：
--
作者：
Arevalo H;Plank G;Helm P;Halperin H;Trayanova N
室性心动过速是一种危及生命的规则和重复性快心律，经常发生在心肌梗死的情况下。最近，坏死瘢痕周围的梗死周围区域（称为灰色区域）已被证明与诱导性室性心动过速相关。然而，它仍然是未知的，后者是如何确定的灰区分布和大小。本研究的目的是研究梗死心脏中心动过速回路的维持，并探讨心动过速组织中心与梗死灰色区大小和异质性程度之间的关系。为了实现这项研究的目标，我们采用了一个复杂的高分辨率的电生理模型的梗死犬心室重建成像数据，代表疤痕和灰色地带。基线犬心室模型还用于生成具有不同灰区大小的其他心室模型，以及灰区表示为活组织和坏死瘢痕的不同异质组合的模型。用许多高分辨率犬心室模型（共22个）进行的心动过速诱导模拟的结果表明，灰色区域是导致心律失常诱导和维持的关键因素。在所有可诱导心律失常的模型中，无论其大小或其组成的异质性水平如何，卷波细丝都完全包含在灰色区域内。因此，灰色区域被认为是促进波破碎和折返形成的致热基质。我们发现，螺旋波灯丝的位置是不敏感的灰区的结构组成，并主要由灰区的形态和大小。这项研究的结果有重要意义的进步，改善标准分层的心肌梗死后患者的心律失常的风险和发展的新方法来确定消融靶点的梗死相关性心动过速。
Ventricular tachycardia, a life-threatening regular and repetitive fast heart rhythm, frequently occurs in the setting of myocardial infarction. Recently, the peri-infarct zones surrounding the necrotic scar (termed gray zones) have been shown to correlate with ventricular tachycardia inducibility. However, it remains unknown how the latter is determined by gray zone distribution and size. The goal of this study is to examine how tachycardia circuits are maintained in the infarcted heart and to explore the relationship between the tachycardia organizing centers and the infarct gray zone size and degree of heterogeneity. To achieve the goals of the study, we employ a sophisticated high-resolution electrophysiological model of the infarcted canine ventricles reconstructed from imaging data, representing both scar and gray zone. The baseline canine ventricular model was also used to generate additional ventricular models with different gray zone sizes, as well as models in which the gray zone was represented as different heterogeneous combinations of viable tissue and necrotic scar. The results of the tachycardia induction simulations with a number of high-resolution canine ventricular models (22 altogether) demonstrated that the gray zone was the critical factor resulting in arrhythmia induction and maintenance. In all models with inducible arrhythmia, the scroll-wave filaments were contained entirely within the gray zone, regardless of its size or the level of heterogeneity of its composition. The gray zone was thus found to be the arrhythmogenic substrate that promoted wavebreak and reentry formation. We found that the scroll-wave filament locations were insensitive to the structural composition of the gray zone and were determined predominantly by the gray zone morphology and size. The findings of this study have important implications for the advancement of improved criteria for stratifying arrhythmia risk in post-infarction patients and for the development of new approaches for determining the ablation targets of infarct-related tachycardia.
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影响因子：
37.8
作者：
Igarashi T;Finet JE;Takeuchi A;Fujino Y;Strom M;Greener ID;Rosenbaum DS;Donahue JK
通讯作者：
Donahue JK
DOI：
10.1152/ajpheart.00082.2004
发表时间：
2004-09-01
影响因子：
4.8
作者：
Dun, W;Baba, SG;Boyden, PA
通讯作者：
Boyden, PA
影响因子：
8.4
作者：
Engelman, Zoar J.;Trew, Mark L.;Smaill, Bruce H.
通讯作者：
Smaill, Bruce H.
影响因子：
24
作者：
Ng, Jason;Jacobson, Jason T.;Goldberger, Jeffrey J.
通讯作者：
Goldberger, Jeffrey J.
影响因子：
120.7
作者：
Curtis, Jeptha P.;Luebbert, Jeffrey J.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.