Computational Representations of Myocardial Infarct Scars and Implications for Arrhythmogenesis.
Computational Representations of Myocardial Infarct Scars and Implications for Arrhythmogenesis.
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DOI：
10.4137/cmc.s39708
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Bishop MJ
中科院分区：
文献类型：
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作者：
Connolly AJ;Bishop MJ
基于图像的计算建模正在成为一种越来越多使用的临床工具，以提供对折返性心律失常机制的深入了解。在缺血性心脏病的背景下，由于已知的疤痕的电生理特性，在模型内梗死区域的电生理特性的忠实表示是必不可少的。在这里，我们回顾了不同的计算表示的梗塞区域，总结了实验测量的基础上，他们。然后，我们专注于两个最常见的代表性的疤痕核心（完全绝缘体或电被动组织），并进行模拟周围理想化的梗死几何形状的电传播。我们的模拟突出了疤痕周围的动作电位时程和局灶性有效不应期（ERP）的显着差异，由电紧张负荷的差异驱动，这取决于疤痕代表的选择。最后，一种新的机制，心律失常诱导，局灶性异位搏动后，证明，这依赖于本地化的梯度ERP直接引起的电紧张性汇效应的相邻的被动疤痕。
Image-based computational modeling is becoming an increasingly used clinical tool to provide insight into the mechanisms of reentrant arrhythmias. In the context of ischemic heart disease, faithful representation of the electrophysiological properties of the infarct region within models is essential, due to the scars known for arrhythmic properties. Here, we review the different computational representations of the infarcted region, summarizing the experimental measurements upon which they are based. We then focus on the two most common representations of the scar core (complete insulator or electrically passive tissue) and perform simulations of electrical propagation around idealized infarct geometries. Our simulations highlight significant differences in action potential duration and focal effective refractory period (ERP) around the scar, driven by differences in electrotonic loading, depending on the choice of scar representation. Finally, a novel mechanism for arrhythmia induction, following a focal ectopic beat, is demonstrated, which relies on localized gradients in ERP directly caused by the electrotonic sink effects of the neighboring passive scar.