Sodium Current Reduction Unmasks a Structure-Dependent Substrate for Arrhythmogenesis in the Normal Ventricles

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Boyle, Patrick M. ; Park, Carolyn J. ; Arevalo, Hermenegild J. ; Vigmond, Edward J. ; Trayanova, Natalia A.
• Description:
  Background
  
  Organ-scale arrhythmogenic consequences of source-sink mismatch caused by impaired excitability remain unknown, hindering the understanding of pathophysiology in disease states like Brugada syndrome and ischemia.
  
  Objective
  
  We sought to determine whether sodium current (INa) reduction in the structurally normal heart unmasks a regionally heterogeneous substrate for the induction of sustained arrhythmia by premature ventricular contractions (PVCs).
  
  Methods
  
  We conducted simulations in rabbit ventricular computer models with 930 unique combinations of PVC location (10 sites) and coupling interval (250–400 ms), INa reduction (30 or 40% of normal levels), and post-PVC sinus rhythm (arrested or persistent). Geometric characteristics and source-sink mismatch were quantitatively analyzed by calculating ventricular wall thickness and a newly formulated 3D safety factor (SF), respectively.
  
  Results
  
  Reducing INa to 30% of its normal level created a substrate for sustained arrhythmia induction by establishing large regions of critical source-sink mismatch (SF<1) for ectopic wavefronts propagating from thin to thick tissue. In the same simulations but with 40% of normal INa, PVCs did not induce reentry because the volume of tissue with SF<1 was >95% smaller. Likewise, when post-PVC sinus activations were persistent instead of arrested, no ectopic excitations initiated sustained reentry because sinus activation breakthroughs engulfed the excitable gap.
  
  Conclusion
  
  Our new SF formulation can quantify ectopic wavefront propagation robustness in geometrically complex 3D tissue with impaired excitability. This novel methodology was applied to show that INa reduction precipitates source-sink mismatch, creating a potent substrate for sustained arrhythmia induction by PVCs originating near regions of ventricular wall expansion, such as the RV outflow tract.
  
  
• Subjects:
  Action Potentials Animals Arrhythmias, Cardiac Heart Ventricles Rabbits Sodium Channels Ventricular Premature Complexes
• Source:
  PLoS One. 2014; 9(1).
• Pubmed ID:
  24489810
• Pubmed Central ID:
  PMC3904970
• Document Type:
  Journal Article
• Funding:
  DP1 HL123271/HL/NHLBI NIH HHS/United States ; NIH-DP1-HL123271/DP/NCCDPHP CDC HHS/United States ; NIH-R01-HL103428/HL/NHLBI NIH HHS/United States
• Volume:
  9
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bd3fb6a6a8a0e039fecfb3f19fd66988aced5fb1f155fb478e0afa17c5d64313
• Download URL:
  https://stacks.cdc.gov/view/cdc/22494/cdc_22494_DS1.pdf
• File Type:
  [PDF - 1.31 MB ]