In silico ischaemia-induced reentry at the Purkinje-ventricle interface

• Published in: Europace (London, England) Vol. 16; no. 3; pp. 444 - 451
• Main Authors: Ramirez, Esteban, Saiz, Javier, Romero, Lucia, Ferrero, Jose M, Trenor, Beatriz
• Format: Journal Article
• Language: English
• Published: England 01-03-2014
• Subjects: Action Potentials; Animals; Computer Simulation; Dogs; Heart Conduction System - physiopathology; Heart Ventricles - physiopathology; Humans; Hyperkalemia - complications; Hyperkalemia - physiopathology; Models, Cardiovascular; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; Purkinje Fibers - physiopathology; Hyperkalaemia; Reentry; Phase 1B ischaemia; Computer simulations; Arrhythmias; Intercellular coupling
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eut386

This computational modelling work illustrates the influence of hyperkalaemia and electrical uncoupling induced by defined ischaemia on action potential (AP) propagation and the incidence of reentry at the Purkinje-ventricle interface in mammalian hearts.
Unidimensional and bidimensional models of the Purkinje-ventricle subsystem, including ischaemic conditions (defined as phase 1B) in the ventricle and an ischaemic border zone, were developed by altering several important electrophysiological parameters of the Luo-Rudy AP model of the ventricular myocyte. Purkinje electrical activity was modelled using the equations of DiFrancesco and Noble. Our study suggests that an extracellular potassium concentration [K(+)]o >14 mM and a slight decrease in intercellular coupling induced by ischaemia in ventricle can cause conduction block from Purkinje to ventricle. Under these conditions, propagation from ventricle to Purkinje is possible. Thus, unidirectional block (UDB) and reentry can result. When conditions of UDB are met, retrograde propagation with a long delay (320 ms) may re-excite Purkinje cells, and give rise to a reentrant pathway. This induced reentry may be the origin of arrhythmias observed in phase 1B ischaemia.
In a defined setting of ischaemia (phase 1B), a small amount of uncoupling between ventricular cells, as well as between Purkinje and ventricular tissue, may induce UDBs and reentry. Hyperkalaemia is also confirmed to be an important factor in the genesis of reentrant rhythms, since it regulates the range of coupling in which UDBs may be induced.