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The Relative Role of Refractoriness and Source–Sink Relationship in Reentry Generation during Simulated Acute Ischemia

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Abstract

During acute myocardial ischemia, reentrant episodes may lead to ventricular fibrillation (VF), giving rise to potentially mortal arrhythmias. VF has been traditionally related to dispersion of refractoriness and more recently to the source–sink relationship. Our goal is to theoretically investigate the relative role of dispersion of refractoriness and source–sink mismatch in vulnerability to reentry in the specific situation of regional myocardial acute ischemia. The electrical activity of a regionally ischemic tissue was simulated using a modified version of the Luo-Rudy dynamic model. Ischemic conditions were varied to simulate the time-course of acute ischemia. Our results showed that dispersion of refractoriness increased with the severity of ischemia. However, no correlation between dispersion of refractoriness and the width of the vulnerable window was found. Additionally, in approximately 50% of the reentries, unidirectional block (UDB) took place in cells completely recovered from refractoriness. We examined patterns of activation after premature stimulation and they were intimately related to the source–sink relationship, quantified by the safety factor (SF). Moreover, the isoline where the SF dropped below unity matched the area where propagation failed. It was concluded that the mismatch of the source–sink relationship, rather than solely refractoriness, was the ultimate cause of the UDB leading to reentry. The SF represents a very powerful tool to study the mechanisms responsible for reentry.

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Acknowledgments

This work was partially supported by the “Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica del Ministerio de Educación y Ciencia” of Spain (TEC 2005-04199 and TEC 2008-02090).

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Authors and Affiliations

  1. Instituto de Investigación e Innovación en Bioingeniería, Universidad Politécnica de Valencia, Camino de Vera s/n, 46022, Valencia, Spain

    Lucía Romero, Beatriz Trénor, Catalina Tobón, Javier Saiz & José M. Ferrero Jr.

  2. Departamento de Sistemas Informáticos y Computación, Universidad Politécnica de Valencia, Camino de Vera s/n, 46022, Valencia, Spain

    José M. Alonso

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  1. Lucía Romero
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  2. Beatriz Trénor
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  3. José M. Alonso
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Correspondence to José M. Ferrero Jr..

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Romero, L., Trénor, B., Alonso, J.M. et al. The Relative Role of Refractoriness and Source–Sink Relationship in Reentry Generation during Simulated Acute Ischemia. Ann Biomed Eng 37, 1560–1571 (2009). https://doi.org/10.1007/s10439-009-9721-2

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