Effect of fibre rotation on the initiation of re-entry in cardiac tissue.

Abstract

Transmural rotation of cardiac fibres can have a big influence on the initiation of re-entry in the heart. However, owing to computational demands, this has not been fully explored in a three-dimensional model of cardiac tissue that has a microscopic description of membrane currents, such as the Luo-Rudy model. Using a previously described model that is computationally fast, re-entry in three-dimensional blocks of cardiac tissue is induced by a cross-shock protocol, and the activity is examined. In the study, the effect of the transmural fibre rotation is ascertained by examining differences between a tissue block with no rotation and ones with 1, 2 and 3 degrees of rotation per fibre layer. The direction of the re-entry is significant in establishing whether or not re-entry can be induced, with clockwise re-entry being easier to initiate. Owing to the rotating anisotropy that results in preferential propagation along the fibre axis, the timing of the second stimulus in the cross-shock protocol has to be changed for different rates of fibre rotation. The fibre rotation either increases or decreases the window of opportunity for re-entry, depending on whether the activation front is perpendicular or parallel to the fibre direction. By varying the transmural extent of the S2, it is found that a deeper stimulus has to be applied to the blocks with fibre rotation to create re-entry. Increasing the transmural resistance also tends to reduce the extent of the S2 required to induce re-entry. Results suggest that increasing fibre rotation reduces the susceptibility of the tissue to re-entry, but that more complex spatiotemporal patterns are possible, e.g. stable figure-of-eight re-entries and transient rotors. Three mechanisms of re-entry annihilation are identified: front catchup, filling of the excitable gap and core wander.