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Europace 2005 7(s2):S93-S104; doi:10.1016/j.eupc.2005.03.018
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Alternating conduction in the ischaemic border zone as precursor of reentrant arrhythmias: A simulation study

Olivier Bernusa,*, Christian W. Zemlina, Roman M. Zaritskyb, Sergey F. Mironova and Arkady M. Pertsova

aDepartment of Pharmacology, SUNY Upstate Medical University 750 East Adams Street (WHA) Syracuse, NY 13210, USA; bComputer Science Department, Montclair State University Upper Montclair, NJ 07043, USA

AIMS: Here, we investigate the mechanisms underlying the onset of conduction-related arrhythmias in a three-dimensional (3D) computational model of acute regional ischaemia.

METHODS: Ischaemia was introduced by realistic gradients of potassium, pH, oxygen and electrical coupling in a 3D slab of ventricular tissue using the LRd model. We focused on a specific stage (10–15 min after occlusion) at which an intramural non-conductive ischaemic core (IC) surrounded by a border zone (BZ) has formed.

RESULTS: At pacing frequencies greater than 4.5 Hz, we observed narrow areas (0.5 mm wide) of 2:1 conduction blocks at the periphery of the IC. As the pacing frequency increased, the area of block widened to 9 mm and gave rise to reentry at the periphery of the BZ. Alternating conduction blocks produced discordant action potential duration (APD) alternans throughout the slab and T-wave alternans in pseudo-ECG. Slowing the recovery of the calcium current broadened the range of pacing frequencies at which blocks were observed. Hyperkalaemia alone was sufficient to induce the alternating blocks.

CONCLUSION: Computer modelling predicts that ischaemia-related arrhythmias are triggered by calcium-mediated alternating conduction blocks in the ischaemic border zone. Alternating conduction blocks lead to intramural reentry and APD alternans.

Key Words: acute regional ischaemia, 2:1 conduction blocks, APD and T-wave alternans, reentry

*Corresponding author. Tel.: +1 315 464 5141; fax: +1 315 464 8014. E-mail address: bernuso{at}upstate.edu (O. Bernus).


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