Scroll-wave dynamics in the presence of ionic and conduction inhomogeneities in an anatomically realistic mathematical model for the pig heart

TL;DR

This study uses a realistic pig heart model to show how ionic and conduction inhomogeneities influence scroll-wave dynamics, revealing scale-dependent effects on arrhythmia mechanisms.

Contribution

First demonstration of how geometrical and biophysical inhomogeneities affect scroll waves in an anatomically realistic pig heart model.

Findings

Conduction inhomogeneities cause scroll-wave breakup at cellular scale.

Ionic inhomogeneities attract or pin scroll waves at tissue scale.

Inhomogeneity effects depend on their size and type.

Abstract

Nonlinear waves of the reaction-diffusion (RD) type occur in many biophysical systems, including the heart, where they initiate cardiac contraction. Such waves can form vortices called scroll waves, which result in the onset of life-threatening cardiac arrhythmias. The dynamics of scroll waves is affected by the presence of inhomogeneities, which, in a very general way, can be of \textit{(i)} ionic type, i.e., they affect the reaction part, or \textit{(ii)} conduction type, i.e., they affect the diffusion part of an RD equation. We demostrate, for the first time, by using a state-of-the-art, anatomically realistic model of the pig heart, how differences in the geometrical and biophysical nature of such inhomogeneities can influence scroll-wave dynamics in different ways. Our study reveals that conduction-type inhomogeneities become increasingly important at small length scales, i.e., in the case of multiple, randomly distributed, obstacles in space at the cellular scale ($0.2-0.4{\rm mm}$). Such configurations can lead to scroll-wave break up. In contrast, ionic inhomogeneities, affect scroll-wave dynamics significantly at large length scales, when these inhomogeneities are localized in space at the tissue level ($5-10$ mm). In such configurations, these inhomogeneities can (a) attract scroll waves, by pinning them to the heterogeneity, or (b) lead to scroll-wave breakup.