Effect of regional ischemia in arrhythmia vulnerability for heterogeneous transmural cardiac wall: A simulation study

It is well known that ventricular fibrillation (VF) is a major cause of sudden cardiac death in developed countries. Myocardial regional acute ischemia constitutes a heterogeneous substrate which tends to destabilize the electrical depolarizing wave front, thus favouring VF. Functional re-entry in the transmural wall has been hypothesized as the underlying mechanism of VF. In this work, we have theoretically studied (using computer simulations) the temporal evolution of the vulnerable window (VW) for re-entry in an acutely ischemic virtual tissue which represents the transmural ventricular wall. The model predicts that the VW for re-entry has biphasic behaviour during acute myocardial ischemia, with re-entry paths comprising endocardial, midmyocardial and epicardial tissue.