Effects of Increased Extracellular Potassium Concentration Induced by Ischemia on the Vulnerability of Ventricular Arrhythmias and the Regularity of Related Ventricular Tachycardia

Myocardial ischemia could induce arrhythmias such as ventricular tachycardia and ventricular fibrillation, leading to sudden death and other serious consequences. This manuscript adopted the cardiac modeling and simulation method to study the activity pattern of myocardial ischemia-related ventricular tachycardia and the effect of increased extracellular potassium concentration on arrhythmia vulnerability. A whole ventricular electrophysiological model of endocardial ischemia caused by distal occlusion of left anterior descending coronary artery was established. The simulation results suggested that the relationship between the vulnerability of ventricular arrhythmias and extracellular potassium concentration was bell shaped with a peak in susceptibility at 12 mM. This result was caused by the effect of extracellular potassium concentration on the dispersion of repolarization and the effective refractory period of cardiomyocytes. The extension of the effective refractory period was due to the electrical remodeling of the ventricle. Specifically, it was because of the delayed recovery of the I-Na current. In addition, the regularity of endocardial/epicardial reentrant pattern during non-transmural ischemia was also analyzed. The endocardium formed micro-reentrant, while the epicardium established macro-reentrant rotating around the ischemic regions provided a new idea for the determination of clinical ablation targets.

Automated summary

Myocardial ischemia can lead to ventricular tachycardia and ventricular fibrillation. Simulation results indicate that susceptibility peaks at 12mM due to the effect of extracellular potassium on repolarization dispersion and effective refractory period. The study also analyzes reentrant patterns during non-transmural ischemia, providing insights for clinical ablation targets.