Arrhythmia from dyad to whole-heart: bi-directional coupling between re-entry and spontaneous calcium release
The mechanisms underlying the initiation and perpetuation of cardiac arrhythmias are inherently multi-scale: whereas arrhythmias are intrinsically tissue-level phenomena, they have a significant dependence cellular electrophysiological factors. Spontaneous sub-cellular calcium release events (SCRE), such as calcium waves, are a exemplars of the multi-scale nature of cardiac arrhythmias: stochastic dynamics at the nanometre-scale can influence tissue excitation patterns at the centimetre scale, as triggered action potentials may elicit focal excitations. This latter mechanism has been long proposed to underlie, in particular, the initiation of rapid arrhythmias such as tachycardia and fibrillation, yet systematic analysis of this mechanism has yet to be fully explored. Moreover, potential bi-directional coupling has been seldom explored even in concept.
A major challenge of dissecting the role and importance of SCRE in cardiac arrhythmias is that of simultaneously exploring sub-cellular and tissue function experimentally. Computational modelling provides a potential approach to perform such analysis, but requires new techniques to be employed to practically simulate sub-cellular stochastic events in tissue-scale models comprising thousands or millions of coupled cells.
This presentation will outline the novel techniques developed to achieve this aim, and explore preliminary studies investigating the mechanisms and importance of SCRE in tissue-scale arrhythmia: How do independent, small-scale sub-cellular events overcome electrotonic load and manifest as a focal excitation? How can SCRE focal (and non-focal) dynamics lead to re-entrant excitation? How does long-term re-entrant excitation interact with SCRE to perpetuate and degenerate arrhythmia?