Arrhythmia as a result of poor intercellular coupling in the sinus node: a simulation study

Potential effects of intrinsic heart pacemaker cell mechanisms on dysrhythmic cardiac action potential firing

The heart's regular electrical activity is initiated by specialized cardiac pacemaker cells residing in the sinoatrial node. The rate and rhythm of spontaneous action potential firing of sinoatrial node cells are regulated by stochastic mechanisms that determine the level of coupling of chemical to electrical clocks within cardiac pacemaker cells. This coupled-clock system is modulated by autonomic signaling from the brain via neurotransmitter release from the vagus and sympathetic nerves. Abnormalities in brain-heart clock connections or in any molecular clock activity within pacemaker cells lead to abnormalities in the beating rate and rhythm of the pacemaker tissue that initiates the cardiac impulse. Dysfunction of pacemaker tissue can lead to tachy-brady heart rate alternation or exit block that leads to long atrial pauses and increases susceptibility to other cardiac arrhythmia. Here we review evidence for the idea that disturbances in the intrinsic components of pacemaker cells may be implemented in arrhythmia induction in the heart.

Upregulation of adenosine A1 receptors facilitates sinoatrial node dysfunction in chronic canine heart failure by exacerbating nodal conduction abnormalities revealed by novel dual-sided intramural optical mapping

BACKGROUND

Although sinoatrial node (SAN) dysfunction is a hallmark of human heart failure (HF), the underlying mechanisms remain poorly understood. We aimed to examine the role of adenosine in SAN dysfunction and tachy-brady arrhythmias in chronic HF.

METHODS AND RESULTS

We applied multiple approaches to characterize SAN structure, SAN function, and adenosine A1 receptor expression in control (n=17) and 4-month tachypacing-induced chronic HF (n=18) dogs. Novel intramural optical mapping of coronary-perfused right atrial preparations revealed that adenosine (10 μmol/L) markedly prolonged postpacing SAN conduction time in HF by 206 ± 99 milliseconds (versus 66 ± 21 milliseconds in controls; P=0.02). Adenosine induced SAN intranodal conduction block or microreentry in 6 of 8 dogs with HF versus 0 of 7 controls (P=0.007). Adenosine-induced SAN conduction abnormalities and automaticity depression caused postpacing atrial pauses in HF versus control dogs (17.1 ± 28.9 versus 1.5 ± 1.3 seconds; P<0.001). Furthermore, 10 μmol/L adenosine shortened atrial repolarization and led to pacing-induced atrial fibrillation in 6 of 7 HF versus 0 of 7 control dogs (P=0.002). Adenosine-induced SAN dysfunction and atrial fibrillation were abolished or prevented by adenosine A1 receptor antagonists (50 μmol/L theophylline/1 μmol/L 8-cyclopentyl-1,3-dipropylxanthine). Adenosine A1 receptor protein expression was significantly upregulated during HF in the SAN (by 47 ± 19%) and surrounding atrial myocardium (by 90 ± 40%). Interstitial fibrosis was significantly increased within the SAN in HF versus control dogs (38 ± 4% versus 23 ± 4%; P<0.001).

CONCLUSIONS

In chronic HF, adenosine A1 receptor upregulation in SAN pacemaker and atrial cardiomyocytes may increase cardiac sensitivity to adenosine. This effect may exacerbate conduction abnormalities in the structurally impaired SAN, leading to SAN dysfunction, and potentiate atrial repolarization shortening, thereby facilitating atrial fibrillation. Atrial fibrillation may further depress SAN function and lead to tachy-brady arrhythmias in HF.

Analyzing the effects of gap junction blockade on neural synchrony via a motoneuron network computational model

In specific regions of the central nervous system (CNS), gap junctions have been shown to participate in neuronal synchrony. Amongst the CNS regions identified, some populations of brainstem motoneurons are known to be coupled by gap junctions. The application of various gap junction blockers to these motoneuron populations, however, has led to mixed results regarding their synchronous firing behavior, with some studies reporting a decrease in synchrony while others surprisingly find an increase in synchrony. To address this discrepancy, we employ a neuronal network model of Hodgkin-Huxley-style motoneurons connected by gap junctions. Using this model, we implement a series of simulations and rigorously analyze their outcome, including the calculation of a measure of neuronal synchrony. Our simulations demonstrate that under specific conditions, uncoupling of gap junctions is capable of producing either a decrease or an increase in neuronal synchrony. Subsequently, these simulations provide mechanistic insight into these different outcomes.

Renormalization of oscillator lattices with disorder

A real-space renormalization transformation is constructed for lattices of nonidentical oscillators with dynamics of the general form dvarphi_{k}/dt=omega_{k}+g summation operator_{l}f_{lk}(varphi_{l},varphi_{k}) . The transformation acts on ensembles of such lattices. Critical properties corresponding to a second-order phase transition toward macroscopic synchronization are deduced. The analysis is potentially exact but relies in part on unproven assumptions. Numerically, second-order phase transitions with the predicted properties are observed as g increases in two structurally different two-dimensional oscillator models. One model has smooth coupling f_{lk}(varphi_{l},varphi_{k})=phi(varphi_{l}-varphi_{k}) , where phi(x) is nonodd. The other model is pulse coupled, with f_{lk}(varphi_{l},varphi_{k})=delta(varphi_{l})phi(varphi_{k}) . Lower bounds for the critical dimensions for different types of coupling are obtained. For nonodd coupling, macroscopic synchronization cannot be ruled out for any dimension D> or =1 , whereas in the case of odd coupling, the well-known result that it can be ruled out for D<3 is regained.

Frequency entrainment in long chains of oscillators with random natural frequencies in the weak coupling limit

We study oscillator chains of the form phi; (k) = omega(k) +K[Gamma( phi(k-1) - phi(k) )+Gamma( phi(k+1) - phi(k) )], where phi(k) epsilon[0,2pi) is the phase of oscillator k. In the thermodynamic limit where the number of oscillators goes to infinity, for suitable choices of Gamma(x), we prove that there is a critical coupling strength K(c), above which a stable frequency-entrained state exists, but below which the probability is zero to have such a state. It is assumed that the natural frequencies are random with finite bandwidth. A crucial condition on Gamma(x) is that it is nonodd, i.e., mid R: Gamma(x)+Gamma(-x) mid R: not equal 0. The interest in the results comes from the fact that any chain of limit-cycle oscillators can be described by equations of the above form in the limits of weak coupling and narrow distribution of natural frequencies.

Intracellular Ca dynamics in ventricular fibrillation

In the heart, membrane voltage ( Vm) and intracellular Ca (Cai) are bidirectionally coupled, so that ionic membrane currents regulate Cai cycling and Cai affects ionic currents regulating action potential duration (APD). Although Cai reliably and consistently tracks Vm at normal heart rates, it is possible that at very rapid rates, sarcoplasmic reticulum Cai cycling may exhibit intrinsic dynamics. Non-voltage-gated Cai release might cause local alternations in APD and refractoriness that influence wavebreak during ventricular fibrillation (VF). In this study, we tested this hypothesis by examining the extent to which Cai is associated with Vm during VF. Cai transients were mapped optically in isolated arterially perfused swine right ventricles using the fluorescent dye rhod 2 AM while intracellular membrane potential was simultaneously recorded either locally with a microelectrode (5 preparations) or globally with the voltage-sensitive dye RH-237 (5 preparations). Mutual information (MI) is a quantitative statistical measure of the extent to which knowledge of one variable ( Vm) predicts the value of a second variable (Cai). MI was high during pacing and ventricular tachycardia (VT; 1.13 ± 0.21 and 1.69 ± 0.18, respectively) but fell dramatically during VF (0.28 ± 0.06, P < 0.001). Cai at sites 4–6 mm apart also showed decreased MI during VF (0.63 ± 0.13) compared with pacing (1.59 ± 0.34, P < 0.001) or VT (2.05 ± 0.67, P < 0.001). Spatially, Cai waves usually bore no relationship to membrane depolarization waves during nonreentrant fractionated waves typical of VF, whereas they tracked each other closely during pacing and VT. The dominant frequencies of Vm and Cai signals analyzed by fast Fourier transform were similar during VT but differed significantly during VF. Cai is closely associated with Vm closely during pacing and VT but not during VF. These findings suggest that during VF, non-voltage-gated Cai release events occur and may influence wavebreak by altering Vm and APD locally.

Pseudoreflection from interface between two oscillatory media: extended driver

The dynamics of a reaction-diffusion medium composed of two uniform self-oscillating regions is considered. We analyze the phenomenon of pseudoreflection of waves at the region's interface. The reflected waves show an unusual change of wavelength, amplitude, and period. In contrast to our previous results, here this behavior can be perceived as an action of a spatially extended higher-frequency "driver." Observed also are the interesting phenomena of the appearance of narrow transient zones near the interface and of diffusion-induced bifurcations. Furthermore, the pseudoreflection is shown to be a possible mechanism of spiral and "target" waves generation. The relevance of the obtained results to the dynamics of the cardiac sinus node is discussed.

Phase transitions towards frequency entrainment in large oscillator lattices

We simulate two-dimensional lattices of pulse-coupled oscillators with random natural frequencies, resembling pacemaker cells in the heart. As coupling increases, this system seems to undergo two phase transitions in the thermodynamic limit. First, the largest cluster of frequency entrained oscillators becomes macroscopic. Second, all oscillators frequency entrain, except possibly some isolated ones. Between the two transitions, the system has features indicating self-organized criticality. To our knowledge, the first transition and the intermediate phase have never been observed before. It remains to be seen if they are generic for large lattices of limit cycle oscillators.

Properties and features of asymmetric partial devil's staircases deduced from piecewise linear maps

A piecewise linear map with one discontinuity is used to link together iterated map properties with the shape of the ensuing staircases. In the main part of the paper, a three-segment map is treated, with a horizontal middle segment next to the discontinuity and the development of partial and asymmetric staircases is demonstrated. In particular, a possible hierarchy of partiality, connected with the ratio of the length of the horizontal segment to the discontinuity jump, is obtained. The map is used for constructing staircases that imitate various experimental and numerical staircases that appear in the literature for excitable systems.

Phase transition to frequency entrainment in a long chain of pulse-coupled oscillators

A long chain of pulse-coupled oscillators was studied. The oscillators interacted via a phase response curve similar to those obtained from pacemaker cells in the heart. The natural frequencies were random numbers from a distribution with finite bandwidth. Stable frequency-entrained states were shown always to exist above a critical coupling strength. Below the critical coupling, the probability to have such states was shown to be zero if the number of oscillators is infinite. This discontinuity establishes the existence of a phase transition in the thermodynamic limit. For weak coupling, clusters of frequency-entrained oscillators emerged. The cluster sizes were exponentially distributed, even when the critical coupling was approached. At this coupling, the mean cluster size diverged to infinity according to a power law. The standard deviation of the distribution of mean frequencies in the chain converged to zero, also according to a power law.