Three-dimensional cardiac tissue image registration for analysis of in vivo electrical mapping

Cardiac intramural electrical mapping reveals focal delays but no conduction velocity slowing in the peri-infarct region

Altered electrical behavior alongside healed myocardial infarcts (MIs) is associated with increased risk of sudden cardiac death. However, the multidimensional mechanisms are poorly understood and described. This study characterizes, for the first time, the intramural spread of electrical activation in the peri-infarct region of chronic reperfusion MIs. Four sheep were studied 13 wk after antero-apical reperfusion infarction. Extracellular potentials (ECPs) were recorded in a ~20 × 20-mm² region adjacent to the infarct boundary (25 plunge needles <0.5-mm diameter with 15 electrodes at 1-mm centers) during multisite stimulation. Infarct geometry and electrode locations were reconstructed from magnetic resonance images. Three-dimensional activation spread was characterized by local activation times and interpolated ECP fields (n = 191 records). Control data were acquired in 4 non-infarcted sheep (n = 96 records). Electrodes were distributed uniformly around 15 ± 5% of the intramural infarct boundary. There were marked changes in pacing success and ECP morphology across a functional border zone (BZ) ±2 mm from the boundary. Stimulation adjacent to the infarct boundary was associated with low-amplitude electrical activity within the BZ and delayed activation of surrounding myocardium. Bulk tissue depolarization occurred 3.5-14.6 mm from the pacing site for 39% of stimuli with delays of 4-37 ms, both significantly greater than control (P < 0.0001). Conduction velocity (CV) adjacent to the infarct was not reduced compared with control, consistent with structure-only computer model results. Insignificant CV slowing, irregular stimulus-site specific activation delays, and obvious indirect activation pathways strongly suggest that the substrate for conduction abnormalities in chronic MI is predominantly structural in nature.NEW & NOTEWORTHY Intramural in vivo measurements of peri-infarct electrical activity were not available before this study. We use pace-mapping in a three-dimensional electrode array to show that a subset of stimuli in the peri-infarct region initiates coordinated myocardial activation some distance from the stimulus site with substantial associated time delays. This is site dependent and heterogeneous and occurs for <50% of ectopic stimuli in the border zone. Furthermore, once coordinated activation is initiated, conduction velocity adjacent to the infarct boundary is not significantly different from control. These results give new insights to peri-infarct electrical activity and do not support the widespread view of uniform electrical remodeling in the border zone of chronic myocardial infarcts, with depressed conduction velocity throughout.

Quantitative descriptions of extended volume cardiac tissue architecture from multiple large hearts

The arrangement of cardiac cells into strand and sheet-like structures within the heart wall, confers important electrical properties onto heart tissue. Unraveling cardiomyocyte architecture in both healthy and diseased hearts is fundamental to understanding the mechanisms generating normal rhythm and arrhythmia. We analyzed five extended volume serial image stacks of normal pig left ventricular tissue. Analysis included: (1) reconstruction of original tissue volume and shape with non-linear correction maps; (2) segmentation and higher-order descriptions, areas and orientations of laminar structures through the heart wall; (3)computation of fiber directions; (4) computation of tissue connectivity using a shell filter. These measures contributed to a deeper and more objective understanding of cardiac tissue structures and their spatial variation than previously possible.

Electrical wave propagation in an anisotropic model of the left ventricle based on analytical description of cardiac architecture

We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher–Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation.

Mathematical model of the anatomy and fibre orientation field of the left ventricle of the heart

Background

One of the main factors affecting propagation of electrical waves and contraction in ventricles of the heart is anisotropy of cardiac tissue. Anisotropy is determined by orientation of myocardial fibres. Determining fibre orientation field and shape of the heart is important for anatomically accurate modelling of electrical and mechanical function of the heart. The aim of this paper is to introduce a theoretical rule-based model for anatomy and fibre orientation of the left ventricle (LV) of the heart and to compare it with experimental data. We suggest explicit analytical formulae that allow us to obtain the left ventricle form and its fibre direction field. The ventricle band concept of cardiac architecture given by Torrent-Guasp is chosen as the model postulate.

Methods

In our approach, anisotropy of the heart is derived from some general principles. The LV is considered as a set of identical spiral surfaces, each of which can be produced from the other by rotation around one vertical axis. Each spiral surface is filled with non-intersecting curves which represent myocardial fibres.

For model verification, we use experimental data on fibre orientation in human and canine hearts.

Results

LV shape and anisotropy are represented by explicit analytical expressions in a curvilinear 3-D coordinate system. The derived fibre orientation field shows good qualitative agreement with experimental data. The model reveals the most thorough quantitative simulation of fibre angles at the LV middle zone.

Conclusions

Our analysis shows that the band concept can generate realistic anisotropy of the LV. Our model shows good qualitative agreement between the simulated fibre orientation field and the experimental data on LV anisotropy, and the model can be used for various numerical simulations to study the effects of anisotropy on cardiac excitation and mechanical function.