Cardiac tissue structure. Electric field interactions in polarizing the heart: 3D computer models and applications

The goal of this research is to investigate the interactions between the cardiac tissue structure and applied electric fields in producing complex polarization patterns. It is hypothesized that the response of the heart in the conditions of strong electric shocks, as those applied in defibrillation, is dominated by mechanisms involving the cardiac muscle structure perceived as a continuum. Analysis is carried out in three-dimensional models of the heart with detailed fiber architecture. Shock-induced transmembrane potentials are calculated using the bidomain model in its finite element implementation.; The major new findings of this study can be summarized as follows: (1) The mechanisms of polarization due to cardiac fiber curvature and fiber rotation are elucidated in three-dimensional ellipsoidal hearts of variable geometry; (2) Results are presented showing that the axis of stimulation and the polarization axis on a whole heart level might differ significantly due to geometric and anisotropic factors; (3) Virtual electrode patterns are demonstrated numerically inside the ventricular wall in internal defibrillation conditions. The role of the tissue-bath interface in shaping the shock-induced polarization is revealed; (4) The generation of 3D phase singularity scrolls by shock-induced intramural virtual electrode patterns is proposed as evidence for a possible new mechanism for the failure to defibrillate.; The results of this study emphasize the role of unequal anisotropy in the intra- and extracellular domains, as well as the salient fiber architecture characteristics, such as curvature and transmural rotation, in polarizing the myocardium. Experimental support of the above findings was actively sought and found in recent optical mapping studies using voltage-sensitive dyes. If validated in vivo, these findings would significantly enrich the prevailing concepts about the mechanisms of stimulation and defibrillation of the heart.