Source-Sink Mismatch Causing Functional Conduction Block in Re-Entrant Ventricular Tachycardia

Edward J. Ciaccio, James Coromilas, Andrew L. Wit, Nicholas S. Peters, Hasan Garan

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Ventricular tachycardia (VT) caused by a re-entrant circuit is a life-threatening arrhythmia that at present cannot always be treated adequately. A realistic model of re-entry would be helpful to accurately guide catheter ablation for interruption of the circuit. In this review, models of electrical activation wavefront propagation during onset and maintenance of re-entrant VT are discussed. In particular, the relationship between activation mapping and maps of transition in infarct border zone thickness, which results in source-sink mismatch, is considered in detail and supplemented with additional data. Based on source-sink mismatch, the re-entry isthmus can be modeled from its boundary properties. Isthmus boundary segments with large transitions in infarct border zone thickness have large source-sink mismatch, and functional block forms there during VT. These alternate with segments having lesser thickness change and therefore lesser source-sink mismatch, which act as gaps, or entrance and exit points, to the isthmus during VT. Besides post-infarction substrates, the source-sink model is likely applicable to other types of volumetric changes in the myocardial conducting medium, such as when there is presence of fibrosis or dissociation of muscle fibers.

Original languageEnglish (US)
Pages (from-to)1-16
Number of pages16
JournalJACC: Clinical Electrophysiology
Volume4
Issue number1
DOIs
StatePublished - Jan 2018

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Keywords

  • MRI
  • activation
  • re-entry
  • ventricular tachycardia
  • wavefront

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