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Using one-dimensional models of myocardial tissue, implemented as chains of virtual ventricular muscle segments that are kinematically connected in series, we studied the role of the excitation sequence in spatio-temporal organization of cardiac function. Each model element was represented by a well-verified mathematical model of cardiac electro-mechanical activity. We found that homogeneous chains, consisting of identical elements, respond to non-simultaneous stimulation by generation of complex spatio-temporal heterogeneities in element deformation. These are accompanied by the establishment of marked gradients in local electro-mechanical properties of the elements (heterogeneity in action potential duration, Ca2+ transient characteristics and sarcoplasmic reticulum Ca2+ loading). In heterogeneous chains, composed of elements simulating fast and slow contracting cardiomyocytes from different transmural layers, we found that only activation sequences where stimulation of the slower elements preceded that of faster ones gave rise to optimization of the system's electro-mechanical function, which was confirmed experimentally. Based on the results obtained, we hypothesize that the sequence of activation of cardiomyocytes in different ventricular layers is one of the key factors of spatio-temporal organization of myocardium. Moreover, activation sequence and regional differences in intrinsic electro-mechanical properties of cardiac muscle must be matched in order to optimize myocardial function.

This paper reviews the development and application of paired muscle preparations, called duplex, for the investigation of mechanisms and consequences of intra-myocardial electro-mechanical heterogeneity. We illustrate the utility of the underlying combined experimental and computational approach for conceptual development and integration of basic science insight with clinically relevant settings, using previously published and new data. Directions for further study are identified.

Waves of electrical excitation rotating around an obstacle is one of the important mechanisms of dangerous cardiac arrhythmias occurring in the heart damaged by post-infarction scar. Such a scar also has a border zone around it, which has electrophysiological properties different from the rest of normal myocardial tissue. Spatial patterns of wave rotation in the presence of such tissue heterogeneity are poorly studied. In this paper we perform a comprehensive numerical study of various regimes of rotation of a wave in a plane layer of the ventricular tissue around an obstacle surrounded by a gray zone. We use a TP06 cellular ionic model which reproduces the electrophysiological properties cardiomyocytes in the left ventricle of human heart. We vary the extent of obstacle and gray zone and study the pattern of wave rotation and its period. We observed different regimes of wave rotation that can be subdivided into several classes: (1) functional rotation and (2) scar rotation regimes, which were identified in the previous studies, and new (3) gray zone rotation regime: where the wave instead of rotation around the obstacle, rotates around the gray zone (an area of tissue heterogeneity) itself. For each class, the period of rotation is determined by different factors, which we discuss and quantify. We also found that due to regional pathological remodeling of myocardial tissue, we can obtain additional regimes associated with dynamical instabilities of two types which may affect or not affect the period of rotation.

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