Reactive Interstitial and Reparative Fibrosis as Substrates for Cardiac Ectopic Pacemakers and Reentries.

Dangerous cardiac arrhythmias have been frequently associated with focal sources of fast pulses, i.e. ectopic pacemakers. However, there is a lack of experimental evidences that could explain how ectopic pacemakers could be formed in cardiac tissue. In recent studies, we have proposed a new theory for the genesis of ectopic pacemakers in pathological cardiac tissues: reentry inside microfibrosis, i.e., a small region where excitable myocytes and non-conductive material coexist. In this work, we continue this investigation by comparing different types of fibrosis, reparative and reactive interstitial fibrosis. We use detailed and modern models of cardiac electrophysiology that account for the micro-structure of cardiac tissue. In addition, for the solution of our models we use, for the first time, a new numerical algorithm based on the Uniformization method. Our simulation results suggest that both types of fibrosis can support reentries, and therefore can generate in-silico ectopic pacemakers. However, the probability of reentries differs quantitatively for the different types of fibrosis. In addition, the new Uniformization method yields 20-fold increase in cardiac tissue simulation speed and, therefore, was an essential technique that allowed the execution of over a thousand of simulations.