Mechano-electric effect and a heart assist device in the synergistic model of cardiac function

Eun-jin Kim; Massimo Capoccia; Eun-jin Kim; Massimo Capoccia

doi:10.3934/mbe.2020282

Mathematical Biosciences and Engineering

2020, Volume 17, Issue 5: 5212-5233. doi: 10.3934/mbe.2020282

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Mechano-electric effect and a heart assist device in the synergistic model of cardiac function

Eun-jin Kim ^{1,2
,
,},
Massimo Capoccia ³

1.
Fluid and Complex Systems Research Centre, Coventry University, Coventry, CV1 5FB, UK
2.
School of Mathematics and Statistics, University of Sheffield, Sheffield, S3 7RH, UK
3.
Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK

Received: 28 May 2020 Accepted: 22 July 2020 Published: 04 August 2020

The breakdown of cardiac self-organization leads to heart diseases and failure, the number one cause of death worldwide. Within the traditional time-varying elastance model, cardiac self-organization and breakdown cannot be addressed due to its inability to incorporate the dynamics of various feedback mechanisms consistently. To face this challenge, we recently proposed a paradigm shift from the time-varying elastance concept to a synergistic model of cardiac function by integrating mechanical, electric and chemical activity on micro-scale sarcomere and macro-scale heart. In this paper, by using our synergistic model, we investigate the mechano-electric feedback (MEF) which is the effect of mechanical activities on electric activity—one of the important feedback loops in cardiac function. We show that the (dysfunction of) MEF leads to various forms of heart arrhythmias, for instance, causing the electric activity and left-ventricular volume and pressure to oscillate too fast, too slowly, or erratically through periodic doubling bifurcations or ectopic excitations of incommensurable frequencies. This can result in a pathological condition, reminiscent of dilated cardiomyopathy, where a heart cannot contract or relax properly, with an ineffective cardiac pumping and abnormal electric activities. This pathological condition is then shown to be improved by a heart assist device (an axial rotary pump) since the latter tends to increase the stroke volume and aortic pressure while inhibiting the progression (bifurcation) to such a pathological condition. These results highlight a nontrivial effect of a mechanical pump on the electric activity of the heart.
- haemodynamics,
- cardiac cycle,
- axial rotary pump,
- mechano-electric effect,
- arrhythmias,
- feedback,
- lumped-parameter model,
- biological complexity,
- self-organization,
- nonlinear dynamics
Citation: Eun-jin Kim, Massimo Capoccia. Mechano-electric effect and a heart assist device in the synergistic model of cardiac function[J]. Mathematical Biosciences and Engineering, 2020, 17(5): 5212-5233. doi: 10.3934/mbe.2020282

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Abstract

The breakdown of cardiac self-organization leads to heart diseases and failure, the number one cause of death worldwide. Within the traditional time-varying elastance model, cardiac self-organization and breakdown cannot be addressed due to its inability to incorporate the dynamics of various feedback mechanisms consistently. To face this challenge, we recently proposed a paradigm shift from the time-varying elastance concept to a synergistic model of cardiac function by integrating mechanical, electric and chemical activity on micro-scale sarcomere and macro-scale heart. In this paper, by using our synergistic model, we investigate the mechano-electric feedback (MEF) which is the effect of mechanical activities on electric activity—one of the important feedback loops in cardiac function. We show that the (dysfunction of) MEF leads to various forms of heart arrhythmias, for instance, causing the electric activity and left-ventricular volume and pressure to oscillate too fast, too slowly, or erratically through periodic doubling bifurcations or ectopic excitations of incommensurable frequencies. This can result in a pathological condition, reminiscent of dilated cardiomyopathy, where a heart cannot contract or relax properly, with an ineffective cardiac pumping and abnormal electric activities. This pathological condition is then shown to be improved by a heart assist device (an axial rotary pump) since the latter tends to increase the stroke volume and aortic pressure while inhibiting the progression (bifurcation) to such a pathological condition. These results highlight a nontrivial effect of a mechanical pump on the electric activity of the heart.

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