Sudden cardiac death kills 5-10 people per 10,000 population in Europe and the US each year. Individual propensity to arrhythmia and sudden cardiac death is typically assessed through clinical biomarkers. Variability in these biomarkers is a major challenge for risk stratification. Variability is observed at a wide range of spatio-temporal scales within the heart, from temporal fluctuations in ion channel behaviour, to inter-cell and inter-regional differences in ion channel expression, to structural differences between hearts. The extent to which variability manifests between spatial and temporal scales remains unclear but has a potentially crucial role in determining susceptibility to arrhythmia. In this dissertation we present a multi-scale study of the causes and consequences of variability in electrophysiology. At a sub-cellular level we demonstrate that, taking into account inter-individual variability in ion channel conductance, mRNA expression levels in failing human hearts predict the electrophysiological remodelling observed experimentally. On a tissue scale, we advocate the use of phenomenological models where information on subcellular processes is unavailable. We introduce a modification to a phenomenological model to capture beat-to-beat variability in action potential repolarisation recorded from four individual guinea pig myocytes. We demonstrate that, whilst temporal variability is dramatically reduced by inter-cell coupling, differences in their mean action potential duration may become apparent at a tissue level. The ventricular myocardium has a heterogeneous structure not captured by the simplified representation of conduction used above. In our final case study, we challenge a model of conduction by directly comparing simulations to optical mapping recordings of ventricular activation from failing and non-failing human hearts. We observe that good fits to experimental data are obtained only when endocardially bound structures are not in view, suggesting a role in conduction for these structures that are often ignored in cardiac simulations. Finally, we present future directions for the work presented. We make the case for reporting of inter-sample variability in experimental results and conclude that whilst variability may not always manifest across scales, its impact should be considered in both theoretical and experimental studies.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:640026 |
| Date | January 2014 |
| Creators | Walmsley, John |
| Contributors | Burrage, Kevin; Rodriguez, Blanca; Mirams, Gary R. |
| Publisher | University of Oxford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://ora.ox.ac.uk/objects/uuid:6c653c3c-64e8-4337-bb97-728b99361573 |
Page generated in 0.0019 seconds