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Effects of stretch on heart rhythm: theory & practice

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7 Author(s)
Kohl, P. ; Lab. of Physiol., Oxford Univ., UK ; Cooper, P. ; Cheng, L.-X. ; Linz, K.
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Effects of stretch on heart rhythm have been known for over a century. They possess considerable clinical importance and range from the increase in heart rate during enhanced venous return to the right atrium (Bainbridge effect) to sudden cardiac death caused by pre-cordial chest thumps (Commotio cordis). The underlying cellular and molecular mechanisms have only recently started to become evident and include stretch-activation of ion channels and mechanical modulation of intracellular calcium handling. We have investigated the effects of stretch-activation of ion channels in working myocardium, pacemaker cells and cardiac fibroblasts, using experimental procedures (single and double cell patch-clamp technique as well as in-situ recordings) and mathematical modelling (single cell `ionic' models, cell pairs, tissue sheets and anatomical models). Our findings illustrate why (i) transient stretch may trigger ectopic excitation via depolarization of resting myocytes or fibroblasts; (ii) sustained stretch may increase the heart's susceptibility to re-entry by generating spatial and temporal dispersion of excitability, refractoriness and electrical load; (iii) combined cyclic and maintained stretch, as occurs during ischaemic bulging of myocardium, is particularly arrhythmogenic; and (iv) areas of increased connective tissue content, like post-ischaemic scars or regions of fibrosis, are prone to act as foci of ectopic excitation

Published in:

[Engineering in Medicine and Biology, 1999. 21st Annual Conference and the 1999 Annual Fall Meetring of the Biomedical Engineering Society] BMES/EMBS Conference, 1999. Proceedings of the First Joint  (Volume:2 )

Date of Conference:

Oct 1999