Spatial heterogeneity of restitution properties and the onset of alternans

Traditionally, it was believed that cardiac rhythm stability was governed by the slope of the restitution curve (RC), which relates the duration of an action potential to the preceding diastolic interval. However, a single RC does not exist; rate-dependence leads to multiple distinct RCs. We measure spatial differences in the steady-state action potential duration (APD), as well as in three different RCs: the S1-S2 (SRC), constant-basic-cycle-length (BRC), and dynamic (DRC), and correlate these differences with the tissue's propensity to develop alternans. The results show that spatial differences in APD, SRC slope, and DRC slope are correlated with the tissue's propensity to exhibit alternans. These results may lead to a new diagnostic approach to identifying patients with vulnerability to arrhythmias, which will involve pacing at slow rates and analyzing spatial differences in restitution properties.