The importance of anisotropy in modeling ST segment shift in subendocardial ischaemia

In this paper, a simple mathematical model of a slab of cardiac tissue is p resented in an attempt to better understand the relationship between subend ocardial ischaemia and the resulting epicardial potential distributions. Th e cardiac tissue is represented by the bidomain model where tissue anisotro py and fiber rotation have been incorporated with a view to predicting the epicardial surface potential distribution. The source of electric potential in this steady-state problem is the difference between plateau potentials in normal and ischaemic tissue, where it is assumed that ischaemic tissue h as a lower plateau potential. Simulations with tissue anisotropy and no fib er rotation are also considered. Simulations are performed for various thic knesses of the transition region between normal and ischaemic tissue and fo r various sizes of the ischaemic region. The simulated epicardial potential distributions, based on an anisotropic model of the cardiac tissue, show t hat there are large potential gradients above the border of the ischaemic r egion and that there are dips in the potential distribution above the regio n of ischaemia. It could be concluded from the simulations that it would be possible to pre dict the region of subendocardial ischaemia from the epicardial potential d istribution, a conclusion contrary to observed experimental data. Possible reasons for this discrepancy are discussed. In the interests of mathematica l simplicity, isotropic models of the cardiac tissue are also considered, b ut results from these simulations predict epicardial potential distribution s vastly different from experimental observations. A major conclusion from this work is that tissue anisotropy and fiber rotation must be included to obtain meaningful and realistic epicardial potential distributions.