The Role of Stellate Ganglion Induced Repolarization Heterogeneities in Post-Myocardial Infarction Arrhythmias: A Computational Approach

This study aimed to explore the influence of betaadrenergic stimulation exerted by the stellate ganglia on the ventricles and its role in the generation of reentrant arrhythmias in post-myocardial infarction.It ultimately considered the potential of sympathetic denervation as a more specific alternative to cardioverter-defibrillators (ICDs) in antiarrhythmic therapy.The digital twin of a patient who suffered a myocardial infarction with a scar in the posterior lateral region of the left ventricle was constructed based on cardiac magnetic resonance images with late gadolinium enhancement (LGE-CMR).The simulation included left stellate ganglion stimulation, increasing the slow delayed rectifier current (IKs) conductance, and thus reducing the action potential duration (APD).A finite element solver applied a clinical arrhythmia induction protocol based on a train of extra stimuli.Each case was simulated with and without APD changes in the innervated segments, replicating sympathetic stimulation.Results indicated that APD shortening due to sympathetic stimulation significantly increased the occurrence of reentrant arrhythmias, providing a deeper understanding of the mechanisms underlying ventricular tachycardia (VT).