Predicting Arrhythmias via Reentrant Vulnerability Index Mapping in Post-Infarction Hearts Under Stellate Ganglion Modulation

Reentrant arrhythmias deriving from cardiac infarction scars can lead to sudden cardiac death. While implantable defibrillators are standard therapy, their limitations motivate alternative approaches such as autonomic modulation. This work sets computational ventricular models reconstructed from LGE-MRI data of two infarct cases, segmented into healthy tissue, border zone, and scar. Electrophysiological properties were assigned by tissue type, and sympathetic effects were modeled as IKs increases leading to 3~0% APD shortening in stellate innervated regions. Programmed stimulation and Reentrant Vulnerability Index (RVI) analysis revealed that arrhythmia risk increased when sympathetic remodeling overlapped with the scar, whereas mismatched distributions had little effect. Sites of negative RVI values predicted reentry initiation, supporting RVI as a noninvasive marker of post-MI arrhythmic risk and a potential tool to guide autonomic modulation strategies.