The stochastic nature of cardiac propagation due to the discrete cellular structure of the myocardium

The object of this paper is to describe cardiac conduction phenomena caused by the discrete nature of cardiac cellular structure. Recent results show that the myocardial architecture creates inhomogeneities of electrical load at the microscopic level that cause cardiac propagation to be stochastic in nature. That is, the excitatory events during propagation are constantly changing and disorderly in the sense of varying intracellular events and delays between cells. A unique feature of the stochastic nature of cardiac propagation is that electrical boundaries produced by cellular myocardial architecture create inhomogeneities of electrical load that affect conduction inside individual cells and influence conduction delays across gap junctions, as well as at muscle bundle junctions. This process produces discontinuous propagation as a primary reflection of the nonuniformities of electrical load due to the irregular arrangement of the cellular borders and the associated nonuniform distribution of their electrical interconnections. A fundamental consequence of the stochastic nature of normal propagation at a microscopic level is that it provides a major protective effect against arrhythmias by re-establishing the general trend of wave front movement after small variations in excitation events occur. When the diversity at a very small size scale decreases throughout the tissue, such as occurs when there are regularly repeating relatively isolated groups of cells, larger fluctuations of load can develop and be distributed over more cells than occurs normally. The myocardial architecture may then fail to re-establish a smoothed wave front and re-entry can develop. These relatively new discontinuous conduction phenomena provide important theoretical and experimental challenges to synthesize a complete theory linking continuous and discontinuous media as applied to cardiac conduction. The results show that it will be important to distinguish differences in wave front movement and conduction block caused by mechanisms of continuous media versus wave front movement and block imposed by directional or localized changes in cellular connectivity; i.e., the topology of the electrical connections between cells (gap junctions).