Physiological accuracy in simulating refractory cardiac tissue: the volume-averaged bidomain model vs. the cell-based EMI model

The refractory period of cardiac tissue can be quantitatively described using strength-interval (SI) curves. The information captured in SI curves is pertinent to the design of anti-arrhythmic devices including pacemakers and implantable cardioverter defibrillators. As computational cardiac modelling becomes more prevalent, it is feasible to consider the generation of computationally derived SI curves as a supplement or precursor to curves that are experimentally derived. It is beneficial, therefore, to examine the profiles of the SI curves produced by different cardiac tissue models to determine whether some models capture the refractory period more accurately than others. In this study, we compare the unipolar SI curves of two tissue models: the current state-of-the-art bidomain model and the recently developed extracellular-membrane-intracellular (EMI) model. The EMI models resolution of individual cell structure makes it a more detailed model than the bidomain model, which forgoes the structure of individual cardiac cells in favour of treating them homogeneously as a continuum. We find that the resulting SI curves elucidate differences between the models, including that the behaviour of the EMI model is noticeably closer to the refractory behaviour of experimental data compared to that of the bidomain model. These results hold implications for future computational pacemaker simulations and shed light on the predicted refractory properties of cardiac tissue from each model. Author summaryMathematical modelling and computational simulation of cardiac activity have the potential to greatly enhance our understanding of heart function and improve the precision of cardiac medicine. The current state-of-the-art model is the bidomain model, which considers a volume average of cardiac activity. Although the bidomain model has had success in several applications, in other situations, its approach may obscure critical details of heart function. The extracellular-membrane-intracellular (EMI) model is a recently developed model of cardiac tissue that addresses this limitation. It models cardiac cells individually; therefore, it offers significantly greater physiological accuracy than bidomain simulations. This increase in accuracy comes at a higher computational cost, however. To explore the benefits of one model over the other, here we compare the performance of the bidomain and EMI models in a pacing study of cardiac tissue often employed in pacemaker design. We find that the behaviour of the EMI model is noticeably closer to experimental data than the behaviour of the bidomain model. These results hold implications for future pacemaker design and improve our understanding of the two models in relation to one another.