Molecular and Structural Prerequisites of Enhanced Arrhythmogenesis in Heart Failure: Microtubular Hypothesis of Increased Mechanical Dispersion

Increased left ventricular mechanical dispersion is an important echocardiographic indicator of ventricular dyssynchrony and enhanced arrhythmogenesis, particularly in patients with heart failure. Precise structural and molecular aberrations explaining increased mechanical dispersion remain incompletely understood, warranting further investigation. Various ion channel, gap junction and calcium handling protein remodeling mechanisms have all been studied in connection with increased mechanical dispersion, offering however only partial solutions. This author debates that microtubular dysfunction may play distinctive role in left ventricular dyssynchrony and enhanced arrhythmogenesis observed in patients with heart failure, highlighted by increased mechanical dispersion. Testing this hypothesis may be technically challenging, however not impossible and therefore should be encouraged. In case of success potential therapeutic benefits could be diverse, including prevention of malignant arrhythmia, delay of heart failure progression, and promotion of LV reverse remodeling.