{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T03:46:14Z","timestamp":1782618374722,"version":"3.54.5"},"reference-count":75,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR302718"],"award-info":[{"award-number":["NIHR302718"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["221650\/Z\/20\/Z"],"award-info":[{"award-number":["221650\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"abstract":"Abstract<\/jats:title>\n \n Ventricular tachycardia (VT) in the post\u2010myocardial\u2010infarction heart is sustained by re\u2010entry arising from slow and heterogeneous impulse propagation within the infarct border zone. Seminal histological and electrophysiological studies demonstrated that re\u2010entry is enabled by conduction corridors of surviving myocardial bundles embedded within fibrotic scar. However, growing experimental and clinical evidence indicates that this structural concept alone does not fully account for the complex electrophysiological behaviours observed in infarct\u2010related VT. In this review, we examine the evolution of the arrhythmogenic substrate following myocardial infarction and the development of the critical slow\u2010conducting pathway known as the \u2018diastolic isthmus\u2019. Post\u2010infarct remodelling that includes inflammatory, fibrogenic and chronic maturation phases transforms the border zone into a heterogeneous, multicellular environment, wherein surviving cardiomyocytes coexist with (myo)fibroblasts, immune cells, adipocytes and neural elements. The interactions among these cellular populations influence impulse propagation through modifications in electrotonic coupling, paracrine signalling and membrane excitability modulation. Within these constrained myocardial strands, minor alterations in intercellular coupling or ionic currents can substantially affect conduction velocity and propagation safety, leading to delayed activation while preserving the conditions necessary for re\u2010entry. Furthermore, we discuss how these changes contribute to the three\u2010dimensional architecture of re\u2010entrant circuits and the implications for identifying the arrhythmogenic substrate during electroanatomical mapping, as well as the interaction between ablation energy and heterogeneous infarct tissue. Collectively, these observations challenge the traditional conception of VT corridors as passive fibrotic channels. Instead, scar\u2010related ventricular tachycardia represents an evolving electrophysiological phenomenon resulting from progressive multicellular remodelling of the infarct border zone.\n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>","DOI":"10.1113\/jp290144","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T03:36:03Z","timestamp":1782617763000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The multicellular environment of the re\u2010entrant circuit in post\u2010myocardial infarction ventricular tachycardia: Beyond fibrosis"],"prefix":"10.1113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-3004","authenticated-orcid":false,"given":"Mohammed","family":"Obeidat","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaffar","family":"Al\u2010Sheikhli","sequence":"additional","affiliation":[{"name":"Heart Rhythm Research Group, Directorate of Biomedical Sciences, Warwick Medical School Clinical Sciences Research Laboratory Coventry UK"},{"name":"Institute for Cardio\u2010Metabolic Medicine University Hospital Coventry and Warwickshire NHS Trust Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1073-6081","authenticated-orcid":false,"given":"Andrew M.","family":"Blanks","sequence":"additional","affiliation":[{"name":"Directorate of Biomedical Sciences, Warwick Medical School University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8882-7357","authenticated-orcid":false,"given":"Joseph","family":"Mayer","sequence":"additional","affiliation":[{"name":"Heart Rhythm Research Group, Directorate of Biomedical Sciences, Warwick Medical School Clinical Sciences Research Laboratory Coventry UK"},{"name":"Institute for Cardio\u2010Metabolic Medicine University Hospital Coventry and Warwickshire NHS Trust Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Lellouche","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Assistance Publique\u2010H\u00f4pitaux de Paris Henri Mondor University Hospital Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarvinder","family":"Dhanjal","sequence":"additional","affiliation":[{"name":"Heart Rhythm Research Group, Directorate of Biomedical Sciences, Warwick Medical School Clinical Sciences Research Laboratory Coventry UK"},{"name":"Institute for Cardio\u2010Metabolic Medicine University Hospital Coventry and Warwickshire NHS Trust Coventry 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