Review articles

Modelling the heart: insights,

failures and progress
Denis Noble

Summary illustrate this interaction in biological simulation using some

Mathematical models of the heart have developed over of the cell models that I have been involved in developing.
a period of about 40 years. Cell types in all regions of
the heart have been modelled and they are now being Since my purpose is didactic, I will be highly selective. A more
incorporated into anatomically detailed models of the complete historical review of cardiac cell models can be found
whole organ. This combination is leading to the creation elsewhere(4) and the volume in which that article appeared is
of the first ‘virtual organ,’ which is being used in drug also a rich source of material on modelling the heart, since that
discovery and testing, and in simulating the action of was its focus.
devices, such as cardiac defibrillators. Simulation is a
necessary tool of analysis in attempting to understand At each stage, I will highlight the theoretical insights that
biological complexity. We often learn as much from the came from mathematical modelling as well as the experi-
failures as from the successes of mathematical models. mental basis. I will then briefly review the use of cell models in
It is the iterative interaction between experiment and tissue and organ simulations.
simulation that is important. Examples are given where
this process has been instrumental in some of the major
advances in the field. BioEssays 24:1155–1163, 2002. Energy conservation during the cardiac cycle:
ß 2002 Wiley Periodicals, Inc.
discovery of various forms of potassium
channels
Introduction
The first cardiac cell models sought insight into the most
Mathematical modelling is widely accepted as an essential
obvious difference between electrical activity in heart and
tool of analysis in the physical sciences and engineering, yet
nerve: the duration of the action potential. A nerve action
many are still sceptical about its role in biology. Why is this so?
potential may last only 1 msec. Its function is to encode infor-
A partial answer would be that many chose to work as biolo-
mation as rapidly as possible. In contrast, a human ventricular
gists precisely because they were not mathematically inclined.
action potential may last 400 msec, during which time many
But I think there is a stronger reason. There is also a wide-
events are triggered that initiate and control mechanical
spread belief in the biological sciences that, to be useful,
contraction.
theory must be correct. Failure is seen as just that, i.e. failure,
FitzHugh(5) showed that the Hodgkin–Huxley model of
rather than as an essential part of a two-way iterative process
the nerve impulse could generate slow repolarization by
between theory and experiment.
greatly reducing the amplitude and speed of activation of the
In the case of excitable cells, it could also be that the para-
delayed potassium current, IK. These changes not only slowed
digm model, the Hodgkin–Huxley(1) equations for the squid
repolarization; they also created a plateau. This result showed
nerve action potential, was so spectacularly successful that it
that there must be some property inherent in the Hodgkin–
created an unrealistic expectation for the rapid application of
Huxley formulation of the sodium current that permits a
the same principles elsewhere. In fact, modelling of the much
persistent inward current to occur. The main defect of the
more complex cardiac cell has required many years of inter-
FitzHugh model was that it was a very expensive way of
action between experiment and theory. In modelling com-
generating a plateau, with such high ionic conductances that,
plex biological phenomena, this is precisely what we should
during each action potential, the sodium and potassium ionic
expect(2,3) and it is standard for such interaction to occur over
gradients would be run down at a rate at least an order of
many years in the physical sciences and engineering. I will first
magnitude too large.
That this was not the case was already evident since
Weidmann’s(6,7) pioneering work showed that the conduc-
University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, tance during the action potential is very low. The experimental
UK. E-mail: denis.noble@Physiolox.ac.uk
reason for this became clear with the discovery of the inward-
Funding agencies: The British Heart Foundation, The Medical
Research Council, The Wellcome Trust and Physiome Sciences Inc.
rectifier current, IK1(8–10) (see Fig. 1, top). The permeability of
DOI 10.1002/bies.10186 this channel falls almost to zero during strong depolarisation.
Published online in Wiley InterScience (www.interscience.wiley.com). These experiments were also the first to show that there are at
least two Kþ conductances in the heart, IK1 and IK (referred to

BioEssays 24:1155–1163, ß 2002 Wiley Periodicals, Inc. BioEssays 24.12 1155

Review articles
Figure 1. Top: Experimental basis of the first classification
of potassium currents. Redrawn from reference (10, Fig. 2B).
The solid line shows the total membrane current recorded in
a Purkinje fibre in a sodium-depleted solution. The inward-
rectifying current was identified as iK1, which is extrapolated
here as nearly zero at positive potentials. The outward-
rectifying current, IK, is now known to be mostly formed by
the component IKr. The horizontal arrow indicates the trajectory
at the beginning of the action potential, while the vertical
arrow indicates the time-dependent activation of IK which
initiates repolarization. Bottom: Sodium and potassium
conductance changes computed from the 1962 model(12) of
the Purkinje fibre. Two cycles of activity are shown. The con-
ductances are plotted on a logarithmic scale to accommodate
the large changes in sodium conductance. Note the persistent
level of sodium conductance during the plateau of the action
potential, which is about 2% of the peak conductance. Note
also the rapid fall in potassium conductance at the beginning of
the action potential. This is attributable to the properties of the
inward rectifier iK1.
1156 BioEssays 24.12
as IK2 in early work, but now known to consist of IKr and IKs).
The Noble 1962 model(11,12) (Fig. 1, bottom) was construct-
ed to determine whether this combination of Kþ channels,
together with a Hodgkin–Huxley type (see Box 1 in Marder and
Prinz in this issue of BioEssays) sodium channel could explain
all the classical Weidmann experiments on conductance
changes. The model not only succeeded in doing this; it also
demonstrated that an energy-conserving plateau mechanism
was an automatic consequence of the inward-rectifying pro-
perties of IK1. This has featured in all subsequent models,
and it is a very important insight. The main advantage of a low
conductance is minimising energy expenditure.
Unfortunately, however, a low conductance plateau was
achieved at the cost of making the repolarization process
fragile. Pharmaceutical companies today are struggling to deal
with evolution’s answer to this problem, which was to entrust
repolarization to the potassium channel iKr. This channel pro-
tein is one of the most promiscuous receptors known: large
ranges of drugs can enter the channel mouth to block it, and
even more interact with the G-protein-coupled receptors that
control it. The consequence can be failed repolarization, and
the triggering of fatal arrhythmias (see http://georgetowncert.
org/qtdrugs_torsades.asp). Computer simulation is now play-
ing a major role in attempting to find a way around this difficult
and seemingly intractable problem.(13)
The main defect of the 1962 model was that it included
only one voltage-gated inward current, INa. There was a good
reason for this. Calcium currents had not then been dis-
covered. There was, nevertheless, a clue in the model that
something important was missing. The only way in which
the model could be made to work was to greatly extend the
voltage range of the sodium ‘window’ current by reducing
the voltage dependence of the sodium activation process (see
Ref. 12, Figure 15). In effect, the sodium current was made to
serve the function of both the sodium and calcium channels so
far as the plateau is concerned. There was a clear prediction
here: either sodium channels in the heart are quantitatively
different from those in nerve, or other inward current-carrying
channels must exist. Both predictions are correct.
The first successful voltage clamp measurements came in
1964(14) and they rapidly led to the discovery of the cardiac
calcium current.(15) By the end of the 1960s therefore, it was
already clear that the 1962 model needed replacing.
Controversy over the ‘pacemaker’
current: the MNT model
In addition to the discovery of the calcium current, the early
voltage clamp experiments also revealed multiple compo-
nents of IK. Noble & Tsien(16) labelled them Ix1 and Ix2, but they
are now referred to as IKr and IKs.(17) They also showed that
these slow gated currents in the plateau range of potentials
were quite distinct from those near the resting potential, i.e.
that there were two separate voltage ranges in which very slow
 Review articles

conductance changes could be observed.(16,18) These experi-
ments formed the basis of the MNT model.(19)
The MNT model reconstructed a much wider range of
experimental results, and it did so with great accuracy in some
cases. A good example of this was the reconstruction of the
paradoxical effect of small current pulses on the pacemaker
depolarisation in Purkinje fibres (see Fig. 2)—paradoxical
because brief depolarisations slow the process and brief
hyperpolarizations greatly accelerate it. Reconstructing para-
doxical or counter-intuitive results is of course a major function
of modelling work. This is one of the roles of modelling in
unravelling complexity in biological systems.
But the MNT model also contained the seeds of a spec-
tacular failure. Following the experimental evidence,(18) it
attributed the slow conductance changes near the resting
potential to a slow gated potassium current, IK2. In fact, what
became the ‘pacemaker current,’ or If, is an inward current
activated by hyperpolarization(20) not an outward current acti-
vated by depolarisation. At the time, it seemed hard to imagine
a more serious failure than getting both the current direction
and the gating by voltage completely wrong. There cannot be
much doubt therefore that this stage in the iterative interaction
between experiment and simulation created a major problem
of credibility. Perhaps cardiac electrophysiology was not really
ready for modelling work to be successful?
This was how the failure was widely perceived. Yet that
perception was a deep misunderstanding of the significance
of what was emerging from this experience. It was no
coincidence that both the current direction and the gating
were wrong, as one follows from the other. And so did much
else in the modelling! Working that out in detail was the ground
on which future progress could be made.
This is the point at which to emphasise one of the important
points about the philosophy of modelling which I highlighted
at the beginning of this article: it is one of the functions of
models to be wrong! (Indeed, a Popperian philosopher of
science would say that one can only ever establish the falsity
of theories.) Of course, there are many ways of being wrong,
and I am not talking here of failing in arbitrary or purely con-
tingent ways, but in ways that advance our understanding by
exploring possible logics of complex systems and determining
which are most accurate. Again, this situation is familiar to
those working in simulation studies in engineering or cosmol-
ogy or in many other physical sciences. And, in fact, the failure
of the MNT model is one of the most instructive examples
of experiment–simulation interaction in physiology, and of
subsequent successful model development. I do not have the
space here to review this issue in all its details. That has
already been done.(21,22) Here I will simply draw the conclu-
sions relevant to modern work.
First, careful analysis of the MNT model revealed that its
pacemaker current mechanism could not be consistent with
what is known of the process of ion accumulation and depletion
in the extracellular spaces between cells. The model itself
was therefore a key tool in understanding the next stage of
development.
Second, a complete and accurate mapping between the
IK2 model and the new If model could be constructed(21)
(see Fig. 2) demonstrating how both models related to the
same experimental results and to each other. Such mapping
between different models is rare in biological work, but it can be
very instructive.
Third, this spectacular turn-around was the trigger for
the development of models that include changes in ion

Figure 2. Reconstruction of the paradoxical effect of small currents injected during pacemaker activity. Left: Computations from the MNT
model.(19) Small depolarising and hyperpolarizing currents were applied for 100 msec during the middle of the pacemaker depolarisation.
Hyperpolarizations are followed by an acceleration of the pacemaker depolarisation, while subthreshold depolarisations induce a slowing.
Middle: Experimental records from Weidmann (Ref. 6, Fig. 3). Right: Similar computations using the DiFrancesco-Noble (1985)
model.(24) Despite the fundamental differences between these two models, the feature that explains the paradoxical effects of small current
pulses survives. This kind of detailed comparison was part of the process of mapping the two models onto each other.

BioEssays 24.12 1157

Review articles
concentrations inside and outside the cell and between
intracellular compartments.
Finally, the MNT model was the point of departure for the
ground-breaking work of Beeler and Reuter(23) who developed
the first ventricular cell model. As they wrote of their model:
‘‘in a sense, it forms a companion presentation to the recent
publication of McAllister et al. (1975) on a numerical re-
construction of the cardiac Purkinje fibre action potential.
There are sufficiently many and important differences be-
tween these two types of cardiac tissue, both functionally and
experimentally, that a more or less complete picture of mem-
brane ionic currents in the myocardium must include both
simulations.’’ For a recent assessment of this model and the
subsequent Luo-Rudy models see Ref. 4.
Ion concentrations, pumps and exchangers:
The DiFrancesco–Noble model(24)
The incorporation not only of ion channels (following the
Hodgkin–Huxley paradigm) but also of ion exchangers, such
as Na–K exchange (the sodium pump), Na–Ca exchange,
the SR calcium pump and, more recently, the transporters
involved in controlling cellular pH,(25) was a fundamental
advance since these are essential to the study of some dis-
ease states such as congestive heart failure(26) and ischaemic
heart disease.
It was necessary to incorporate the Na–K exchange pump
since what made If so closely resemble a potassium channel
in Purkinje fibres was the depletion of Kþ ions in extracel-
lular spaces. This was a key feature enabling the accurate
mapping of the IK2 model (MNT) onto the If model.(21) But, to
incorporate changes in ion concentrations it became neces-
sary to represent the processes by which ion gradients can be
restored and maintained. In a form of modelling ‘avalanche,’
once changes in one cation concentration gradient (Kþ) had
been introduced, the others (Naþ and Ca2þ) had also to be
incorporated since the changes are all linked via the Na–K and
Na–Ca exchange mechanisms. This ‘avalanche’ of additional
processes was the basis of the DiFrancesco–Noble (1985)
Purkinje fibre model.(24)
The greatly increased complexity of the DiFrancesco–
Noble model, which for the first time also represented intra-
cellular events by incorporating a model of calcium release
from the sarcoplasmic reticulum, increased both the range of
predictions and the opportunities for failure. Here I will limit
myself to one example of each.
The most influential prediction was that relating to the
sodium–calcium exchanger. In the early 1980s, it was still
widely thought that the original electrically neutral stoichio-
metry (Na:Ca ¼ 2:1) derived from early flux measurements
was correct. The DiFrancesco-Noble model achieved two
important conclusions. The first was that, with the experimen-
tally known Naþ gradient, there simply wasn’t enough energy
in a neutral exchanger to keep resting intracellular calcium
1158 BioEssays 24.12
levels below 1 mM, i.e. at a level low enough to permit relax-
ation to occur. Switching to a stoichiometry of 3:1 readily
allowed resting calcium to be maintained below 100 nM. This
automatically led to the prediction that there must be a current
carried by the Na–Ca exchanger and that, if this exchanger
was activated by intracellular calcium, it must also be strongly
time-dependent since intracellular calcium varies by an order
of magnitude during each action potential. Even as the model
was being published, experiments demonstrating the current
INaCa were being performed(27) and the variation of this current
during activity was being revealed either as a late compo-
nent of inward current or as a current tail on repolarization.
This prediction has turned out to have very important con-
sequences for the elucidation of some of the mechanisms of
cardiac arrhythmia in disease states in which cells accumulate
sodium and calcium, either through loss of energy supply, as
in ischaemia, or as a consequence of reduced activity of the
Na–K ATPase (Na pump) as in treatment with cardiac
glycosides. At a critical level of sodium and calcium accumula-
tion, calcium release occurs spontaneously and becomes
repetitive between sodium concentrations around 13 and
22 mM,(28–31) a phenomenon also seen experimentally.
Each calcium release activates inward current carried by
sodium–calcium exchange which, if large enough, can trigger
additional (ectopic) action potentials,(32) as shown in Fig. 3.
The main defect of the DiFrancesco–Noble model was
that the intracellular calcium transient was far too large, mainly
because the model did not represent the attachment of
calcium to intracellular proteins. This signalled the need to
incorporate intracellular calcium buffering.
Calcium balance: the Hilgemann-Noble model
This deficiency was tackled in the Hilgemann–Noble(33)
(1987) modelling of the atrial action potential. Although this
was directed towards atrial cells, it also provided a basis for
modelling ventricular cells in species (rat, mouse) with short
ventricular action potentials, and many of its features were
adopted in later ventricular cell models of species with high
plateaus.(34–38)
The Hilgemann–Noble model addressed a number of
important questions concerning calcium balance:
1. When does the calcium that enters during each action
potential return to the extracellular space? Does it do this
during diastole (as most people had presumed) or during
systole itself, i.e. during, not after, the action potential?
Hilgemann(39) had done experiments with tetramethylmur-
exide, a calcium indicator restricted to the extracellular
space, showing that the recovery of extracellular calcium
(in intercellular clefts) occurs remarkably quickly (see Fig. 4,
inset). In fact, net calcium efflux is established as soon as
20 msec after the beginning of the action potential, which at
that time was considered to be surprisingly soon. Calcium
 Review articles

Figure 3. Left: Calcium oscillations computed in a model of the Purkinje fibre during the rise in intracellular sodium (red) following block of
the sodium-potassium ATPase. Each oscillation of intracellular calcium (blue trace below) triggers inward sodium-calcium exchange
current (brown trace top) (from Ref. 25). These computations were done under voltage clamp conditions. Right: Free-running action
potentials in the same model with intracellular sodium set at a level corresponding to the middle of the oscillation period in the left hand figure
(from Ref. 32). For a theoretical analysis of this phenomenon in the DiFrancesco–Noble model see Refs. 28,29 and for an analysis of the
more detailed Winslow–Rice–Jafri model(30) see Ref. 31.

activation of efflux via the Na–Ca exchanger achieved this
in the model (see Fig. 4—compare the computed trace
[Ca]0 with the experimental trace labelled [Ca]0)
2. Where was the current that this would generate and did it
correspond to the quantity of calcium that the exchanger
Figure 4. The first reconstruction of calcium balance in
cardiac cells. The Hilgemann – Noble model (33) incor-
porated complete calcium cycling, such that intracellular and
extracellular calcium levels returned to their original state after
each cycle and that the effects of sudden changes in frequency
could be reproduced. Left: Computed action potential (AP),
intracellular calcium transient, contraction (represented by
cross-bridge formation) and extracellular calcium transient.
Inset: Experimental recording of action potential (AP), cell
motion and extracellular calcium transient.
needed to pump? Mitchell et al(40) had already done
experiments in rat ventricle showing that replacement of
sodium with lithium removes the late plateau. This was the
first experimental evidence that the late plateau in action
potentials with this shape might be maintained by sodium–
calcium exchange current. The Hilgemann–Noble model
showed that this is precisely what one would expect.
3. Could a model of the SR that reproduces at least the
major features of Fabiato’s experiments(41,42) showing
calcium-induced calcium release (CICR) be incorporated
into the cell models and integrate in with whatever were
the answers to questions 1 and 2. This was a major
challenge (see reference (33), pp 173–174). The model
followed as much of the Fabiato data as possible, but the
conclusions were that the modelling, while broadly con-
sistent with the Fabiato work, could not be based on that
alone. It is an important function of simulation to reveal
when experimental data needs extending.
4. Were the quantities of calcium, free and bound, at each
stage of the cycle consistent with the properties of the
cytosol buffers? The answer here was a very satisfactory
yes. The great majority of the cytosol calcium is bound so
that, although much more calcium movement was involved,
the free calcium transients were much smaller, within the
experimental range.
There were however some gross inadequacies in the
calcium dynamics. An additional voltage-dependence of Ca
release was inserted to obtain a fast calcium transient. This
was a compromise that really requires proper modelling of
the subsarcolemmal space where calcium channels and the

BioEssays 24.12 1159

Review articles
ryanodine receptors interact, a problem later tackled by Jafri,
Rice & Winslow(43,44) and by Noble et al.(38) Another problem
was how would the conclusions apply to action potentials with
high plateaus. This was tackled both experimentally(45) and
computationally.(35,38) The answer is that the high plateau in
ventricular cells of guinea-pig, dog, human etc greatly delays
the reversal of the sodium calcium exchanger so that net
calcium entry continues for a longer fraction of the action
potential. This property is important in determining the force-
frequency characteristics.
Incorporation of cell models into tissue
and organ models
Although single-cell models of the heart were first constructed
over 40 years ago, it is only relatively recently that it has
become possible to move up to the next levels: tissue and
organ models into which the cell models can be incorporated.
This was always one of the aims of the single cell work, but
until the development of sufficiently powerful supercomputers
this objective was beyond reach.
One of the early examples of massive three-dimensional
ionic tissue models used intracellular calcium oscillator models
of the kind shown in Fig. 3 to address the question of the
minimal size of an ischaemic focus, simulated by sodium
overload in a defined tissue region, that would be arrhyth-
mogenic.(46) A sodium-overloaded cell group was placed in a
20-cell-diameter spherical volume in the centre of a three-
dimensional network of 128
128
32 atrial cells using the
Earm–Noble single cell model(47) (i.e. more than 500,000 ionic
cell models were used). It was shown that this relatively small
‘ischaemic’ focus—in real terms, the tissue volume would be
in the order of no more than a cubic millimetre—is capable of
1160 BioEssays 24.12
triggering a spreading wave of excitation in the whole tissue
model (Fig. 5). This was an important step forward in link-
ing a subcellular mechanism of arrhythmia to multicellular
processes. However, the initiation of an ectopic beat is not,
in itself, sufficient to trigger a life-threatening arrhythmia
(fortunately most ectopic beats are benign!) It still remains to
work out how this mechanism interacts with other features of
ischemic tissue, such as slowed conduction due to potassium
accumulation(48–50) and action potential shortening, to trigger
re-entrant arrhythmias that may break down into full-scale
ventricular fibrillation.
On the one hand, this example shows that both qualitative
and quantitative conclusions may be drawn from computations
based on multidimensional, uniform grid-structured cardiac
models. On the other hand, the deficiencies in these models
also show that geometrical factors, tissue (in)homogeneity,
cell-to-cell coupling, etc., are critical to an understanding of
detailed physiology and pathology. Thus, while grid-structured
cardiac tissue models clearly have their place, more sophis-
ticated ‘anatomical’ models are required to progress be-
yond the reproduction of biophysical behaviour and towards
the provision of physiologically and clinically relevant new
insights.
Simulating myocardial excitation in three-dimensional
anatomically detailed models of the heart began with the work
of Panfilov and colleagues(51,52) who mapped finite difference
models of FitzHugh–Nagumo equations to experimentally
determined cardiac geometry and fibre distribution data.(53)
The first solutions of ionic current models used finite
difference techniques and non-deforming anatomical heart
geometry.(54)Later, ionic current models were linked to mate-
rial points of a moving finite element mesh.(55) This allowed
Figure 5. A three-dimensional atrial model with
centrally located small sodium-overloaded ischae-
mic focus. The dimensions of the atrial tissue block
are outlined in orange, while the action potential
wavefront and plateau are colour coded (red and
magenta, respectively). The excitation begins in the
small central region of sodium overload, where a
calcium oscillation generates an action potential by
activating sodium-calcium exchange (see Fig. 3).
If the overload region (top left) is sufficiently large,
the current it generates is capable of exciting the
surrounding ‘normal’ tissue (top right), so initiating
a propagated wave (bottom left). Reprinted from
Winslow RL, Varghese A, Noble D, Adlakha C,
Hoythya A. Proc Roy Soc B 1990;240:83–96, with
permission from The Royal Society.
 Review articles

simulation of the electromechanical coupling between the

activation process and the mechanically deforming finite
element model in both directions: the solution of the electro-
physiological equations described the calcium current that
initiates contraction, and the shape changes caused by
cardiac contraction influenced electrical propagation.(56)
Extensions of this work have now been made to accommodate
more-sophisticated models of cardiac ion channels(36–38) and
cellular electromechanical coupling.(57)
At the same time, other important elements of a whole-
heart model are being put in place. Modelling of the coronary
circulation(58) has advanced to the point at which it is possible
to simulate coronary occlusion and so define the areas in the
ventricle that would become ischaemic.(32) Work is also in
progress to incorporate the SA node, atrial and Purkinje
conducting network. A reasonably complete ‘virtual heart’ is
well on the way to construction. Such a project, with immense
implications for practical use in designing new therapies,(32)
would have been inconceivable until very recently.
I will finish this article with a spectacular example of this
kind of use of the ‘virtual heart’. Figure 6 (top) shows the
anatomical model of the canine ventricles(59) with a 1 mm thick
slice in which the fibre orientations are shown. The lower part
of the figure shows three frames from a simulation of arrhy-
thmia (called a tachycardia) in which a rotating spiral wave
(at the back), triggered by the collision of two stimulated
waves, is generating successive waves that propagate
through the structure of the slice. This simulation uses a
modified version of the Beeler–Reuter ventricular cell equa-
tions.(60) It is part of a major study not only of the conditions for
initiating arrhythmia but also of the mechanisms by which
electrical defibrillation may work. The model is the first to use
bi-domain simulation (in which the electrical field outside
the cells is reconstructed as well as the potentials across
the cell membranes), with detailed fibre geometry and detailed
cellular electrophysiology.(61,62)
Such simulations require enormous computing resources,
currently available only on large supercomputers (which is
the main reason why the simulation is restricted to a slice of Figure 6. Top: Diagram of the canine ventricular model(59)
showing the fibre structure of the slice in which the computa-
the ventricle—computations of the whole canine ventricle
tions shown below were carried out. The slice is represented
would, at present, be too demanding). as a full bi-domain model, i.e. the electric current flow in
the extracellular space is also computed. This enables such
Modularity in biological systems models to be used to investigate the effects of massive electric
A recurring theme in these developments is what I have shocks of the kind used in defibrillation. Bottom: Rotating
spiral wave generating successive propagated waves com-
called a modelling ‘avalanche’ in which incorporation of one
puted within the slice model using a modification of the Beeler–
new element has required incorporation of a set of related Reuter ventricular cell ionic current equations (from Refs.
processes. Biological modelling often exhibits this form of 61,62).
modularity, making it necessary to incorporate a group of
protein components together. It will be one of the major chal-
lenges of mathematical biology to use simulation work to approach. This piecemeal approach to reconstructing the
unravel the modularity of nature. Groups of proteins co- ‘logic of life,’ which is the strict meaning of the word ‘phy-
operating to generate a function and therefore being selected siology,’(63) could also be the route through which a systematic
together in the evolutionary process will be revealed by this theoretical biology could eventually emerge.(64,65)

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Review articles
Future challenges and the nature
of biological simulation
Progress in this field was slow and spasmodic in the period
between 1960 and 1990. This reflected the lack of experi-
mental data (a problem that was overcome at the cellular level
with the introduction of the patch clamp technique and its
application to isolated cells), and the lack of computing power.
But since 1990 there has been an extraordinary explosion of
modelling work on the heart.(66) There are multiple models of
all the cell types, and I confidently predict that there will be
many more to come. Why do we have so many? Couldn’t
we simply ‘standardise’ the field and choose the ‘best’? To
some extent, that is happening. None of the historical models
described in this article is now used much in its original form.
One of the major reasons for the multiplicity of models is
that there will always be a compromise between complexity
and computability. A good example here is the modelling of
calcium dynamics. As we understand these dynamics in ever
greater detail,(31) models become more accurate and they
encompass more biological data, but they also become
computationally demanding. This was the motivation behind
the simplified dyadic space model of Noble et al.(38) which
achieves many of the required features of the initiation of
calcium signalling with only a modest (10%) increase in
computation time, an important consideration when import-
ing such models into models of the whole heart. But no-one
would use that model to study the fine properties of calcium
dynamics at the subcellular level. That was not its purpose.
There will probably therefore be no unique model that does
everything at all levels. Any of the boxes at one level could be
deepened in complexity at a lower level, or fused with other
processes at a higher level. In any case, all models are only
partial representations of reality. One of the first questions to
ask of a model therefore is what questions does it answer best.
It is through the iterative interaction between experiment and
simulation that we will gain that understanding.
It is however already clear that incorporation of cell models
into tissue and organ models is capable of spectacular
insights. The incorporation of cell models into anatomically
detailed heart models, as shown in Fig. 6, has been an exciting
development. The goal of creating an organ model capable of
spanning the whole spectrum of levels from genes(67–71) to
the electrocardiogram(13,32) is within sight, and is one of the
challenges of the immediate future. The potential of such
simulations for teaching, drug discovery, device development
and, of course, for pure physiological insight is only beginning
to be appreciated.
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