Alternans and higher-order rhythms in an ionic model of a sheet of ischemic ventricular muscle

Life-threatening arrhythmias such as ventricular tachycardia and fibrillation often occur during acute myocardial ischemia. During the first few minutes following coronary occlusion, there is a gradual rise in the extracellular concentration of potassium ions ([K(+)](0)) within ischemic tissue. This elevation of [K(+)](0) is one of the main causes of the electrophysiological changes produced by ischemia, and has been implicated in inducing arrhythmias. We investigate an ionic model of a 3 cmx3 cm sheet of normal ventricular myocardium containing an ischemic zone, simulated by elevating [K(+)](0) within a centrally-placed 1 cmx1 cm area of the sheet. As [K(+)](0) is gradually raised within the ischemic zone from the normal value of 5.4 mM, conduction first slows within the ischemic zone and then, at higher [K(+)](0), an arc of block develops within that area. The area distal to the arc of block is activated in a delayed fashion by a retrogradely moving wavefront originating from the distal edge of the ischemic zone. With a further increase in [K(+)](0), the point eventually comes where a very small increase in [K(+)](0) (0.01 mM) results in the abrupt transition from a global period-1 rhythm to a global period-2 rhythm in the sheet. In the peripheral part of the ischemic zone and in the normal area surrounding it, there is an alternation of action potential duration, producing a 2:2 response. Within the core of the ischemic zone, there is an alternation between an action potential and a maintained small-amplitude response ( approximately 30 mV in height). With a further increase of [K(+)](0), the maintained small-amplitude response turns into a decrementing subthreshold response, so that there is 2:1 block in the central part of the ischemic zone. A still further increase of [K(+)](0) leads to a transition in the sheet from a global period-2 to a period-4 rhythm, and then to period-6 and period-8 rhythms, and finally to a complete block of propagation within the ischemic core. When the size of the sheet is increased to 4 cmx4 cm (with a 2 cmx2 cm ischemic area), one observes essentially the same sequence of rhythms, except that the period-6 rhythm is not seen. Very similar sequences of rhythms are seen as [K(+)](0) is increased in the central region (1 or 2 cm long) of a thin strand of tissue (3 or 4 cm long) in which propagation is essentially one-dimensional and in which retrograde propagation does not occur. While reentrant rhythms resembling tachycardia and fibrillation were not encountered in the above simulations, well-known precursors to such rhythms (e.g., delayed activation, arcs of block, two-component upstrokes, retrograde activation, nascent spiral tips, alternans) were seen. We outline how additional modifications to the ischemic model might result in the emergence of reentrant rhythms following alternans. (c) 2000 American Institute of Physics.     

Turbulence control with local pacing and its implication in cardiac defibrillation

In this review article, we describe turbulence control in excitable systems by using a local periodic pacing method. The controllability conditions of turbulence suppression and the mechanisms underlying these conditions are analyzed. The local pacing method is applied to control Winfree turbulence (WT) and defect turbulence (DT) induced by spiral-wave breakup. It is shown that WT can always be suppressed by local pacing if the pacing amplitude and frequency are properly chosen. On the other hand, the pacing method can achieve suppression of DT induced by instabilities associated with the motions of spiral tips while failing to suppress DT induced by the instabilities of wave propagation far from tips. In the latter case, an auxiliary method of applying gradient field is suggested to improve the control effects. The implication of this local pacing method to realistic cardiac defibrillation is addressed.     

多可激性障碍下的螺旋波动力学

在许多实际可激系统中局部不均匀是广泛存在的, 它们是螺旋波形成以及动力学行为改变的重要因素. 本文研究了可激性障碍对螺旋波动力学行为的影响. 研究表明, 在障碍区域内可激性参数大于区域外情况下障碍会对其附近的螺旋波波头有吸引作用, 多局部障碍共存时吸引行为不仅依赖障碍分布, 而且依赖障碍的大小以及区域内可激性参数的具体取值. 通过抑制变量小值区域的变化分析了这些行为发生的原因. 在障碍区域内可激性参数小于区域外情况下障碍对其近邻的螺旋波波头有排斥作用, 排斥后波头的运动依赖初始螺旋波是刚性旋转的还是漫游的. 多局部障碍共存时排斥作用对螺旋波动力学行为的改变依赖障碍的分布、大小与区域内可激性参数的具体取值以及初始螺旋波的类型. 关键词： 螺旋波 时空混沌 可激性障碍     

Exploring the role of inhibitory coupling in duplex networks

The electrical coupling of myocytes and fibroblasts can play a role in inhibiting electrical impluse propagation in cardiac muscle. To understand the function of fibroblast–myocyte coupling in the aging heart, the spiral-wave dynamics in the duplex networks with inhibitory coupling is numerically investigated by the Br–Eiswirth model. The numerical results show that the inhibitory coupling can change the wave amplitude, excited phase duration and excitability of the system. When the related parameters are properly chosen, the inhibitory coupling can induce local abnormal oscillation in the system and the Eckhaus instability of the spiral wave. For the dense inhibitory network, the maximal decrement(maximal increment) in the excited phase duration can reach 24.3%(13.4%), whereas the maximal decrement in wave amplitude approaches 28.1%. Upon increasing the inhibitory coupling strength, the system excitability is reduced and even completely suppressed when the interval between grid points in the inhibitory network is small enough. Moreover, the inhibitory coupling can lead to richer phase transition scenarios of the system, such as the transition from a stable spiral wave to turbulence and the transition from a meandering spiral wave to a planar wave. In addition, the self-sustaining planar wave, the unique meandering of spiral wave and inward spiral wave are observed. The physical mechanisms behind the phenomena are analyzed.     

Triggered alternans in an ionic model of ischemic cardiac ventricular muscle

It has been known for several decades that electrical alternans occurs during myocardial ischemia in both clinical and experimental work. There are a few reports showing that this alternans can be triggered into existence by a premature ventricular contraction. Detriggering of alternans by a premature ventricular contraction, as well as pause-induced triggering and detriggering, have also been reported. We conduct a search for triggered alternans in an ionic model of ischemic ventricular muscle in which alternans has been described recently: a one-dimensional cable of length 3 cm, containing a central ischemic zone 1 cm long, with 1 cm segments of normal (i.e., nonischemic) tissue at each end. We use a modified form of the Luo-Rudy [Circ. Res. 68, 1501-1526 (1991)] ionic model to represent the ventricular tissue, modeling the effect of ischemia by raising the external potassium ion concentration ([K(+)](o)) in the central ischemic zone. As [K(+)](o) is increased at a fixed pacing cycle length of 400 ms, there is first a transition from 1:1 rhythm to alternans or 2:2 rhythm, and then a transition from 2:2 rhythm to 2:1 block. There is a range of [K(+)](o) over which there is coexistence of 1:1 and 2:2 rhythms, so that dropping a stimulus from the periodic drive train during 1:1 rhythm can result in the conversion of 1:1 to 2:2 rhythm. Within the bistable range, the reverse transition from 2:2 to 1:1 rhythm can be produced by injection of a well-timed extrastimulus. Using a stimulation protocol involving delivery of pre- and post-mature stimuli, we derive a one-dimensional map that captures the salient features of the results of the cable simulations, i.e., the {1:1-->2:2-->2:1} transitions with {1:1<-->2:2} bistability. This map uses a new index of the global activity in the cable, the normalized voltage integral. Finally, we put forth a simple piecewise linear map that replicates the {1:1<-->2:2} bistability observed in the cable simulations and in the normalized voltage integral map. (c) 2002 American Institute of Physics.     

Suppressing arrhythmias in cardiac models using overdrive pacing and calcium channel blockers

Recent findings indicate that ventricular fibrillation might arise from spiral wave chaos. Our objective in this computational study was to investigate wave interactions in excitable media and to explore the feasibility of using overdrive pacing to suppress spiral wave chaos. This work is based on the finding that in excitable media, propagating waves with the highest excitation frequency eventually overtake all other waves. We analyzed the effects of low-amplitude, high-frequency pacing in one-dimensional and two-dimensional networks of coupled, excitable cells governed by the Luo-Rudy model. In the one-dimensional cardiac model, we found narrow high-frequency regions of 1:1 synchronization between the input stimulus and the system's response. The frequencies in this region were higher than the intrinsic spiral wave frequency of cardiac tissue. When we paced the two-dimensional cardiac model with frequencies from this region, we found that spiral wave chaos could, in some cases, be suppressed. When we coupled the overdrive pacing with calcium channel blockers, we found that spiral wave chaos could be suppressed in all cases. These findings suggest that low-amplitude, high-frequency overdrive pacing, in combination with calcium channel inhibitors (e.g., class II or class IV antiarrhythmic drugs), may be useful for eliminating fibrillation. (c) 2002 American Institute of Physics.     

Enhanced self-termination of re-entrant arrhythmias as a pharmacological strategy for antiarrhythmic action

Ventricular tachycardia and fibrillation are potentially lethal cardiac arrhythmias generated by high frequency, irregular spatio-temporal electrical activity. Re-entrant propagation has been demonstrated as a mechanism generating these arrhythmias in computational and in vitro animal models of these arrhythmias. Re-entry can be idealised in homogenous isotropic virtual cardiac tissues as spiral and scroll wave solutions of reaction-diffusion equations. A spiral wave in a bounded medium can be terminated if its core reaches a boundary. Ventricular tachyarrhythmias in patients are sometimes observed to spontaneously self-terminate. One possible mechanism for self-termination of a spiral wave is meander of its core to an inexcitable boundary. We have previously proposed the hypothesis that the spatial extent of meander of a re-entrant wave in the heart can be directly related to its probability of self-termination, and so inversely related to its lethality. Meander in two-dimensional virtual ventricular tissues based on the Oxsoft family of cell models, with membrane excitation parameters simulating the inherited long Q-T syndromes has been shown to be consistent with this hypothesis: the largest meander is seen in the syndrome with the lowest probability of death per arrhythmic episode. Here we extend our previous results to virtual tissues based on the Luo-Rudy family of models. Consistent with our hypothesis, for both families of models, whose different ionic mechanisms produce different patterns of meander, the LQT virtual tissue with the larger meander simulates the syndrome with the lower probability of death per episode. Further, we search the parameter space of the repolarizing currents to find their conductance parameter values that give increased meander of spiral waves. These parameters may provide targets for antiarrhythmic drugs designed to act by increasing the likelihood of self-termination of re-entrant arrhythmias. (c) 2002 American Institute of Physics.     

通过抑制波头旋转消除心脏中的螺旋波和时空混沌

本文采用Luo-Rudy相I模型研究如何通过调控心肌细胞钠电流变化来控制心脏中的螺旋波和时空混沌,提出了这样的钠电流调控方案:当细胞将被激发时启动钠电流调节,若由模型方程得到的钠电流的绝对值小于钠电流控制阈值的绝对值,就让钠电流等于钠电流控制阈值,其他情况下则限制钠电流的绝对值不能高于一个给定的最大值;当膜电位上升超过-5 mV时,让钠电流自然演化.这种调节钠电流的方式保证了所有细胞几乎具有相同的钠电流幅值,从而使所有细胞具有相同的激发性,数值模拟结果表明,只要钠电流控制阈值达到一定临界值,就可以有效抑制螺旋波波头的旋转,导致螺旋波运动出系统边界而消失,以及时空混沌演化为螺旋波后消失,如果钠电流控制阈值足够大,螺旋波和时空混沌还可通过传导障碍而消失.这些结果能够为抗心律失常治疗提供新的思路.     

Wave front fragmentation due to ventricular geometry in a model of the rabbit heart

The role of the heart's complex shape in causing the fragmentation of activation wave fronts characteristic of ventricular fibrillation (VF) has not been well studied. We used a finite element model of cardiac propagation capable of simulating functional reentry on curved two-dimensional surfaces to test the hypothesis that uneven surface curvature can cause local propagation block leading to proliferation of reentrant wave fronts. We found that when reentry was induced on a flat sheet, it rotated in a repeatable meander pattern without breaking up. However, when a model of the rabbit ventricles was formed from the same medium, reentrant wave fronts followed complex, nonrepeating trajectories. Local propagation block often occurred when wave fronts propagated across regions where the Gaussian curvature of the surface changed rapidly. This type of block did not occur every time wave fronts crossed such a region; rather, it only occurred when the wave front was very close behind the previous wave in the cycle and was therefore propagating into relatively inexcitable tissue. Close wave front spacing resulted from nonstationary reentrant propagation. Thus, uneven surface curvature and nonstationary reentrant propagation worked in concert to produce wave front fragmentation and complex activation patterns. None of the factors previously thought to be necessary for local propagation block (e.g., heterogeneous refractory period, steep action potential duration restitution) were present. We conclude that the complex geometry of the heart may be an important determinant of VF activation patterns. (c) 2002 American Institute of Physics.     

Critical role of inhomogeneities in pacing termination of cardiac reentry

Reentry around nonconducting ventricular scar tissue, a cause of lethal arrhythmias, is typically treated by rapid electrical stimulation from an implantable cardioverter defibrillator. However, the dynamical mechanisms of termination (success and failure) are poorly understood. To elucidate such mechanisms, we study the dynamics of pacing in one- and two-dimensional models of anatomical reentry. In a crucial realistic difference from previous studies of such systems, we have placed the pacing site away from the reentry circuit. Our model-independent results suggest that with such off-circuit pacing, the existence of inhomogeneity in the reentry circuit is essential for successful termination of tachycardia under certain conditions. Considering the critical role of such inhomogeneities may lead to more effective pacing algorithms. (c) 2002 American Institute of Physics.     

具有早期后除极化现象的可激发系统中螺旋波破碎方式研究

在Greenberg-Hasting元胞自动机模型中引入了正常元胞和老化元胞,并规定只有老化元胞存在早期后除极化现象且早期后除极化可以激发其他元胞.在正常元胞和老化元胞均匀分布的情况下,研究了早期后除极化对螺旋波演化行为的影响,重点探讨了早期后除极化导致的螺旋波破碎方式.数值模拟结果表明:早期后除极化在比率约为26.4%的少数情况下不对螺旋波产生影响,在其他情况下则会对螺旋波产生各种影响,包括使螺旋波漫游、漂移、波臂发生形变以及导致螺旋波破碎和消失等.观察到早期后除极化通过传导障碍消失和通过转变为反靶波消失,早期后除极化导致螺旋波破碎有8种方式,包括非对称破缺导致的破碎、对称破缺导致的破碎、同时激发双波导致的破碎、非对称激发导致的破碎、整体传导障碍导致的破碎、整体快速破碎等.分析发现这些螺旋波破碎现象都与早期后除极化产生回火波有关,得到螺旋波破碎的总比率通常约为13.8%,但是在适当选取老化元胞密度和早期后除极化的激发下,螺旋波破碎比率可达到32.4%,这些结果与心律失常致死的统计结果基本一致,本文对产生这些现象的物理机理做了简要分析.     

Reentry wave formation in excitable media with stochastically generated inhomogeneities

Clinical research shows that the frequency of arrhythmia events depends on the number and area of the border zones of infarct scars. We investigate the possibility that arrhythmia is initiated by reentry waves generated by the inhomogeneity of conduction velocity at the border zone. The interaction of a plane wave with a spatially extended inhomogeneity is simulated in the FitzHugh- Nagumo model. The inhomogeneity is introduced into the model by modifying the spatial dependence of the diffusion coefficient in a stochastic manner. This results in a rich variety of spatial distributions of conductivity. A plane wave propagating through such a system may break up on the regions with low conductivity and produce numerous spiral waves. The frequency of reentry wave formation is studied as a function of the parameters of the inhomogeneity generation algorithm. Three main scenarios of reentry wave formation were found: unidirectional block, main wave-wavelet collision, and wave break up during collision, on a region in which a conduction velocity gradient occurs. These scenarios are likely candidates for the mechanisms of arrhythmia initiation in a damaged tissue, e.g., the border zone of an infarct scar.     

用晚钠电流终止心脏中的螺旋波和时空混沌

采用人类心脏模型研究了用晚钠电流控制二维心脏组织中的螺旋波和时空混沌,我们提出这样的控制策略来产生晚钠电流:让慢失活门变量j始终等于0.7,同时实时调节钠电流的快失活门变量h的阈值电压V_I,即先让阈值电压V_I经过T_1时间从71.55 mV均匀减少到50.55 mV,然后经过T_2时间再从50.55 mV均匀增加到71.55 mV,当阈值电压V_I回到71.55 mV,钠电流的快、慢失活门变量恢复正常变化.数值模拟结果表明:只要适当选择控制时间,不论心肌细胞是否存在自发的晚钠电流,控制产生的晚钠电流都可以有效抑制螺旋波和时空混沌,而且需要的晚钠电流都很小,且控制时间都很短,因为螺旋波和时空混沌消失主要是通过传导障碍消失,少数情况下时空混沌是通过转变为靶波消失.我们希望这种控制方法能为室颤控制提供新的思路.     

Death,dynamics and disorder: Terminating reentry in excitable media by dynamically-induced inhomogeneities

Formation of feedback loops of excitation waves (reentrant circuit) around non-conducting ventricular scar tissue is a common cause of cardiac arrhythmias, such as ventricular tachycardia, often leading to death. This is typically treated by rapid stimulation from an implantable device (ICD). However, the mechanisms of reentry termination success and, more importantly, failure, are poorly understood. To study such mechanisms, we simulated pacing termination of reentry in a model of cardiac tissue having significant restitution and dispersion properties. Our results show that rapid pacing dynamically generates conduction inhomogeneities in the reentrant circuit, leading to successful pacing termination of tachycardia. The study suggests that more effective pacing algorithms can be designed by taking into account the role of such dynamical inhomogeneities.     

Curvature-dependent excitation propagation in cultured cardiac tissue

The geometry of excitation wave front may play an important role on the propagation block and spiral wave formation. The wave front which is bent over the critical value due to interaction with the obstacles may partially cease to propagate and appearing wave breaks evolve into rotating waves or reentry. This scenario may explain how reentry spontaneously originates in a heart. We studied highly curved excitation wave fronts in the cardiac tissue culture and found that in the conditions of normal, non-inhibited excitability the curvature effects do not play essential role in the propagation. Neither narrow isthmuses nor sharp corners of the obstacles, being classical objects for production of extremely curved wave front, affect non-inhibited wave propagation. The curvature-related phenomena of the propagation block and wave detachment from the obstacle boundary were observed only after partial suppression of the sodium channels with Lidocaine. Computer simulations confirmed the experimental observations. The explanation of the observed phenomena refers to the fact that the heart tissue is made of finite size cells so that curvature radii smaller than the cardiomyocyte size loses sense, and in non-inhibited tissue the single cell is capable to transmit excitation to its neighbors.     

Conduction block in one-dimensional heart fibers

We present a nonlinear dynamical systems analysis of the transition to conduction block in one-dimensional cardiac fibers. We study a simple model of wave propagation in heart tissue that depends only on the recovery of action potential duration and conduction velocity. If the recovery function has slope >or=1 and the velocity recovery function is nonconstant, rapid activation causes dynamical heterogeneity and finally conduction block away from the activation site. This dynamical mechanism may play a role in the initiation and breakup of spiral waves in excitable media.     

Characterization of patterned irregularity in locally interacting,spatially extended systems: Ventricular fibrillation

The re-entrant ventricular arrhythmias of monomorphic ventricular tachycardia and fibrillation are produced by abnormal spatio-temporal patterns of propagation in the ventricular myocardium. These behaviors can be described by solutions of reaction-diffusion equation excitable medium models. The direct comparison of such solutions with existing experimental observations is virtually impossible as there are too many factors to be taken into account, including not only the complicated dynamics of the re-entrant waves of excitation in the tissue, but also the way the appearance of these waves on the surface is modified by the inhomogeneity, anisotropy and three-dimensional nature of heart tissue. One way of indirect comparison is to compare characteristics of the complexity of the model and the real data, that are invariant under these modifications of the signal. Karhunen-Loeve decomposition is a standard tool for evaluating the complexity of multidimensional signals. A comparison of the separate and conjoint complexities of the signals on the opposite sides of the preparation can be considered as an indicator how much three-dimensional effects are essential in the preparation behavior. (c) 2001 American Institute of Physics.     

Patterns of spiral tip motion in cardiac tissues

In support of the spiral wave theory of reentry, simulation studies and animal models have been utilized to show various patterns of spiral wave tip motion such as meandering and drifting. However, the demonstration of these or any other patterns in cardiac tissues have been limited. Whether such patterns of spiral tip motion are commonly observed in fibrillating cardiac tissues is unknown, and whether such patterns form the basis of ventricular tachycardia or fibrillation remain debatable. Using a computerized dynamic activation display, 108 episodes of atrial and ventricular tachycardia and fibrillation in isolated and intact canine cardiac tissues, as well as in vitro swine and myopathic human cardiac tissues, were analyzed for patterns of nonstationary, spiral wave tip motion. Among them, 46 episodes were from normal animal myocardium without pharmacological perturbations, 50 samples were from normal animal myocardium, either treated with drugs or had chemical ablation of the subendocardium, and 12 samples were from diseased human hearts. Among the total episodes, 11 of them had obvious nonstationary spiral tip motion with a life span of >2 cycles and with consecutive reentrant paths distinct from each other. Four patterns were observed: (1) meandering with an inward petal flower in 2; (2) meandering with outward petals in 5; (3) irregularly concentric in 3 (core moving about a common center); and (4) drift in 1 (linear core movement). The life span of a single nonstationary spiral wave lasted no more than 7 complete cycles with a mean of 4.6+/-4.3, and a median of 4.5 cycles in our samples. Conclusion: (1) Patently evident nonstationary spiral waves with long life spans were uncommon in our sample of mostly normal cardiac tissues, thus making a single meandering spiral wave an unlikely major mechanism of fibrillation in normal ventricular myocardium. (2) A tendency toward four patterns of nonstationary spiral tip motion was observed. (c) 1998 American Institute of Physics.     

Noninvasive electromechanical wave imaging and conduction-relevant velocity estimation in vivo

Electromechanical wave imaging is a novel technique for the noninvasive mapping of conduction waves in the left ventricle through the combination of ECG gating, high frame rate ultrasound imaging and radio-frequency (RF)-based displacement estimation techniques. In this paper, we describe this new technique and characterize the origin and velocity of the wave under distinct pacing schemes. First, in vivo imaging (30 MHz) was performed on anesthetized, wild-type mice (n = 12) at high frame rates in order to take advantage of the transient electromechanical coupling occurring in the myocardium. The RF signal acquisition in a long-axis echocardiographic view was gated between consecutive R-wave peaks of the mouse electrocardiogram (ECG) and yielded an ultra-high RF frame rate of 8000 frames/s (fps). The ultrasound RF signals in each frame were digitized at 160 MHz. Axial, frame-to-frame displacements were estimated using 1D cross-correlation (window size of 240 μm, overlap of 90%). Three pacing protocols were sequentially applied in each mouse: (1) sinus rhythm (SR), (2) right-atrial (RA) pacing and (3) right-ventricular (RV) pacing. Pacing was performed using an eight-electrode catheter placed into the right side of the heart with the capability of pacing from any adjacent bipole. During a cardiac cycle, several waves were depicted on the electromechanical wave images that propagated transmurally and/or from base to apex, or apex to base, depending on the type of pacing and the cardiac phase. Through comparison between the ciné-loops and their corresponding ECG obtained at different pacing protocols, we were able to identify and separate the electrically induced, or contraction, waves from the hemodynamic (or, blood-wall coupling) waves. In all cases, the contraction wave was best observed along the posterior wall starting at the S-wave of the ECG, which occurs after Purkinje fiber, and during myocardial, activation. The contraction wave was identified based on the fact that it changed direction only when the pacing origin changed, i.e., it propagated from the apex to the base at SR and RA pacing and from base to apex at RV pacing. This reversal in the wave propagation direction was found to be consistent in all mice scanned and the wave velocity values fell within the previously reported conduction wave range with statistically significant differences between SR/RA pacing (0.85 ± 0.22 m/s and 0.84 ± 0.20 m/s, respectively) and RV pacing (−0.52 ± 0.31 m/s; p < 0.0001). This study thus shows that imaging the electromechanical function of the heart noninvasively is feasible. It may therefore constitute a unique noninvasive method for conduction wave mapping of the entire left ventricle. Such a technology can be extended to 3D mapping and/or used for early detection of dyssynchrony, arrhythmias, left-bundle branch block, or other conduction abnormalities as well as diagnosis and treatment thereof.