Controlling the complex spatio-temporal dynamics underlying life-threatening cardiac arrhythmias such as fibrillation is extremely difficult due to the nonlinear interaction of excitation waves within a heterogeneous anatomical substrate1–4. Lacking a better strategy, strong, globally resetting electrical shocks remain the only reliable treatment for cardiac fibrillation5–7. Here, we establish the relation between the response of the tissue to an electric field and the spatial distribution of heterogeneities of the scale-free coronary vascular structure. We show that in response to a pulsed electric field E, these heterogeneities serve as nucleation sites for the generation of intramural electrical waves with a source density ρ(E), and a characteristic time τ for tissue depolarization that obeys a power law τ∝Eα. These intramural wave sources permit targeting of electrical turbulence near the cores of the vortices of electrical activity that drive complex fibrillatory dynamics. We show in vitro that simultaneous and direct access to multiple vortex cores results in rapid synchronization of cardiac tissue and therefore efficient termination of fibrillation. Using this novel control strategy, we demonstrate, for the first time, low-energy termination of fibrillation in vivo. Our results give new insights into the mechanisms and dynamics underlying the control of spatio-temporal chaos in heterogeneous excitable media and at the same time provide new research perspectives towards alternative, life-saving low-energy defibrillation techniques.

A new phenomenological model of turbulent fluctuations is constructed by considering the Lagrangian dynamics of 4 points (the tetrad). The closure of the equations of motion is achieved by postulating an anisotropic, i.e. tetrad shape dependent, relation of the local pressure and the velocity gradient defined on the tetrad. The non-local contribution to the pressure and the incoherent small scale fluctuations are modeled as Gaussian white "noise". The resulting stochastic model for the coarse-grained velocity gradient is analyzed approximately, yielding predictions for the probability distribution functions of different 2nd and 3d order invariants. The results are compared with the direct numerical simulation of the Navier-Stokes. The model provides a reasonable representation of the non-linear dynamics involved in energy transfer and vortex stretching and allows to study interesting aspects of the statistical geometry of turbulence, e.g. vorticity/strain alignment. In a state with a constant energy flux (and K41 power spectrum) it exhibits the anomalous scaling of high moments associated with formation of high gradient sheets -events associated with large energy transfer. An approach to the more complete analysis of the stochastic model, properly including the effect of fluctuations, is outlined and will enable further quantitative juxtaposition of the model with the results of the DNS.

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