Distribution of Excitation Frequencies on the Epicardial and Endocardial Surfaces of Fibrillating Ventricular Wall of the Sheep Heart

Zaitsev, Alexey V.; Berenfeld, Omer; Mironov, Sergey; Jalife, José; Pertsov, Arkady M.

doi:10.1161/01.res.86.4.408

Cited by 224 publications

(228 citation statements)

References 35 publications

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“…However, other work has questioned the chaotic fibrillation hypothesis (45,46). The current prevailing theory (47), supported by a range of mathematical (48)(49)(50)(51)(52)(53)(54)(55)(56), in vitro (57)(58)(59), and in vivo (57,(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) studies, is that fibrillation is a complex nonlinear combination of stochastic and deterministic components, such as scroll waves of electrical activity meandering within the ventricular wall. Given this body of evidence, it is apparent that fibrillation is characterized by high-dimensional nonstationary spatiotemporal dynamics that are too complex for current nonlinear-dynamical control techniques.…”

Section: Discussionmentioning

confidence: 99%

Nonlinear-dynamical arrhythmia control in humans

Christini

Steín²,

Markowitz³

et al. 2001

Proc. Natl. Acad. Sci. U.S.A.

114

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Nonlinear-dynamical control techniques, also known as chaos control, have been used with great success to control a wide range of physical systems. Such techniques have been used to control the behavior of in vitro excitable biological tissue, suggesting their potential for clinical utility. However, the feasibility of using such techniques to control physiological processes has not been demonstrated in humans. Here we show that nonlinear-dynamical control can modulate human cardiac electrophysiological dynamics by rapidly stabilizing an unstable target rhythm. Specifically, in 52͞54 control attempts in five patients, we successfully terminated pacing-induced period-2 atrioventricular-nodal conduction alternans by stabilizing the underlying unstable steady-state conduction. This proof-of-concept demonstration shows that nonlinear-dynamical control techniques are clinically feasible and provides a foundation for developing such techniques for more complex forms of clinical arrhythmia.I ncreasingly, it is recognized that many cardiac arrhythmias can be characterized on the basis of the physical principles of nonlinear dynamics (1, 2). A nonlinear-dynamical system is one that changes with time and cannot be broken down into a linear sum of its individual components. For certain nonlinear systems, known as chaotic systems, behavior is aperiodic and long-term prediction is impossible, even though the dynamics are entirely deterministic (i.e., the dynamics of the system are completely determined from known inputs and the previous state of the system, with no influence from random inputs). Importantly, such determinism actually can be exploited to control the dynamics of a chaotic system. To this end, a variety of nonlineardynamical control techniques, also known as chaos control, ‡ have been developed (3, 4) and applied successfully to a wide range of physical systems (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Such techniques are modelindependent, i.e., they require no a priori knowledge of the underlying equations of a system and are therefore appropriate for systems that are essentially ''black boxes.''The success of nonlinear-dynamical control techniques in stabilizing physical systems, together with the facts that many physiological systems are nonlinear (e.g., the cardiac conduction system, because of its numerous complex nonlinear component interactions) and lack the detailed analytical system models required for model-based control techniques, have fostered widespread interest in applying these model-independent techniques to biological dynamical systems (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). In a pioneering application, Garfinkel et al. (15) stabilized drug-induced irregular cardiac rhythms by means of dynamically timed electrical stimulation in an in vitro rabbit ventricular-tissue preparation. That work was an important demonstration that the physical principles of nonlinear-dynamical control could be extended into the realm of cardiac dynamics. Although extension of that work to the control of fibrill...

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Section: Discussionmentioning

confidence: 99%

Nonlinear-dynamical arrhythmia control in humans

Christini

Steín²,

Markowitz³

et al. 2001

Proc. Natl. Acad. Sci. U.S.A.

114

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“…The interaction between a sustained mother rotor and underlying heterogeneity could result in conduction blocks and a complex spatial distribution of excitation frequencies, leading to VF. 2,18 …”

Section: Possible Mechanisms Of Cardiac Fibrillationmentioning

confidence: 99%

Mother Rotors and the Mechanisms of D600-Induced Type 2 Ventricular Fibrillation

Lin

Baher

et al. 2004

Circulation

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Background-Two types of ventricular fibrillation (VF) have been demonstrated in isolated rabbit hearts during D600 infusion. Type 1 VF is characterized by the presence of multiple, wandering wavelets, whereas type 2 VF shows local spatiotemporal periodicity. We hypothesized that a single mother rotor underlies type 2 VF. Methods and Results-One (protocol I) or 2 (protocol II) cameras were used to map the epicardial ventricular activations in Langendorff-perfused rabbit hearts. Multiple episodes of type 2 VF were induced in 22 hearts by high-concentration (Ն2.5 mg/L) D600 (protocol I). During type 2 VF, a single spiral wave (nϭ19) and/or an epicardial breakthrough pattern (nϭ11) was present in 14 hearts. These spiral waves either slowly drifted or intermittently anchored on the papillary muscle (PM) of the left ventricle. Dominant-frequency (DF) analyses showed that the highest local DF was near the PM (12.5Ϯ1.1 Hz). There was an excellent correlation between the highest local DF of these spiral waves and breakthroughs (11.8Ϯ1.7 Hz) and the DF of simultaneously obtained global pseudo-ECG (11.2Ϯ1.8 Hz, rϭ0.97, PϽ0.0001) during type 2 VF. We also successfully reproduced the major features of type 2 VF by using the Luo-Rudy action-potential model in a simulated, 3-dimensional tissue slab, under conditions of reduced excitability and flat action-potential duration restitution. Conclusions-Either a stationary or a slowly drifting mother rotor can result in type 2 VF. Colocalization of the stationary mother rotors with the PM suggests the importance of underlying anatomic structures in mother rotor formation.

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“…Fibrillatory conduction blocks at specific locations in the periphery of the rotor were responsible for the organization of discrete dominant-frequency domains over the ventricular surface. Zaitsev et al 21 performed Fourier analysis of VF in sheep ventricular tissue slabs. They observed that the frequency domain patterns were relatively stable and could persist from several seconds to several minutes.…”

Section: Multiple Wavelet Hypothesismentioning

confidence: 99%