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Pacing-induced spatiotemporal dynamics can be exploited to improve reentry termination efficacy

Trine Krogh-Madsen1 and David J. Christini1,2

  • 1Department of Medicine, Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York 10021, USA
  • 2Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York 10021, USA

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Phys. Rev. E 80, 021924 – Published 21 August, 2009

DOI: https://doi.org/10.1103/PhysRevE.80.021924

Abstract

Some potentially fatal cardiac arrhythmias may be terminated by a series of premature stimuli. Monomorphic ventricular tachycardia, which may be modeled as an excitation wave traveling around in a ring, is one such arrhythmia. We investigated the mechanisms and requirements for termination of such reentry using an ionic cardiac ring model. Termination requires conduction block, which in turn is facilitated by spatial dispersion in repolarization and recovery time. When applying short series of two or three stimuli, we found that for conduction block to robustly occur, the magnitude of the spatial gradient in recovery time must exceed a critical value of 20 ms/cm. Importantly, the required spatial gradient can be induced in this homogeneous system by the dynamics of the stimulus-induced waves—we show analytically the necessary conditions. Finally, we introduce a type of pacing protocol, the “aggressive ramp,” which increases the termination efficacy by exploiting such pacing-induced heterogeneities. This technique, which is straightforward to implement, may therefore have important clinical implications.

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Phys. Rev. E 80, 021924– Published 21 August, 2009
  • Received 20 March 2009

© 2009 American Physical Society

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