Low-energy control of electrical turbulence in the heart.

Controlling the complex spatio-temporal dynamics underlying life-threatening cardiac arrhythmias such as fibrillation is extremely difficult, because of the nonlinear interaction of excitation waves in a heterogeneous anatomical substrate. In the absence of a better strategy, strong, globally resetting electrical shocks remain the only reliable treatment for cardiac fibrillation. Here we establish the relationship between the response of the tissue to an electric field and the spatial distribution of heterogeneities in 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 the power law τ ∝ E(α). 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 control strategy, we demonstrate 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 provide new research perspectives towards alternative, life-saving low-energy defibrillation techniques.

Phase-resolved analysis of the susceptibility of pinned spiral waves to far-field pacing in a two-dimensional model of excitable media.

Life-threatening cardiac arrhythmias are associated with the existence of stable and unstable spiral waves. Termination of such complex spatio-temporal patterns by local control is substantially limited by anchoring of spiral waves at natural heterogeneities. Far-field pacing (FFP) is a new local control strategy that has been shown to be capable of unpinning waves from obstacles. In this article, we investigate in detail the FFP unpinning mechanism for a single rotating wave pinned to a heterogeneity. We identify qualitatively different phase regimes of the rotating wave showing that the concept of vulnerability is important but not sufficient to explain the failure of unpinning in all cases. Specifically, we find that a reduced excitation threshold can lead to the failure of unpinning, even inside the vulnerable window. The critical value of the excitation threshold (below which no unpinning is possible) decreases for higher electric field strengths and larger obstacles. In contrast, for a high excitation threshold, the success of unpinning is determined solely by vulnerability, allowing for a convenient estimation of the unpinning success rate. In some cases, we also observe phase resetting in discontinuous phase intervals of the spiral wave. This effect is important for the application of multiple stimuli in experiments.