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Excitable media; Cardiac arrhythmias; Reentrant waves; Unpinning
Abstract:
Spiral waves in cardiac tissue can pin to tissue heterogeneities and form stable pinned waves. These waves can be unpinned by electric stimuli applied close to the pinning center during the vulnerable window of the spiral. Using a phase transition curve (PTC), we quantify the response of a pinned wave in a cardiac monolayer to secondary excitations generated electric field pulses. The PTC can be used to construct a one-dimensional map that faithfully predicts the pinned wave's response to periodic field stimuli. Based on this 1D map, we predict that pacing at a frequency greater than the spiral frequency, over drive pacing, leads to phase locking of the spiral to the stimulus, which hinders unpinning. In contrast, under drive pacing can lead to scanning of the phase window of the spiral, which facilitates unpinning. The predicted mechanisms of phase scanning and phase locking are experimentally tested and confirmed in the same monolayers that were used to obtain the PTC. Our results have the potential to help choose optimal parameters for low energy antifibrillation pacing schemes.
