A review of experimental, computational, and theoretical studies highlights complex dynamical phenomena linked to the initiation, maintenance, and control of cardiac wave turbulence and arrhythmias.
This review provides a comprehensive overview of the physical and dynamical mechanisms underlying cardiac arrhythmogenesis and potential novel electrical control methods.
A normal heartbeat is orchestrated by the stable propagation of an excitation wave that produces an orderly contraction. In contrast, wave turbulence in the ventricles, clinically known as ventricular fibrillation (VF), stops the heart from pumping and is lethal without prompt defibrillation. I review experimental, computational, and theoretical studies that have shed light on complex dynamical phenomena linked to the initiation, maintenance, and control of wave turbulence. I first discuss advances made to understand the precursor state to a reentrant arrhythmia where the refractory period of cardiac tissue becomes spatiotemporally disordered; this is known as an arrhythmogenic tissue substrate. I describe observed patterns of transmembrane voltage and intracellular calcium signaling that can contribute to this substrate, and symmetry breaking instabilities to explain their formation. I then survey mechanisms of wave turbulence and discuss novel methods that exploit electrical pacing stimuli to control precursor patterns and low-energy pulsed electric fields to control turbulence.
Alain Karma (Wed,) conducted a review in Cardiac Arrhythmogenesis / Ventricular Fibrillation. A review of experimental, computational, and theoretical studies highlights complex dynamical phenomena linked to the initiation, maintenance, and control of cardiac wave turbulence and arrhythmias.
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