Mechanisms of vortices termination in the cardiac muscle.

D Hornung,V I Krinsky,N F Otani,T K Shajahan,T Baig,S Han,S Berg,S Luther,V N Biktashev

doi:10.1098/rsos.170024

Abstract

We propose a solution to a long-standing problem: how to terminate multiple vortices in the heart, when the locations of their cores and their critical time windows are unknown. We scan the phases of all pinned vortices in parallel with electric field pulses (E-pulses). We specify a condition on pacing parameters that guarantees termination of one vortex. For more than one vortex with significantly different frequencies, the success of scanning depends on chance, and all vortices are terminated with a success rate of less than one. We found that a similar mechanism terminates also a free (not pinned) vortex. A series of about 500 experiments with termination of ventricular fibrillation by E-pulses in pig isolated hearts is evidence that pinned vortices, hidden from direct observation, are significant in fibrillation. These results form a physical basis needed for the creation of new effective low energy defibrillation methods based on the termination of vortices underlying fibrillation.

Highlights

Vortices play a crucial role in many domains of physics, including catalytic waves, and condensed matter physics
Note that elimination of a free, rather than pinned, vortex by inducing its drift via the mechanism described in [28], requires the pacing frequency to be above the arrhythmia frequency, f > 1. These experiments provide evidence that pinned vortices, hidden from direct observation, are significant in fibrillation. They show that the vulnerable window (VW) mechanism is an explanation for the high success rate of ventricular fibrillation (VF) termination using electric field pacing
After more than 25 years of research, we propose a solution to a problem; how to terminate multiple vortices in the cardiac tissue hidden from direct observation

Summary

Introduction

Vortices play a crucial role in many domains of physics, including catalytic waves, and condensed matter physics. The contemporary method of terminating life-threatening cardiac fibrillation is still aimed at termination of not vortices, but all waves in the heart [11,12]. It delivers a high-energy electric shock, which is damaging and painful. Research aimed at reducing the energy to a non-damaging, pain-free level gave rise to methods [13,14,15,16,17,18] aimed at terminating vortices rather than all waves. We investigate mechanisms of vortices termination by electric field pulses (E-pulses)

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Conclusion