Abstract
High-voltage electrical defibrillation remains the only reliable method of quickly controlling life-threatening cardiac arrhythmias. This paper is devoted to studying an alternative approach, low-voltage cardioversion (LVC), which is based on ideas from non-linear dynamics and aims to remove sources of cardiac arrhythmias by applying high-frequency stimulation to cardiac tissue. We perform a detailed in-silico study of the elimination of arrhythmias caused by rotating spiral waves in a TP06 model of human cardiac tissue. We consider three parameter sets with slopes of the APD restitution curve of 0.7, 1.1 and 1.4, and we study LVC at the baseline and under the blocking of INa and ICaL and under the application of the drugs verapamil and amiodarone. We show that pacing can remove spiral waves; however, its efficiency can be substantially reduced by dynamic instabilities. We classify these instabilities and show that the blocking of INa and the application of amiodarone increase the efficiency of the method, while the blocking of ICaL and the application of verapamil decrease the efficiency. We discuss the mechanisms and the possible clinical applications resulting from our study.
Highlights
High-voltage electrical defibrillation remains the only reliable method of quickly controlling lifethreatening cardiac arrhythmias
We performed a detailed study of lowvoltage cardioversion (LVC) via high-frequency pacing in a 2D TP06 model of human cardiac tissue
We found that LVC can eliminate a spiral wave by pushing it towards the boundary of the tissue where the spiral wave disappears
Summary
High-voltage electrical defibrillation remains the only reliable method of quickly controlling lifethreatening cardiac arrhythmias. The impulses can be divided into three energy classes, the highest-energy shocks, which use voltages about 200 V or more, low-voltage shocks, which use potentials between 10 and 100 V, and pacing stimuli, which use less than 10 V but usually more than 1 V Biophysical mechanisms of those treatments have been studied for about a century. The idea of the shock electrotherapy is to depolarize all heart cells using one stimulus and reset arrhythmic excitation pattern to normal cardiac excitation. Such a shock results in serious adverse e ffects[3]. It is largely unknown why this therapy succeeds or fails in specific cases
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