Resetting and annihilation of reentrant activity in a model of a one-dimensional loop of ventricular tissue.

Abstract

Resetting and annihilation of reentrant activity by a single stimulus pulse (S1) or a pair (S1-S2) of coupled pulses are studied in a model of one-dimensional loop of cardiac tissue using a Beeler-Reuter-type ionic model. Different modes of reentry termination are described. The classical mode of termination by unidirectional block, in which a stimulus produces only a retrograde front that collides with the activation front of the reentry, can be obtained for both S1 and S1-S2 applied over a small vulnerable window. We demonstrate that another scenario of termination-that we term collision block-can also be induced by the S1-S2 protocol. This scenario is obtained over a much wider range of S1-S2 coupling intervals than the one leading to a unidirectional block. In the collision block, S1 produces a retrograde front, colliding with the activation front of the pre-existing reentry, and an antegrade front propagating in the same direction as the initial reentry. Then, S2 also produces an antegrade and a retrograde front. However, the propagation of these fronts in the spatial profile of repolarization left by S1 leads to a termination of the reentrant activity. More complex behaviors also occur in which the antegrade fronts produced by S1 and S2 both persist for several turns, displaying a growing alternation in action potential duration ("alternans amplification") that may lead to the termination of the reentrant activity. The hypothesis that both collision block and alternans amplification depend on the interaction between the action potential duration restitution curve and the recovery curve of conduction velocity is supported by the fact that the dynamical behaviors were reproduced using an integro-delay equation based on these two properties. We thus describe two new mechanisms (collision block and alternans amplification) whereby electrical stimulation can terminate reentrant activity. (c) 2002 American Institute of Physics.