title: Nonlinear-dynamical arrhythmia control in humans.
abstract: Nonlinear-dynamical control techniques, also known as chaos control, have been used with great success to control a wide range of physical systems. Such techniques have been used to control the behavior of in vitro excitable biological tissue, suggesting their potential for clinical utility. However, the feasibility of using such techniques to control physiological processes has not been demonstrated in humans. Here we show that nonlinear-dynamical control can modulate human cardiac electrophysiological dynamics by rapidly stabilizing an unstable target rhythm. Specifically, in 52/54 control attempts in five patients, we successfully terminated pacing-induced period-2 atrioventricular-nodal conduction alternans by stabilizing the underlying unstable steady-state conduction. This proof-of-concept demonstration shows that nonlinear-dynamical control techniques are clinically feasible and provides a foundation for developing such techniques for more complex forms of clinical arrhythmia.
authors.affiliation: Department of Medicine, Division of Cardiology, Cornell University Medical College, New York, NY 10021, USA. dchristi@med.cornell.edu
authors.forename: D J
authors.initials: DJ
authors.lastname: Christini
authors.forename: K M
authors.initials: KM
authors.lastname: Stein
authors.forename: S M
authors.initials: SM
authors.lastname: Markowitz
authors.forename: S
authors.initials: S
authors.lastname: Mittal
authors.forename: D J
authors.initials: DJ
authors.lastname: Slotwiner
authors.forename: M A
authors.initials: MA
authors.lastname: Scheiner
authors.forename: S
authors.initials: S
authors.lastname: Iwai
authors.forename: B B
authors.initials: BB
authors.lastname: Lerman
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D001283:Atrioventricular Node / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged