title: Low-energy control of electrical turbulence in the heart.
abstract: Controlling the complex spatio-temporal dynamics underlying life-threatening cardiac arrhythmias such as fibrillation is extremely difficult, because of the nonlinear interaction of excitation waves in a heterogeneous anatomical substrate. In the absence of a better strategy, strong, globally resetting electrical shocks remain the only reliable treatment for cardiac fibrillation. Here we establish the relationship between the response of the tissue to an electric field and the spatial distribution of heterogeneities in the scale-free coronary vascular structure. We show that in response to a pulsed electric field, E, these heterogeneities serve as nucleation sites for the generation of intramural electrical waves with a source density ρ(E) and a characteristic time, τ, for tissue depolarization that obeys the power law τ ∝ E(α). These intramural wave sources permit targeting of electrical turbulence near the cores of the vortices of electrical activity that drive complex fibrillatory dynamics. We show in vitro that simultaneous and direct access to multiple vortex cores results in rapid synchronization of cardiac tissue and therefore, efficient termination of fibrillation. Using this control strategy, we demonstrate low-energy termination of fibrillation in vivo. Our results give new insights into the mechanisms and dynamics underlying the control of spatio-temporal chaos in heterogeneous excitable media and provide new research perspectives towards alternative, life-saving low-energy defibrillation techniques.
authors.affiliation: Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, D-37077 Göttingen, Germany. stefan.luther@ds.mpg.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Luther
authors.forename: Flavio H
authors.initials: FH
authors.lastname: Fenton
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Kornreich
authors.forename: Amgad
authors.initials: A
authors.lastname: Squires
authors.forename: Philip
authors.initials: P
authors.lastname: Bittihn
authors.forename: Daniel
authors.initials: D
authors.lastname: Hornung
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
authors.forename: James
authors.initials: J
authors.lastname: Flanders
authors.forename: Andrea
authors.initials: A
authors.lastname: Gladuli
authors.forename: Luis
authors.initials: L
authors.lastname: Campoy
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cherry
authors.forename: Gisa
authors.initials: G
authors.lastname: Luther
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.forename: Valentin I
authors.initials: VI
authors.lastname: Krinsky
authors.forename: Alain
authors.initials: A
authors.lastname: Pumir
authors.forename: Robert F
authors.initials: RF
authors.lastname: Gilmour
authors.forename: Eberhard
authors.initials: E
authors.lastname: Bodenschatz
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology*; D003287:Contrast Media; D003331:Coronary Vessels / Q000033:anatomy & histology; D004285:Dogs; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D006321:Heart / Q000033:anatomy & histology / Q000502:physiology* / Q000503:physiopathology*; D014693:Ventricular Fibrillation / Q000503:physiopathology*; D055114:X-Ray Microtomography
chemical_list: D003287:Contrast Media