Utilizing the eikonal relationship in strategies for reentrant wave termination in excitable media

Terminating spiral waves with a single designed stimulus: Teleportation as the mechanism for defibrillation

Many chemical and biological systems can sustain complex spiral wave dynamics. In the heart, spiral waves of electrical activity induce deadly arrhythmias and must be eliminated with a large, system-wide perturbation to restore a healthy rhythm. However, the high-energy shocks required for defibrillation therapies are very painful and can even damage heart tissue. In this study, we demonstrate a method for eliminating spiral waves with what should be the minimal possible stimulus required in space for termination. To do this, we show how a localized perturbation can be designed to annihilate simultaneously all spiral waves both free and bound. This identified mechanism is applicable to any excitable system and, for the heart, may lead to more efficient defibrillation strategies.

We identify and demonstrate a universal mechanism for terminating spiral waves in excitable media using an established topological framework. This mechanism dictates whether high- or low-energy defibrillation shocks succeed or fail. Furthermore, this mechanism allows for the design of a single minimal stimulus capable of defibrillating, at any time, turbulent states driven by multiple spiral waves. We demonstrate this method in a variety of computational models of cardiac tissue ranging from simple to detailed human models. The theory described here shows how this mechanism underlies all successful defibrillation and can be used to further develop existing and future low-energy defibrillation strategies.

Removal of pinned scroll waves in cardiac tissues by electric fields in a generic model of three-dimensional excitable media

Spirals or scroll waves pinned to heterogeneities in cardiac tissues may cause lethal arrhythmias. To unpin these life-threatening spiral waves, methods of wave emission from heterogeneities (WEH) induced by low-voltage pulsed DC electric fields (PDCEFs) and circularly polarized electric fields (CPEFs) have been used in two-dimensional (2D) cardiac tissues. Nevertheless, the unpinning of scroll waves in three-dimensional (3D) cardiac systems is much more difficult than that of spiral waves in 2D cardiac systems, and there are few reports on the removal of pinned scroll waves in 3D cardiac tissues by electric fields. In this article, we investigate in detail the removal of pinned scroll waves in a generic model of 3D excitable media using PDCEF, AC electric field (ACEF) and CPEF, respectively. We find that spherical waves can be induced from the heterogeneities by these electric fields in initially quiescent excitable media. However, only CPEF can induce spherical waves with frequencies higher than that of the pinned scroll wave. Such higher-frequency spherical waves induced by CPEF can be used to drive the pinned scroll wave out of the cardiac systems. We hope this remarkable ability of CPEF can provide a better alternative to terminate arrhythmias caused by pinned scroll waves.

Elimination of a spiral wave pinned at an obstacle by a train of plane waves: Effect of diffusion between obstacles and surrounding media

In excitable media such as cardiac tissue and Belousov-Zhabotinsky reaction medium, spiral waves tend to anchor (pin) to local heterogeneities. In general, such pinned waves are difficult to eliminate and may progress to spatio-temporal chaos. Heterogeneities can be classified as either the absence or presence of diffusive interaction with the surrounding medium. In this study, we investigated the difference in the unpinning of spiral waves from obstacles with and without diffusive interaction, and found a profound difference. The pacing period required for unpinning at fixed obstacle size is larger in case of diffusive obstacles. Further, we deduced a generic theoretical framework that can predict the minimal unpinning period. Our results explain the difference in pacing periods between for the obstacles with and without diffusive interaction, and the difference is interpreted in terms of the local decrease of spiral wave velocity close to the obstacle boundary caused in the case of diffusive interaction.

Mechanism of unpinning spirals by a series of stimuli

Antitachycardia pacing (ATP) is widely used to terminate tachycardia before it proceeds to lethal fibrillation. The important prerequisite for successful ATP is unpinning of the spirals anchored to the obstacle by a series of stimuli. Here, to understand the mechanism of unpinning spirals by ATP, we propose a theoretical explanation based on a nonlinear eikonal relation and a kinematical model. The theoretical results are quantitatively consistent with the numerical simulations in both weak and high excitabilities.

Negative curvature boundaries as wave emitting sites for the control of biological excitable media

Understanding the interaction of electric fields with the complex anatomy of biological excitable media is key to optimizing control strategies for spatiotemporal dynamics in those systems. On the basis of a bidomain description, we provide a unified theory for the electric-field-induced depolarization of the substrate near curved boundaries of generalized shapes, resulting in the localized recruitment of control sites. Our findings are confirmed in experiments on cardiomyocyte cell cultures and supported by two-dimensional numerical simulations on a cross section of a rabbit ventricle.

Termination of pinned vortices by high-frequency wave trains in heartlike excitable media with anisotropic fiber orientation

A variety of chemical and biological nonlinear excitable media, including heart tissue, exhibit vortices (spiral waves) that can anchor to nonexcitable obstacles. Such anchored vortices can be terminated by the application of high-frequency wave trains, as shown previously in isotropic excitable media. In this study, we examined the basic dependencies of the conduction velocities of planar waves and waves around curved obstacles as a function of anisotropy through numerical simulations of excitable media that mimic the fiber orientation in a real heart. We also investigated the unpinning of anchored spiral waves by high-frequency wave trains in an anisotropic excitable medium. Unlike the findings regarding the termination of spiral waves in isotropic excitable systems, we found a nonmonotonic relationship between the maximum unpinning period and the obstacle radius depending on the fiber orientation, where the formation of unwanted secondary pinned vortices or chaotic waves is seen over a wide range of parameters.

Wave emission on interacting heterogeneities in cardiac tissue

Cardiac arrhythmias, a precursor of fibrillationlike states in the beating heart, are associated with spiral waves, which are likely to become pinned to heterogeneities. Far-field pacing (FFP) is a promising method for terminating such waves by using heterogeneities in the tissue as internal pacing sites. In this study we investigated the role of multiple obstacles and their interaction during FFP. We show that a secondary nearby obstacle can significantly modulate the minimum electrical field in FFP. Further, we show that essentially the same effect can be observed in cardiac tissue culture, which is a powerful experimental model to simulate heart activity. Here, an isotropic cell distribution leads to domain formation of locally distributed depolarization sites. Both secondary obstacles and domain formation of local depolarization sites can modulate energy requirements to originate wave propagation on obstacles. Our theoretical result was confirmed by experiments with cardiomyocyte monolayers. This result may be useful for the future application of FFP to a real beating heart.