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Hussaini S, Mamyraiym Kyzy A, Schröder-Schetelig J, Lädke SL, Venkatesan V, Diaz-Maue L, Quiñonez Uribe RA, Richter C, Biktashev VN, Majumder R, Krinski V, Luther S. Efficient termination of cardiac arrhythmias using optogenetic resonant feedback pacing. CHAOS (WOODBURY, N.Y.) 2024; 34:031103. [PMID: 38526981 DOI: 10.1063/5.0191519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Malignant cardiac tachyarrhythmias are associated with complex spatiotemporal excitation of the heart. The termination of these life-threatening arrhythmias requires high-energy electrical shocks that have significant side effects, including tissue damage, excruciating pain, and worsening prognosis. This significant medical need has motivated the search for alternative approaches that mitigate the side effects, based on a comprehensive understanding of the nonlinear dynamics of the heart. Cardiac optogenetics enables the manipulation of cellular function using light, enhancing our understanding of nonlinear cardiac function and control. Here, we investigate the efficacy of optically resonant feedback pacing (ORFP) to terminate ventricular tachyarrhythmias using numerical simulations and experiments in transgenic Langendorff-perfused mouse hearts. We show that ORFP outperforms the termination efficacy of the optical single-pulse (OSP) approach. When using ORFP, the total energy required for arrhythmia termination, i.e., the energy summed over all pulses in the sequence, is 1 mJ. With a success rate of 50%, the energy per pulse is 40 times lower than with OSP with a pulse duration of 10 ms. We demonstrate that even at light intensities below the excitation threshold, ORFP enables the termination of arrhythmias by spatiotemporal modulation of excitability inducing spiral wave drift.
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Affiliation(s)
- S Hussaini
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - A Mamyraiym Kyzy
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - J Schröder-Schetelig
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - S L Lädke
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - V Venkatesan
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - L Diaz-Maue
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
- Research Electronics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - R A Quiñonez Uribe
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - C Richter
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
- WG Cardiovascular Optogenetics, Lab Animal Science Unit, Leibniz Institute for Primate Research, Göttingen 37077, Germany
| | - V N Biktashev
- Department of Mathematics and Statistics, University of Exeter, Exeter EX4 4QF, United Kingdom
| | - R Majumder
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
| | - V Krinski
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
| | - S Luther
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organisation, Göttingen 37077, Germany
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen 37075, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Göttingen 37075, Germany
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Aron M, Lilienkamp T, Luther S, Parlitz U. Optimising low-energy defibrillation in 2D cardiac tissue with a genetic algorithm. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1172454. [PMID: 37555132 PMCID: PMC10406519 DOI: 10.3389/fnetp.2023.1172454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
Sequences of low-energy electrical pulses can effectively terminate ventricular fibrillation (VF) and avoid the side effects of conventional high-energy electrical defibrillation shocks, including tissue damage, traumatic pain, and worsening of prognosis. However, the systematic optimisation of sequences of low-energy pulses remains a major challenge. Using 2D simulations of homogeneous cardiac tissue and a genetic algorithm, we demonstrate the optimisation of sequences with non-uniform pulse energies and time intervals between consecutive pulses for efficient VF termination. We further identify model-dependent reductions of total pacing energy ranging from ∼4% to ∼80% compared to reference adaptive-deceleration pacing (ADP) protocols of equal success rate (100%).
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Affiliation(s)
- Marcel Aron
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Computational Physics for Life Science, Nuremberg Institute of Technology Georg Simon Ohm, Nuremberg, Germany
| | - Stefan Luther
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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3
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Lilienkamp T, Parlitz U, Luther S. Taming cardiac arrhythmias: Terminating spiral wave chaos by adaptive deceleration pacing. CHAOS (WOODBURY, N.Y.) 2022; 32:121105. [PMID: 36587312 DOI: 10.1063/5.0126682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/26/2022] [Indexed: 06/17/2023]
Abstract
Sequences of weak electrical pulses are considered a promising alternative for terminating ventricular and atrial fibrillations while avoiding strong defibrillation shocks with adverse side effects. In this study, using numerical simulations of four different 2D excitable media, we show that pulse trains with increasing temporal intervals between successive pulses (deceleration pacing) provide high success rates at low energies. Furthermore, we propose a simple and robust approach to calculate inter-pulse spacing directly from the frequency spectrum of the dynamics (for instance, computed based on the electrocardiogram), which can be practically used in experiments and clinical applications.
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Affiliation(s)
- Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
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4
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Feng X, Yin X, Wen J, Wu H, Gao X. Removal of spiral turbulence by virtual electrodes through the use of a circularly polarized electric field. CHAOS (WOODBURY, N.Y.) 2022; 32:093145. [PMID: 36182381 DOI: 10.1063/5.0102031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Heart disease is the leading cause of death and is often accompanied by cardiac fibrillation. Defibrillation using the virtual electrode effects is a promising alternative compared to using the high-voltage electric shock in the clinic. Our earlier works [S. L. Murphy, K. D. Kochanek, J. Xu, and E. Arias, NCHS Data Brief 427 (2021); R. A. Gray, A. M. Pertsov, and J. Jalife, Nature 392, 75-78 (1998); F. X. Witkowski, L. J. Leon, P. A. Penkoske, W. R. Giles, M. L. Spano, W. L. Ditto, and A. T. Winfree, Nature 392, 78-82 (1998); M. Santini, C. Pandozi, G. Altamura, G. Gentilucci, M. Villani, M. C. Scianaro, A. Castro, F. Ammirati, and B. Magris, J. Interv. Card. Electrophysiol. 3, 45-51 (1999).] prove that, compared with other external electric fields, a low voltage circularly polarized electric field is more efficient in turning non-excitable defects in cardiac tissue into virtual electrodes. It, therefore, needs lower voltage to stimulate the excitation waves and causes less harm to reset the spiral turbulence of cardiac excitation for defibrillation. In this paper, we investigate the virtual electrode effect of multiple defects by the circularly polarized electric field for the removal of spiral turbulence. Considering different shapes, sizes, and distributions of multiple defects, we reveal the phase locking of stimulated excitations around multiple virtual electrodes. Furthermore, the circularly polarized electric field parameters are optimized to remove the spiral turbulence.
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Affiliation(s)
- Xia Feng
- Faculty of Science, Xi'an Shiyou University, Xi'an 710065, China
| | - XunLi Yin
- Faculty of Science, Xi'an Shiyou University, Xi'an 710065, China
| | - JunQing Wen
- Faculty of Science, Xi'an Shiyou University, Xi'an 710065, China
| | - Hua Wu
- Faculty of Science, Xi'an Shiyou University, Xi'an 710065, China
| | - Xiang Gao
- School of Physics and Information Technology, Shaanxi Normal University, Xi'an 710062, China
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Lilienkamp T, Parlitz U, Luther S. Non-monotonous dose response function of the termination of spiral wave chaos. Sci Rep 2022; 12:12043. [PMID: 35835979 PMCID: PMC9283470 DOI: 10.1038/s41598-022-16068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
The conventional termination technique of life threatening cardiac arrhythmia like ventricular fibrillation is the application of a high-energy electrical defibrillation shock, coming along with severe side-effects. In order to improve the current treatment reducing these side-effects, the application of pulse sequences of lower energy instead of a single high-energy pulse are promising candidates. In this study, we show that in numerical simulations the dose-response function of pulse sequences applied to two-dimensional spiral wave chaos is not necessarily monotonously increasing, but exhibits a non-trivial frequency dependence. This insight into crucial phenomena appearing during termination attempts provides a deeper understanding of the governing termination mechanisms in general, and therefore may open up the path towards an efficient termination of cardiac arrhythmia in the future.
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Affiliation(s)
- Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany.
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany.,Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, 37077, Göttingen, Germany
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, 37077, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 37075, Germany. .,Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, 37077, Göttingen, Germany. .,University Medical Center Goettingen, Institute of Pharmacology and Toxicology, 37075, Göttingen, Germany.
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6
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Punacha S, A NK, Shajahan TK. Theory of unpinning of spiral waves using circularly polarized electric fields in mathematical models of excitable media. Phys Rev E 2020; 102:032411. [PMID: 33076004 DOI: 10.1103/physreve.102.032411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
Spiral waves of excitation are common in many physical, chemical, and biological systems. In physiological systems like the heart, such waves can lead to cardiac arrhythmias and need to be eliminated. Spiral waves anchor to heterogeneities in the excitable medium, and to eliminate them they need to be unpinned first. Several groups focused on developing strategies to unpin such pinned waves using electric shocks, pulsed electric fields, and recently, circularly polarized electric fields (CPEF). It was shown that in many situations, CPEF is more efficient at unpinning the wave compared to other existing methods. Here, we study how the circularly polarized field acts on the pinned spiral waves and unpins it. We show that the termination always happens within the first rotation of the electric field. For a given obstacle size, there exists a threshold time period of the CPEF below which the spiral can always be terminated. Our analytical formulation accurately predicts this threshold and explains the absence of the traditional unpinning window with the CPEF. We hope our theoretical work will stimulate further experimental studies about CPEF and low energy methods to eliminate spiral waves.
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Affiliation(s)
- Shreyas Punacha
- Department of Physics, National Institute of Technology Karnataka Surathkal, Mangalore, Karnataka, 575025, India
| | - Naveena Kumara A
- Department of Physics, National Institute of Technology Karnataka Surathkal, Mangalore, Karnataka, 575025, India
| | - T K Shajahan
- Department of Physics, National Institute of Technology Karnataka Surathkal, Mangalore, Karnataka, 575025, India
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Punacha S, Berg S, Sebastian A, Krinski VI, Luther S, Shajahan TK. Spiral wave unpinning facilitated by wave emitting sites in cardiac monolayers. Proc Math Phys Eng Sci 2019; 475:20190420. [PMID: 31736652 DOI: 10.1098/rspa.2019.0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022] Open
Abstract
Rotating spiral waves of electrical activity in the heart can anchor to unexcitable tissue (an obstacle) and become stable pinned waves. A pinned rotating wave can be unpinned either by a local electrical stimulus applied close to the spiral core, or by an electric field pulse that excites the core of a pinned wave independently of its localization. The wave will be unpinned only when the pulse is delivered inside a narrow time interval called the unpinning window (UW) of the spiral. In experiments with cardiac monolayers, we found that other obstacles situated near the pinning centre of the spiral can facilitate unpinning. In numerical simulations, we found increasing or decreasing of the UW depending on the location, orientation and distance between the pinning centre and an obstacle. Our study indicates that multiple obstacles could contribute to unpinning in experiments with intact hearts.
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Affiliation(s)
- Shreyas Punacha
- National Institute of Technology Karnataka, Surathkal, Mangalore 575025, India
| | - Sebastian Berg
- Max Planck Institute of Dynamics and Self Organization, Göttingen 37017, Germany
| | - Anupama Sebastian
- National Institute of Technology Karnataka, Surathkal, Mangalore 575025, India
| | - Valentin I Krinski
- Max Planck Institute of Dynamics and Self Organization, Göttingen 37017, Germany
| | - Stefan Luther
- Max Planck Institute of Dynamics and Self Organization, Göttingen 37017, Germany
| | - T K Shajahan
- National Institute of Technology Karnataka, Surathkal, Mangalore 575025, India.,Max Planck Institute of Dynamics and Self Organization, Göttingen 37017, Germany
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Bragard J, Sankarankutty AC, Sachse FB. Extended Bidomain Modeling of Defibrillation: Quantifying Virtual Electrode Strengths in Fibrotic Myocardium. Front Physiol 2019; 10:337. [PMID: 31001135 PMCID: PMC6456788 DOI: 10.3389/fphys.2019.00337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Defibrillation is a well-established therapy for atrial and ventricular arrhythmia. Here, we shed light on defibrillation in the fibrotic heart. Using the extended bidomain model of electrical conduction in cardiac tissue, we assessed the influence of fibrosis on the strength of virtual electrodes caused by extracellular electrical current. We created one-dimensional models of rabbit ventricular tissue with a central patch of fibrosis. The fibrosis was incorporated by altering volume fractions for extracellular, myocyte and fibroblast domains. In our prior work, we calculated these volume fractions from microscopic images at the infarct border zone of rabbit hearts. An average and a large degree of fibrosis were modeled. We simulated defibrillation by application of an extracellular current for a short duration (5 ms). We explored the effects of myocyte-fibroblast coupling, intra-fibroblast conductivity and patch length on the strength of the virtual electrodes present at the borders of the normal and fibrotic tissue. We discriminated between effects on myocyte and fibroblast membranes at both borders of the patch. Similarly, we studied defibrillation in two-dimensional models of fibrotic tissue. Square and disk-like patches of fibrotic tissue were embedded in control tissue. We quantified the influence of the geometry and fibrosis composition on virtual electrode strength. We compared the results obtained with a square and disk shape of the fibrotic patch with results from the one-dimensional simulations. Both, one- and two-dimensional simulations indicate that extracellular current application causes virtual electrodes at boundaries of fibrotic patches. A higher degree of fibrosis and larger patch size were associated with an increased strength of the virtual electrodes. Also, patch geometry affected the strength of the virtual electrodes. Our simulations suggest that increased fibroblast-myocyte coupling and intra-fibroblast conductivity reduce virtual electrode strength. However, experimental data to constrain these modeling parameters are limited and thus pinpointing the magnitude of the reduction will require further understanding of electrical coupling of fibroblasts in native cardiac tissues. We propose that the findings from our computational studies are important for development of patient-specific protocols for internal defibrillators.
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Affiliation(s)
- Jean Bragard
- Department of Physics and Applied Mathematics, University of Navarra, Pamplona, Spain
| | - Aparna C. Sankarankutty
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Frank B. Sachse
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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Connolly A, Kelly A, Campos FO, Myles R, Smith G, Bishop MJ. Ventricular Endocardial Tissue Geometry Affects Stimulus Threshold and Effective Refractory Period. Biophys J 2018; 115:2486-2498. [PMID: 30503533 PMCID: PMC6301915 DOI: 10.1016/j.bpj.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Understanding the biophysical processes by which electrical stimuli applied to cardiac tissue may result in local activation is important in both the experimental and clinical electrophysiology laboratory environments, as well as for gaining a more in-depth knowledge of the mechanisms of focal-trigger-induced arrhythmias. Previous computational models have predicted that local myocardial tissue architecture alone may significantly modulate tissue excitability, affecting both the local stimulus current required to excite the tissue and the local effective refractory period (ERP). In this work, we present experimental validation of this structural modulation of local tissue excitability on the endocardial tissue surface, use computational models to provide mechanistic understanding of this phenomena in relation to localized changes in electrotonic loading, and demonstrate its implications for the capture of afterdepolarizations. METHODS AND RESULTS Experiments on rabbit ventricular wedge preparations showed that endocardial ridges (surfaces of negative mean curvature) had a stimulus capture threshold that was 0.21 ± 0.03 V less than endocardial grooves (surfaces of positive mean curvature) for pairwise comparison (24% reduction, corresponding to 56.2 ± 6.4% of the energy). When stimulated at the minimal stimulus strength for capture, ridge locations showed a shorter ERP than grooves (n = 6, mean pairwise difference 7.4 ± 4.2 ms). When each site was stimulated with identical-strength stimuli, the difference in ERP was further increased (mean pairwise difference 15.8 ± 5.3 ms). Computational bidomain models of highly idealized cylindrical endocardial structures qualitatively agreed with these findings, showing that such changes in excitability are driven by structural modulation in electrotonic loading, quantifying this relationship as a function of surface curvature. Simulations further showed that capture of delayed afterdepolarizations was more likely in trabecular ridges than grooves, driven by this difference in loading. CONCLUSIONS We have demonstrated experimentally and explained mechanistically in computer simulations that the ability to capture tissue on the endocardial surface depends upon the local tissue architecture. These findings have important implications for deepening our understanding of excitability differences related to anatomical structure during stimulus application that may have important applications in the translation of novel experimental optogenetics pacing strategies. The uncovered preferential vulnerability to capture of afterdepolarizations of endocardial ridges, compared to grooves, provides important insight for understanding the mechanisms of focal-trigger-induced arrhythmias.
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Affiliation(s)
- Adam Connolly
- Department of Bioengineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Allen Kelly
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Fernando O Campos
- Department of Bioengineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Rachel Myles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Godfrey Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Martin J Bishop
- Department of Bioengineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
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10
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Buran P, Bär M, Alonso S, Niedermayer T. Control of electrical turbulence by periodic excitation of cardiac tissue. CHAOS (WOODBURY, N.Y.) 2017; 27:113110. [PMID: 29195336 DOI: 10.1063/1.5010787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Electrical turbulence in cardiac tissue is associated with arrhythmias such as life-threatening ventricular fibrillation. Recent experimental studies have shown that a sequence of low-energy electrical far-field pulses is able to terminate fibrillation more gently than a single high-energy pulse which causes severe side effects. During this low-energy antifibrillation pacing (LEAP), only tissue near sufficiently large conduction heterogeneities, such as large coronary arteries, is activated. In order to optimize LEAP, we performed extensive simulations of cardiac tissue perforated by blood vessels, employing two alternative cellular models that exhibit electrical turbulence at a similar length scale. Moreover, the scale of blood vessels in our two-dimensional simulations was chosen such that the threshold for single pulse defibrillation matches experimental values. For each of the 100 initial conditions, we tested different electrical field strengths, pulse shapes, numbers of pulses, and periods between the pulses. LEAP is successful for both models, albeit with substantial differences. One model exhibits a spectrum of chaotic activity featuring a narrow peak around a dominant frequency. In this case, the optimal period between low-energy pulses matches this frequency and LEAP greatly reduces the required energy for successful defibrillation. For pulses with larger energies, the system is perturbed such that underdrive pacing becomes advantageous. The spectrum of the second model features a broader peak, resulting in a less pronounced optimal pacing period and a decreased energy reduction. In both cases, pacing with five or six pulses which are separated by the dominant period maximizes the energy reduction.
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Affiliation(s)
- Pavel Buran
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
| | - Markus Bär
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
| | - Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Av. Dr. Marañón 44, 08028 Barcelona, Spain
| | - Thomas Niedermayer
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2-12, 10587 Berlin, Germany
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11
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Connolly A, Robson MD, Schneider J, Burton R, Plank G, Bishop MJ. Highly trabeculated structure of the human endocardium underlies asymmetrical response to low-energy monophasic shocks. CHAOS (WOODBURY, N.Y.) 2017; 27:093913. [PMID: 28964115 PMCID: PMC5570597 DOI: 10.1063/1.4999609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
Novel low-energy defibrillation therapies are thought to be driven by virtual-electrodes (VEs), due to the interaction of applied monophasic electric shocks with fine-scale anatomical structures within the heart. Significant inter-species differences in the cardiac (micro)-anatomy exist, however, particularly with respect to the degree of endocardial trabeculations, which may underlie important differences in response to low-energy defibrillation protocols. Understanding the interaction of monophasic electric fields with the specific human micro-anatomy is therefore imperative in facilitating the translation and optimisation of these promising experimental therapies to the clinic. In this study, we sought to investigate how electric fields from implanted devices interact with the highly trabeculated human endocardial surface to better understand shock success in order to help optimise future clinical protocols. A bi-ventricular human computational model was constructed from high resolution (350 μm) ex-vivo MR data, including anatomically accurate endocardial structures. Monophasic shocks were applied between a basal right ventricular catheter and an exterior ground. Shocks of varying strengths were applied with both anodal [positive right ventricle (RV) electrode] and cathodal (negative RV electrode) polarities at different states of tissue refractoriness and during induced arrhythmias. Anodal shocks induced isolated positive VEs at the distal side of "detached" trabeculations, which rapidly spread into hyperpolarised tissue on the surrounding endocardial surfaces following the shock. Anodal shocks thus depolarised more tissue 10 ms after the shock than cathodal shocks where the propagation of activation from VEs induced on the proximal side of "detached" trabeculations was prevented due to refractory endocardium. Anodal shocks increased arrhythmia complexity more than cathodal shocks during failed anti-arrhythmia shocks. In conclusion, multiple detached trabeculations in the human ventricle interact with anodal stimuli to induce multiple secondary sources from VEs, facilitating more rapid shock-induced ventricular excitation compared to cathodal shocks. Such a mechanism may help explain inter-species differences in response to shocks and help to develop novel defibrillation strategies.
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Affiliation(s)
- Adam Connolly
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Matthew D Robson
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Jürgen Schneider
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Rebecca Burton
- Pharmacology Department, University of Oxford, Oxford, United Kingdom
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Martin J Bishop
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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12
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Dynamics of spatiotemporal line defects and chaos control in complex excitable systems. Sci Rep 2017; 7:7757. [PMID: 28798384 PMCID: PMC5552747 DOI: 10.1038/s41598-017-08011-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/30/2017] [Indexed: 12/01/2022] Open
Abstract
Spatiotemporal pattern formation governs dynamics and functions in various biological systems. In the heart, excitable waves can form complex oscillatory and chaotic patterns even at an abnormally higher frequency than normal heart beats, which increase the risk of fatal heart conditions by inhibiting normal blood circulation. Previous studies suggested that line defects (nodal lines) play a critical role in stabilizing those undesirable patterns. However, it remains unknown if the line defects are static or dynamically changing structures in heart tissue. Through in vitro experiments of heart tissue observation, we reveal the spatiotemporal dynamics of line defects in rotating spiral waves. We combined a novel signaling over-sampling technique with a multi-dimensional Fourier analysis, showing that line defects can translate, merge, collapse and form stable singularities with even and odd parity while maintaining a stable oscillation of the spiral wave in the tissue. These findings provide insights into a broad class of complex periodic systems, with particular impact to the control and understanding of heart diseases.
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Ji YC, Uzelac I, Otani N, Luther S, Gilmour RF, Cherry EM, Fenton FH. Synchronization as a mechanism for low-energy anti-fibrillation pacing. Heart Rhythm 2017; 14:1254-1262. [DOI: 10.1016/j.hrthm.2017.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Indexed: 10/19/2022]
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Boccia E, Luther S, Parlitz U. Modelling far field pacing for terminating spiral waves pinned to ischaemic heterogeneities in cardiac tissue. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2016.0289. [PMID: 28507234 PMCID: PMC5434080 DOI: 10.1098/rsta.2016.0289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 05/24/2023]
Abstract
In cardiac tissue, electrical spiral waves pinned to a heterogeneity can be unpinned (and eventually terminated) using electric far field pulses and recruiting the heterogeneity as a virtual electrode. While for isotropic media the process of unpinning is much better understood, the case of an anisotropic substrate with different conductivities in different directions still needs intensive investigation. To study the impact of anisotropy on the unpinning process, we present numerical simulations based on the bidomain formulation of the phase I of the Luo and Rudy action potential model modified due to the occurrence of acute myocardial ischaemia. Simulating a rotating spiral wave pinned to an ischaemic heterogeneity, we compare the success of sequences of far field pulses in the isotropic and the anisotropic case for spirals still in transient or in steady rotation states. Our results clearly indicate that the range of pacing parameters resulting in successful termination of pinned spiral waves is larger in anisotropic tissue than in an isotropic medium.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.
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Affiliation(s)
- E Boccia
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
| | - S Luther
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
- Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Friedrich-Hund-Platz 1, 37077 Göttingen, Germany
- Institute of Pharmacology and Toxicology, University Medical Center, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
- Department of Bioengineering, Northeastern University, 360 Huntington Avenue, Boston MA 02115, USA
- Department of Physics, Northeastern University, 360 Huntington Avenue, Boston MA 02115, USA
| | - U Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany
- Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Friedrich-Hund-Platz 1, 37077 Göttingen, Germany
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Connolly AJ, Vigmond E, Bishop MJ. Bidomain Predictions of Virtual Electrode-Induced Make and Break Excitations around Blood Vessels. Front Bioeng Biotechnol 2017; 5:18. [PMID: 28396856 PMCID: PMC5366349 DOI: 10.3389/fbioe.2017.00018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/02/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction and background Virtual electrodes formed by field stimulation during defibrillation of cardiac tissue play an important role in eliciting activations. It has been suggested that the coronary vasculature is an important source of virtual electrodes, especially during low-energy defibrillation. This work aims to further the understanding of how virtual electrodes from the coronary vasculature influence defibrillation outcomes. Methods Using the bidomain model, we investigated how field stimulation elicited activations from virtual electrodes around idealized intramural blood vessels. Strength–interval curves, which quantify the stimulus strength required to elicit wavefront propagation from the vessels at different states of tissue refractoriness, were computed for each idealized geometry. Results Make excitations occurred at late diastolic intervals, originating from regions of depolarization around the vessel. Break excitations occurred at early diastolic intervals, whereby the vessels were able to excite surrounding refractory tissue due to the local restoration of excitability by virtual electrode-induced hyperpolarizations. Overall, strength–interval curves had similar morphologies and underlying excitation mechanisms compared with previous experimental and numerical unipolar stimulation studies of cardiac tissue. Including the presence of the vessel wall increased the field strength required for make excitations but decreased the field strength required for break excitations, and the field strength at which break excitations occurred was generally greater than 5 V/cm. Finally, in a more realistic ventricular slice geometry, the proximity of virtual electrodes around subepicardial vessels was seen to cause break excitations in the form of propagating unstable wavelets to the subepicardial layer. Conclusion Representing the blood vessel wall microstructure in computational bidomain models of defibrillation is recommended as it significantly alters the electrophysiological response of the vessel to field stimulation. Although vessels may facilitate excitation of relatively refractory tissue via break excitations, the field strength required for this is generally greater than those used in the literature on low-energy defibrillation. However, the high-intensity shocks used in standard defibrillation may elicit break excitation propagation from the coronary vasculature.
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Affiliation(s)
- Adam J Connolly
- Department of Biomedical Engineering and Imaging Sciences, King's College London , London , UK
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Instituté, Fondation Bordeaux Université, Bordeaux, France; IMB, UMR 5251, Univ. Bordeaux, Talence, France
| | - Martin J Bishop
- Department of Biomedical Engineering and Imaging Sciences, King's College London , London , UK
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Connolly A, Vigmond E, Bishop M. Virtual electrodes around anatomical structures and their roles in defibrillation. PLoS One 2017; 12:e0173324. [PMID: 28253365 PMCID: PMC5333918 DOI: 10.1371/journal.pone.0173324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/17/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Virtual electrodes from structural/conductivity heterogeneities are known to elicit wavefront propagation, upon field-stimulation, and are thought to be important for defibrillation. In this work we investigate how the constitutive and geometrical parameters associated with such anatomical heterogeneities, represented by endo/epicardial surfaces and intramural surfaces in the form of blood-vessels, affect the virtual electrode patterns produced. METHODS AND RESULTS The steady-state bidomain model is used to obtain, using analytical and numerical methods, the virtual electrode patterns created around idealized endocardial trabeculations and blood-vessels. The virtual electrode pattern around blood-vessels is shown to be composed of two dominant effects; current traversing the vessel surface and conductivity heterogeneity from the fibre-architecture. The relative magnitudes of these two effects explain the swapping of the virtual electrode polarity observed, as a function of the vessel radius, and aid in the understanding of the virtual electrode patterns predicted by numerical bidomain modelling. The relatively high conductivity of blood, compared to myocardium, is shown to cause stronger depolarizations in the endocardial trabeculae grooves than the protrusions. CONCLUSIONS The results provide additional quantitative understanding of the virtual electrodes produced by small-scale ventricular anatomy, and highlight the importance of faithfully representing the physiology and the physics in the context of computational modelling of field stimulation.
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Affiliation(s)
- Adam Connolly
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Instituté, fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
- Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Martin Bishop
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St. Thomas’ Hospital, London, United Kingdom
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Feng X, Gao X, Tang JM, Pan JT, Zhang H. Wave trains induced by circularly polarized electric fields in cardiac tissues. Sci Rep 2015; 5:13349. [PMID: 26302781 PMCID: PMC4548189 DOI: 10.1038/srep13349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/22/2015] [Indexed: 11/28/2022] Open
Abstract
Clinically, cardiac fibrillation caused by spiral and turbulent waves can be terminated by globally resetting electric activity in cardiac tissues with a single high-voltage electric shock, but it is usually associated with severe side effects. Presently, a promising alternative uses wave emission from heterogeneities induced by a sequence of low-voltage uniform electric field pulses. Nevertheless, this method can only emit waves locally near obstacles in turbulent waves and thereby requires multiple obstacles to globally synchronize myocardium and thus to terminate fibrillation. Here we propose a new approach using wave emission from heterogeneities induced by a low-voltage circularly polarized electric field (i.e., a rotating uniform electric field). We find that, this approach can generate circular wave trains near obstacles and they propagate outwardly. We study the characteristics of such circular wave trains and further find that, the higher-frequency circular wave trains can effectively suppress spiral turbulence.
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Affiliation(s)
- Xia Feng
- Zhejiang Institute of Modern Physics and Department of Physics, Zhejiang University, Hangzhou 310027, China
| | - Xiang Gao
- Zhejiang Institute of Modern Physics and Department of Physics, Zhejiang University, Hangzhou 310027, China.,School of Physics and Information Technology, Shaanxi Normal University, Xi'an 710062, China
| | - Juan-Mei Tang
- Zhejiang Institute of Modern Physics and Department of Physics, Zhejiang University, Hangzhou 310027, China
| | - Jun-Ting Pan
- Institute of Physical Oceanography and Ocean College, Zhejiang University, Hangzhou 310058, China
| | - Hong Zhang
- Zhejiang Institute of Modern Physics and Department of Physics, Zhejiang University, Hangzhou 310027, China
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Quail T, Shrier A, Glass L. Spatial symmetry breaking determines spiral wave chirality. PHYSICAL REVIEW LETTERS 2014; 113:158101. [PMID: 25375745 DOI: 10.1103/physrevlett.113.158101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 05/27/2023]
Abstract
Chirality represents a fundamental property of spiral waves. Introducing obstacles into cardiac monolayers leads to the initiation of clockwise-rotating, counterclockwise-rotating, and pairs of spiral waves. Simulations show that the precise location of the obstacle and the pacing frequency determine spiral wave chirality. Instabilities predicted by curves relating the action potential duration and the pacing frequency at different spatial locations predict sites of wave break initiation and, hence, spiral wave chirality.
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Affiliation(s)
- Thomas Quail
- Department of Physiology, McGill University, Montreal, Canada H3G 1Y6
| | - Alvin Shrier
- Department of Physiology, McGill University, Montreal, Canada H3G 1Y6
| | - Leon Glass
- Department of Physiology, McGill University, Montreal, Canada H3G 1Y6
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Unpinning of rotating spiral waves in cardiac tissues by circularly polarized electric fields. Sci Rep 2014; 4:4831. [PMID: 24777360 PMCID: PMC4003477 DOI: 10.1038/srep04831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/10/2014] [Indexed: 12/05/2022] Open
Abstract
Spiral waves anchored to obstacles in cardiac tissues may cause lethal arrhythmia. To unpin these anchored spirals, comparing to high-voltage side-effect traditional therapies, wave emission from heterogeneities (WEH) induced by the uniform electric field (UEF) has provided a low-voltage alternative. Here we provide a new approach using WEH induced by the circularly polarized electric field (CPEF), which has higher success rate and larger application scope than UEF, even with a lower voltage. And we also study the distribution of the membrane potential near an obstacle induced by CPEF to analyze its mechanism of unpinning. We hope this promising approach may provide a better alternative to terminate arrhythmia.
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Zhao YH, Lou Q, Chen JX, Sun WG, Ma J, Ying HP. Emitting waves from heterogeneity by a rotating electric field. CHAOS (WOODBURY, N.Y.) 2013; 23:033141. [PMID: 24089977 DOI: 10.1063/1.4822417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In a generic model of excitable media, we simulate wave emission from a heterogeneity (WEH) induced by an electric field. Based on the WEH effect, a rotating electric field is proposed to terminate existed spatiotemporal turbulence. Compared with the effects resulted by a periodic pulsed electric field, the rotating electric field displays several improvements, such as lower required intensity, emitting waves on smaller obstacles, and shorter suppression time. Furthermore, due to rotation of the electric field, it can automatically source waves from the boundary of an obstacle with small curvature.
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Affiliation(s)
- Ye-Hua Zhao
- Department of Physics, Hangzhou Dianzi University, Hangzhou 310018, China
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