Optical measurements of transmembrane potential changes during electric field stimulation of ventricular cells

Calculating transmembrane voltage on the electric pulse-affected cancerous cell membrane: using molecular dynamics and finite element simulations

CONTEXT

Electroporation is a technique that creates electrically generated pores in the cell membrane by modifying transmembrane potential. In this work, the finite element method (FEM) was used to examine the induced transmembrane voltage (ITV) of a spherical-shaped MCF-7 cell, allowing researchers to determine the stationary ITV. A greater ITV than the critical value causes permeabilization of the membrane. Furthermore, the present study shows how a specific surface conductivity can act as a stand-in for the thin layer that constitutes a cell membrane as the barrier between extracellular and intracellular environments. Additionally, the distribution of ITV on the cell membrane and its maximum value were experimentally evaluated for a range of applied electric fields. Consequently, the entire cell surface area was electroporated 66% and 68% for molecular dynamics (MD) simulations and FEM, respectively, when the external electric field of 1500 V/cm was applied to the cell suspension using the previously indicated numerical methods. Furthermore, the lipid bilayers' molecular structure was changed, which led to the development of hydrophilic holes with a radius of 1.33 nm. Applying MD and FEM yielded threshold values for transmembrane voltage of 700 and 739 mV, respectively.

METHOD

Using MD simulations of palmitoyloleoyl-phosphatidylcholine (POPC), pores in cell membranes exposed to external electric fields were numerically investigated. The dependence on the electric field was estimated and developed, and the amount of the electroporated cell surface area matches the applied external electric field. To investigate more, a mathematical model based on an adaptive neuro-fuzzy inference system (ANFIS) is employed to predict the percent cell viability of cancerous cells after applying four pulses during electroporation. For MD simulations, ArgusLab, VMD, and GROMACS software packages were used. Moreover, for FEM analysis, COMSOL software package was used. Also, it is worth mentioning that for mathematical model, MATLAB software is used.

Noisy stimulation effect in calcium dynamics on cardiac cells

Noise is present in nature, and it affects the nervous and cardiovascular system. Noise added to stimuli may change the performance of excitable cells. In this paper, we study the effect of noise on the two main heart cell types: pacemaker and myocardial cells. This study investigates whether noise can induce changes in calcium dynamics on the two main heart cell types: pacemaker and myocardial cells, when stimuli with periodic electrical signals are disturbed by Gaussian white noise. Calcium dynamic parameters were obtained using imaging signals. Our results show that low intensities of noise favor amplitude and raise rate calcium dynamics, although our results show that the pacemaker cells are not affected by a noisy stimulus. Altogether, these findings suggest that noise plays a key role in calcium dynamics.

Fluorescent, Bioluminescent, and Optogenetic Approaches to Study Excitable Physiology in the Single Cardiomyocyte

This review briefly summarizes the single cell application of classical chemical dyes used to visualize cardiomyocyte physiology and their undesirable toxicities which have the potential to confound experimental observations. We will discuss, in detail, the more recent iterative development of fluorescent and bioluminescent protein-based indicators and their emerging application to cardiomyocytes. We will discuss the integration of optical control strategies (optogenetics) to augment the standard imaging approach. This will be done in the context of potential applications, and barriers, of these technologies to disease modelling, drug toxicity, and drug discovery efforts at the single-cell scale.

Optical Imaging of Cardiac Action Potential

This chapter reviews the major milestones and scientific achievements facilitated by optical imaging of the action potential in the heart over more than four decades since its introduction. We discuss the limitations of this technique, which sometimes are not fully recognized; the unresolved issues, such as motion artifacts, and the newest developments and future directions.

Imaging of Ventricular Fibrillation and Defibrillation: The Virtual Electrode Hypothesis

Ventricular fibrillation is the major underlying cause of sudden cardiac death. Understanding the complex activation patterns that give rise to ventricular fibrillation requires high resolution mapping of localized activation. The use of multi-electrode mapping unraveled re-entrant activation patterns that underlie ventricular fibrillation. However, optical mapping contributed critically to understanding the mechanism of defibrillation, where multi-electrode recordings could not measure activation patterns during and immediately after a shock. In addition, optical mapping visualizes the virtual electrodes that are generated during stimulation and defibrillation pulses, which contributed to the formulation of the virtual electrode hypothesis. The generation of virtual electrode induced phase singularities during defibrillation is arrhythmogenic and may lead to the induction of fibrillation subsequent to defibrillation. Defibrillating with low energy may circumvent this problem. Therefore, the current challenge is to use the knowledge provided by optical mapping to develop a low energy approach of defibrillation, which may lead to more successful defibrillation.

Plasma membrane charging of Jurkat cells by nanosecond pulsed electric fields

The initial effect of nanosecond pulsed electric fields (nsPEFs) on cells is a change of charge distributions along membranes. This first response is observed as a sudden shift in the plasma transmembrane potential that is faster than can be attributed to any physiological event. These immediate, yet transient, effects are only measurable if the diagnostic is faster than the exposure, i.e., on a nanosecond time scale. In this study, we monitored changes in the plasma transmembrane potential of Jurkat cells exposed to nsPEFs of 60 ns and amplitudes from 5 to 90 kV/cm with a temporal resolution of 5 ns by means of the fast voltage-sensitive dye Annine-6. The measurements suggest the contribution of both dipole effects and asymmetric conduction currents across opposite sides of the cell to the charging. With the application of higher field strengths the membrane charges until a threshold voltage value of 1.4-1.6 V is attained at the anodic pole. This indicates when the ion exchange rates exceed charging currents, thus providing strong evidence for pore formation. Prior to reaching this threshold, the time for the charging of the membrane by conductive currents is qualitatively in agreement with accepted models of membrane charging, which predict longer charging times for lower field strengths. The comparison of the data with previous studies suggests that the sub-physiological induced ionic imbalances may trigger other intracellular signaling events leading to dramatic outcomes, such as apoptosis.

Mechanisms of defibrillation

Electrical shock has been the one effective treatment for ventricular fibrillation for several decades. With the advancement of electrical and optical mapping techniques, histology, and computer modeling, the mechanisms responsible for defibrillation are now coming to light. In this review, we discuss recent work that demonstrates the various mechanisms responsible for defibrillation. On the cellular level, membrane depolarization and electroporation affect defibrillation outcome. Cell bundles and collagenous septae are secondary sources and cause virtual electrodes at sites far from shocking electrodes. On the whole-heart level, shock field gradient and critical points determine whether a shock is successful or whether reentry causes initiation and continuation of fibrillation.

Screening technologies for ion channel drug discovery

For every movement, heartbeat and thought, ion channels need to open and close. It is therefore not surprising that their malfunctioning leads to serious diseases. Currently, only approximately 10% of drugs, with a market value in excess of US$10 billion, act on ion channels. The systematic exploitation of this target class has started, enabled by novel assay technologies and fundamental advances of the structural and mechanistic understanding of channel function. The latter, which was rewarded with the Nobel Prize in 2003, has opened up an avenue for rational drug design. In this review we provide an overview of the current repertoire of screening technologies that has evolved to drive ion channel-targeted drug discovery towards new medicines of the future.

The effects of phase duration on defibrillation success of dual time constant biphasic waveforms

AIM OF STUDY

The effects of first and second phase duration of biphasic waveforms on defibrillation success were evaluated in a guinea pig model of ventricular fibrillation (VF). We hypothesized that waveform duration, and especially the first phase duration, played a main role on defibrillation efficacy in comparison to energy, current and voltage, when a dual time constant biphasic shock was employed.

METHODS

VF was induced and untreated for 5s in 30 male guinea pigs, prior to attempting a single defibrillatory shock with one of 5 defibrillation waveforms which had different durations of the first and second phase. A five step up-down protocol was utilized for determining the defibrillation efficacy. After a 3-min interval, the procedure was repeated. A total of 25 cardiac arrest events and defibrillations were investigated for each animal.

RESULTS

The defibrillation waveforms with an intermediate first phase of 5 ms, yielded the highest defibrillation success (p<0.05). These waveforms also presented significantly lower energy, current and voltage in comparison to waveforms with shorter or longer first phase durations (p<0.001). However, no differences on defibrillation success were observed among waveforms with different second phase durations varying from 1.5 ms to 3.5 ms.

CONCLUSIONS

For dual time constant biphasic waveforms, the first phase duration played a main role on defibrillation success. The intermediate first phase duration of 5 ms, yielded the best defibrillation efficacy compared with shorter or longer first phase durations. While the second phase duration did not affect defibrillation outcomes.

Lethal effect of electric fields on isolated ventricular myocytes

Defibrillator-type shocks may cause electric and contractile dysfunction. In this study, we determined the relationship between probability of lethal injury and electric field intensity (E in isolated rat ventricular myocytes, with emphasis on field orientation and stimulus waveform. This relationship was sigmoidal with irreversible injury for E > 50 V/cm . During both threshold and lethal stimulation, cells were twofold more sensitive to the field when it was applied longitudinally (versus transversally) to the cell major axis. For a given E, the estimated maximum variation of transmembrane potential (Delta V(max)) was greater for longitudinal stimuli, which might account for the greater sensitivity to the field. Cell death, however, occurred at lower maximum Delta V(max) values for transversal shocks. This might be explained by a less steep spatial decay of transmembrane potential predicted for transversal stimulation, which would possibly result in occurrence of electroporation in a larger membrane area. For the same stimulus duration, cells were less sensitive to field-induced injury when shocks were biphasic (versus monophasic). Ours results indicate that, although significant myocyte death may occur in the E range expected during clinical defibrillation, biphasic shocks are less likely to produce irreversible cell injury.

Uniform action potential repolarization within the sarcolemma of in situ ventricular cardiomyocytes

Previous studies have speculated, based on indirect evidence, that the action potential at the transverse (t)-tubules is longer than at the surface membrane in mammalian ventricular cardiomyocytes. To date, no technique has enabled recording of electrical activity selectively at the t-tubules to directly examine this hypothesis. We used confocal line-scan imaging in conjunction with the fast response voltage-sensitive dyes ANNINE-6 and ANNINE-6plus to resolve action potential-related changes in fractional dye fluorescence (DeltaF/F) at the t-tubule and surface membranes of in situ mouse ventricular cardiomyocytes. Peak DeltaF/F during action potential phase 0 depolarization averaged -21% for both dyes. The shape and time course of optical action potentials measured with the water-soluble ANNINE-6plus were indistinguishable from those of action potentials recorded with intracellular microelectrodes in the absence of the dye. In contrast, optical action potentials measured with the water-insoluble ANNINE-6 were significantly prolonged compared to the electrical recordings obtained from dye-free hearts, suggesting electrophysiological effects of ANNINE-6 and/or its solvents. With either dye, the kinetics of action potential-dependent changes in DeltaF/F during repolarization were found to be similar at the t-tubular and surface membranes. This study provides what to our knowledge are the first direct measurements of t-tubule electrical activity in ventricular cardiomyocytes, which support the concept that action potential duration is uniform throughout the sarcolemma of individual cells.

Membrane time constant during internal defibrillation strength shocks in intact heart: effects of Na+ and Ca2+ channel blockers

INTRODUCTION

We assessed defibrillation strength shock-induced changes of the membrane time constant (tau) and membrane potential (DeltaVm) in intact rabbit hearts after administration of lidocaine, a sodium (Na(+)) channel blocker, or nifedipine, a L-type calcium (Ca(2+)) channel blocker.

METHODS AND RESULTS

We optically mapped anterior, epicardial, electrical activity during monophasic shocks (+/-100, +/-130, +/-160, +/-190, and +/-220 V; 150 microF; 8 ms) applied at 25%, 50%, and 75% of the action potential duration via a shock lead system in Langendorff-perfused hearts. The protocol was run twice for each heart under control and after lidocaine (15 microM, n = 6) or nifedipine (2 microM, n = 6) addition. tau in the virtual electrode area away from the shock lead was approximated with single-exponential fits from a total of 121,125 recordings. The same data set was used to calculate DeltaVm. We found (1) Under all conditions, there is inverse relationship between tau and DeltaVm with respect to changes of shock strength, regardless of shock polarity and phase of application: a stronger shock resulted in a larger DeltaVm, which corresponded to a smaller tau (faster cellular response); (2) Lidocaine did not cause appreciable changes in either tau or DeltaVm versus control, and (3) Nifedipine significantly increased both tau and DeltaVm in the virtual cathode area; in contrast, in the virtual anode area, this effect depended on the phase of shock application.

CONCLUSION

tau and DeltaVm are inversely related. Na(+) channel blocker has minimal impact on either tau or DeltaVm. Ca(2+) blocker caused polarity and phase-dependent significant changes in tau and DeltaVm.

A comparison of chronaxies for ventricular fibrillation induction, defibrillation, and cardiac stimulation: unexpected findings and their implications

INTRODUCTION

A low-energy (<or= 4 J) cardioversion shock (LEC) either terminates reentrant ventricular tachycardia (VT) or accelerates it to ventricular fibrillation (VF). Optimization of the duration and amplitude of LEC shocks could improve the success rate of VT termination without VF induction.

METHODS AND RESULTS

In order to learn how LEC shocks may be optimized, we used an animal model to compare the strength-duration curve for VF induction and the strength-duration curve for cardiac stimulation via the shock coil. Conventional implantable cardioverter-defibrillator (ICD) leads were implanted in 12 narcotized pigs from 20 kg to 25 kg in weight. Stimulation, VF induction, and defibrillation pulses were delivered by custom-designed stimulators at preset pulse durations and amplitudes. The corresponding hyperbolic strength-duration curves were constructed using the least-squares fit method and averaged for all the animals. The mean chronaxie for stimulation via the shock coil of 0.23 ms was significantly shorter than both defibrillation (4.8 ms) and VF induction (3.1 ms) chronaxie values. At a shock duration of 0.3 ms or less, the mean VF-induction threshold amplitude exceeded 300 V.

CONCLUSION

It may be reasonable to study whether LEC pulses from 0.25 ms to 0.30 ms in duration and up to 250 V in amplitude would increase therapeutic yield in VT termination without VF induction in humans. Contrary to the current belief, the discrepancy between defibrillation and stimulation chronaxie is not caused by different electrode size. We postulate that the time constant of the fast sodium channel reactivation may be the underlying reason.

Effect of electroporation on cardiac electrophysiology

Defibrillation shocks are commonly used to terminate life-threatening arrhythmias. According to the excitation theory of defibrillation, such shocks are aimed at depolarizing the membranes of most cardiac cells, resulting in resynchronization of electrical activity in the heart. If shock-induced transmembrane potentials are large enough, they can cause transient tissue damage due to electroporation. In this review, evidence is presented that electroporation of the heart tissue can occur during clinically relevant intensities of the external electrical field and that electroporation can affect the outcome of defibrillation therapy, being both pro- and antiarrhythmic.Here, we present experimental evidence for electroporation in cardiac tissue, which occurs above a threshold of 25 V/cm as evident from propidium iodide uptake, transient diastolic depolarization, and reductions of action potential amplitude and its derivative. These electrophysiological changes can induce tachyarrhythmia, due to conduction block and possibly triggered activity; however, our findings provide the foundation for future design of effective methods to deliver genes and drugs to cardiac tissues, while avoiding possible side effects such as arrhythmia and mechanical stunning.

Comparison of optical and electrical mapping of fibrillation

Optical recordings with transmembrane potential (Vm)-sensitive fluorescent dye, or extracellular potential (Ve) recordings are used to map spatiotemporal patterns of cardiac excitation during ventricular fibrillation (VF). While the optical and electrical methods are accepted, there has not been a test of whether they yield equivalent excitation times during VF. Times may differ since previous results indicate optical Vm interrogates deeper than Ve. We tested whether the steepest parts of the downward deflection of the Ve and upward deflection of optical Vm are synchronized during VF. We used simultaneous coepicentral optical and electrical mapping (32 spots, 4 kHz) with translucent indium tin oxide electrodes and a laser scanner on ventricular epicardium. VF was electrically induced in arterially-perfused rabbit hearts stained with di-4-ANEPPS. For both the optical and electrical deflections, maximum magnitudes of the slopes varied over a > 4 fold range, morphologies varied and spatiotemporal distributions were nonuniform. Time differences between the steepest parts of the optical and electrical deflections were typically a few ms. Standard deviations of time differences increased for the deflections that had the smaller slopes, which was only partly due to effects of recording noise as indicated by simulations. For deflections that had slopes ranging from the steepest found at each spot to 1/4 of the steepest, the optical deflections were on average 0.7-1 ms earlier than the Ve deflections. Thus, excitation times during VF measured optically and electrically differ. Considered together with our earlier results indicating that the optical Vm interrogates deeper than Ve, the results suggest that most fibrillatory excitations occur earlier in subsurface tissue than at the heart surface.

Combining stimulus direction and waveform for optimization of threshold stimulation of isolated ventricular myocytes

Electric field stimulation is widely used for heart pacing and arrhythmia reversion. In this study, we analysed the influence of waveform and direction of external stimulating electric field on the excitation threshold of isolated ventricular myocytes. The threshold field (E(T)) was lower when the field was applied longitudinally (E(T,L)) rather than transversally (E(T,T)) to the cell major axis. Rheobase was greater for transversal stimulation, but chronaxie and estimated membrane polarization were similar for both directions. The calculated maximal variation in membrane potential at the threshold (DeltaV(T) approximately 15 mV) was insensitive to field direction. As DeltaV(T) values were similar, we assumed that the E(T,T)/E(T,L) ratio might be described solely as the ratio of the major and minor cell semi-axes. Accordingly, the ratio thus estimated was comparable to that determined experimentally. Stimulus waveform significantly affected both E(T) and DeltaV(T), which were greater for monophasic versus biphasic stimuli. Direction and waveform effects were independent. We conclude that (a) direction affects E(T) by its influence on the ability of a given field intensity to cause threshold membrane polarization and (b) threshold-lowering effects of longitudinal stimulation and biphasic waveforms apparently depend on different mechanisms, are additive and thus may be combined to decrease the energy requirement for myocardial stimulation.

Numerical Determination of Transmembrane Voltage Induced on Irregularly Shaped Cells

The paper presents an approach that reduces several difficulties related to the determination of induced transmembrane voltage (ITV) on irregularly shaped cells. We first describe a method for constructing realistic models of irregularly shaped cells based on microscopic imaging. This provides a possibility to determine the ITV on the same cells on which an experiment is carried out, and can be of considerable importance in understanding and interpretation of the data. We also show how the finite-thickness, nonzero-conductivity membrane can be replaced by a boundary condition in which a specific surface conductivity is assigned to the interface between the cell interior (the cytoplasm) and the exterior. We verify the results obtained using this method by a comparison with the analytical solution for an isolated spherical cell and a tilted oblate spheroidal cell, obtaining a very good agreement in both cases. In addition, we compare the ITV computed for a model of two irregularly shaped CHO cells with the ITV measured on the same two cells by means of a potentiometric fluorescent dye, and also with the ITV computed for a simplified model of these two cells.

Electroporation of the heart

Defibrillation shocks are commonly used to terminate life-threatening arrhythmias. According to the excitation theory of defibrillation, such shocks are aimed at depolarizing the membranes of most cardiac cells resulting in resynchronization of electrical activity in the heart. If shock-induced changes in transmembrane potential are large enough, they can cause transient tissue damage due to electroporation. In this review evidence is presented that (a) electroporation of the heart tissue can occur during clinically relevant intensities of the external electrical field, and (b) electroporation can affect the outcome of defibrillation therapy; being both pro- and anti-arrhythmic.

Artifactual contractions triggered by field stimulation of cardiomyocytes

Although cell shortening in patch-clamped cells (current-clamp mode) is triggered by an ordinary action potential, the trigger mechanism in field-stimulated cells is not so obvious. The contraction characteristics of the two methods differ, and we, therefore, examined the triggering sequence in field-stimulated cells. Isolated rat cardiomyocytes were plated on laminin-coated coverslips that were mounted on an inverted light microscope and superfused with HEPES-Tyrode buffer (pH 7.4; 37°C). The cells were stimulated to contract either by a 0.5-ms current injection (CC cells) through high-resistance electrodes or a 5-ms biphasic field-stimulation pulse (FS cells), and drugs were added to block sarcolemmal proteins involved in excitation-contraction coupling. Time to peak contraction (TTP) was significantly longer in FS cells and was not affected by the polarity or the length of the stimulus pulse. Tetrodotoxin (TTX; 20 μM) blocked cell shortening in CC cells but not in FS cells. Ni2+ (5 mM) blocked cell shortening in FS cells, whereas KB-R7943 (KB; 5 μM) had no effect either on cell shortening or TTP. In FS cells, nifedipine (Nif; 100 μM) and Cd2+ (300 μM) reduced fractional shortening by 34 and 63%, respectively, but only Cd2+ affected TTP (reduced by 48%). A combination of Nif and KB reduced cell shortening by 50%, whereas a combination of Cd2+ and KB almost abolished cell shortening. We conclude that field stimulation per se prolongs TTP and that cell shortening in FS cells is not dependent on Na+ current but is triggered by a combination of L-type Ca2+ current and reverse mode Na+/Ca2+ exchange.

Asymmetry in membrane responses to electric shocks: insights from bidomain simulations

Models of myocardial membrane dynamics have not been able to reproduce the experimentally observed negative bias in the asymmetry of transmembrane potential changes (DeltaVm) induced by strong electric shocks delivered during the action potential plateau. The goal of this study is to determine what membrane model modifications can bridge this gap between simulation and experiment. We conducted simulations of shocks in bidomain fibers and sheets with membrane dynamics represented by the LRd'2000 model. We found that in the fiber, the negative bias in DeltaVm asymmetry could not be reproduced by addition of electroporation only, but by further addition of hypothetical outward current, Ia, activated upon strong shock-induced depolarization. Furthermore, the experimentally observed rectangularly shaped positive DeltaVm, negative-to-positive DeltaVm ratio (asymmetry ratio) = approximately 2, electroporation occurring at the anode only, and the increase in positive DeltaVm caused by L-type Ca2+-channel blockade were reproduced in the strand only if Ia was assumed to be a part of K+ flow through the L-type Ca2+-channel. In the sheet, Ia not only contributed to the negative bias in DeltaVm asymmetry at sites polarized by physical and virtual electrodes, but also restricted positive DeltaVm. Inclusion of Ia and electroporation is thus the bridge between experiment and simulation.

Examination of optical depth effects on fluorescence imaging of cardiac propagation

Optical mapping with voltage-sensitive dyes provides a high-resolution technique to observe cardiac electrodynamic behavior. Although most studies assume that the fluorescent signal is emitted from the surface layer of cells, the effects of signal attenuation with depth on signal interpretation are still unclear. This simulation study examines the effects of a depth-weighted signal on epicardial activation patterns and filament localization. We simulated filament behavior using a detailed cardiac model, and compared the signal obtained from the top (epicardial) layer of the spatial domain with the calculated weighted signal. General observations included a prolongation of the action upstroke duration, early upstroke initiation, and reduction in signal amplitude in the weighted signal. A shallow filament was found to produce a dual-humped action potential morphology consistent with previously reported observations. Simulated scroll wave breakup exhibited effects such as the false appearance of graded potentials, apparent supramaximal conduction velocities, and a spatially blurred signal with the local amplitude dependent upon the immediate subepicardial activity; the combination of these effects produced a corresponding change in the accuracy of filament localization. Our results indicate that the depth-dependent optical signal has significant consequences on the interpretation of epicardial activation dynamics.

Effects of electroporation on optically recorded transmembrane potential responses to high-intensity electrical shocks

The outcome of defibrillation shocks is determined by the nonlinear transmembrane potential (Δ Vm) response induced by a strong external electrical field in cardiac cells. We investigated the contribution of electroporation to Δ Vm transients during high-intensity shocks using optical mapping. Rectangular and ramp stimuli (10–20 ms) of different polarities and intensities were applied to the rabbit heart epicardium during the plateau phase of the action potential (AP). Δ Vm were optically recorded under a custom 6-mm-diameter electrode using a voltage-sensitive dye. A gradual increase of cathodal and well as anodal stimulus strength was associated with 1) saturation and subsequent reduction of Δ Vm; 2) postshock diastolic resting potential (RP) elevation; and 3) postshock AP amplitude (APA) reduction. Weak stimuli induced a monotonic Δ Vm response and did not affect the RP level. Strong shocks produced a nonmonotonic Δ Vm response and caused RP elevation and a reduction of postshock APA. The maximum positive and maximum negative Δ Vm were recorded at 170 ± 20 mA/cm2 for cathodal stimuli and at 240 ± 30 mA/cm2 for anodal stimuli, respectively (means ± SE, n = 8, P = 0.003). RP elevation reached 10% of APA at a stimulus strength of 320 ± 40 mA/cm2 for both polarities. Strong ramp stimuli (20 ms, 600 mA/cm2) induced a nonmonotonic Δ Vm response, reaching the same largest positive and negative values as for rectangular shocks. The transition from monotonic to nonmonotonic morphology correlates with RP elevation and APA reduction, which is consistent with cell membrane electroporation. Strong shocks resulted in propidium iodide uptake, suggesting sarcolemma electroporation. In conclusion, electroporation is a likely explanation of the saturation and nonmonotonic nature of cellular responses reported for strong electric stimuli.

Stimulation of single isolated adult ventricular myocytes within a low volume using a planar microelectrode array

Microchannels (40- microm wide, 10- microm high, 10-mm long, 70- microm pitch) were patterned in the silicone elastomer, polydimethylsiloxane on a microscope coverslip base. Integrated within each microchamber were individually addressable stimulation electrodes (40- microm wide, 20- microm long, 100-nm thick) and a common central pseudo-reference electrode (60- microm wide, 500- microm long, 100-nm thick). Isolated rabbit ventricular myocytes were introduced into the chamber by micropipetting and subsequently capped with a layer of mineral oil, thus creating limited volumes of saline around individual myocytes that could be varied from 5 nL to 100 pL. Excitation contraction coupling was studied by monitoring myocyte shortening and intracellular Ca(2+) transients (using Fluo-3 fluorescence). The amplitude of stimulated myocyte shortening and Ca(2+) transients remained constant for 90 min in the larger volume (5 nL) configuration, although the shortening (but not the Ca(2+) transient) amplitude gradually decreased to 20% of control within 60 min in the low volume (100 pL) arrangement. These studies indicate a lower limit for the extracellular volume required to stimulate isolated adult cardiac myocytes. Whereas this arrangement could be used to create a screening assay for drugs, individual microchannels (100 pL) can also be used to study the effects of limited extracellular volume on the contractility of single cardiac myocytes.

Spatial localization of cardiac optical mapping with multiphoton excitation

Depth and radius of regions interrogated by cardiac optical mapping with a laser beam depend on photon travel inside the heart. It would be useful to limit the range of depth and radius interrogated. We modeled the effects of a condensing lens to concentrate laser light at a target depth inside the heart, and near infrared excitation to increase penetration and produce two-photon absorption. A Monte Carlo simulation that incorporated a 0.55-NA lens, and absorption and scattering of 1064- or 488-nm laser light in 3-D cardiac tissue indicated the distribution of excitation fluence inside the tissue. A subsequent simulation incorporating absorption and scattering of transmembrane voltage-sensitive fluorescence (wavelength 669 nm) indicated locations from which fluorescence photons exiting the tissue surface originated. The results indicate that mapping at depths up to 300 microm in hearts can provide significant improvement in localization over existing cardiac optical mapping. The estimated interrogation region is sufficiently small to examine cardiac events at a cellular or subcellular scale and may allow mapping at various depths in the heart.

Decomposition of field-induced transmembrane potential responses of single cardiac cells

In this study, we used a multi-site optical mapping system to record field-induced responses of single cells isolated from guinea pig hearts. The cells were stained with voltage sensitive dye di-8-ANEPPS and stimulated with two uniform field (S1-S2) pulses along their longitudinal axes. The first pulse (S1 = 5 ms, <10 V/cm) was applied during rest and elicited an action potential. The second pulse (S2 = 10 ms, 4-50 V/cm) was applied 15 ms after the break of the S1 pulse (during the action potential plateau). The transmembrane potential responses, Vm(F)s, were optically recorded from up to 12 sites along the cell length using a fiber optic based optical mapping system at a resolution of 17 or 25 microm. The field-induced Vm(F)s had a complex spatio-temporal pattern. We show that these responses can be decomposed into simpler components. The first component, termed the differential-mode component (Vmd(F)), is like the response of a passive cell. The second component, termed the common-mode component (Vmc(F)), is identical all along the cell and adds a constant offset to the differential mode response of various sites along the cell length, to produce the total Vm(F) responses of the cell.

Spatial heterogeneity of transmembrane potential responses of single guinea-pig cardiac cells during electric field stimulation

Changes in transmembrane voltage (V(m)) of cardiac cells during electric field stimulation have a complex spatial- and time-dependent behaviour that differs significantly from electrical stimulation of space-clamped membranes by current pulses. A multisite optical mapping system was used to obtain 17 or 25 microm resolution maps of V(m) along the long axis of guinea-pig ventricular cells (n = 57) stained with voltage-sensitive dye (di-8-ANEPPS) and stimulated longitudinally with uniform electric field (2, 5 or 10 ms, 3-62 V cm(-1)) pulses (n = 201). The initial polarizations of V(m) responses (V(mr)) varied linearly along the cell length and reversed symmetrically upon field reversal. The remainder of the V(m) responses had parallel time courses among the recording sites, revealing a common time-varying signal component (V(ms)). V(ms) was depolarizing for pulses during rest and hyperpolarizing for pulses during the early plateau phase. V(ms) varied in amplitude and time course with increasing pulse amplitude. Four types of plateau response were observed, with transition points between the different responses occurring when the maximum polarization at the ends of the cell reached values estimated as 60, 110 and 220 mV. Among the cells that had a polarization change of > 200 mV at their ends (for fields > 45 V cm(-1)), some (n = 17/25) had non-parallel time courses among V(m) recordings of the various sites. This implied development of an intracellular field (E(i)) that was found to increase exponentially with time (tau = 7.2 +/- 3.2 ms). Theoretical considerations suggest that V(ms) represents the intracellular potential (phi(i)) as well as the average polarization of the cell, and that V(mr) is the manifestation of the extracellular potential gradient resulting from the field stimulus. For cells undergoing field stimulation, phi(i) acts as the cellular physiological state variable and substitutes for V(m), which is the customary variable for space-clamped membranes.

Electric field stimulation of cardiac myocytes during postnatal development

Studies on cardiac cell response to electric field stimulation are important for understanding basic phenomena underlying cardiac defibrillation. In this work, we used a model of a prolate spheroidal cell in a uniform external field (Klee and Plonsey, 1976) to predict the threshold electric field (ET) for stimulation of isolated ventricular myocytes of rats at different ages. The model assumes that ET is primarily determined by cell shape and dimensions, which markedly change during postnatal development. Neonatal cells showed very high ET, which progressively decreased with maturation (experimental mean values were 29, 21, 13, and 5.9 and 6.3 V/cm for 3-6, 13-16, 20-21, 28-35, and 120-180 day-old rats, respectively, P < 0.001; theoretical values were 24, 18, 11, 9, and 6 V/cm, respectively). Estimated maximum membrane depolarization at threshold (deltaVT approximately equals 35 mV, under our experimental conditions) was reasonably constant during development, except for cells from 1-mo-old animals, in which deltaVT was lower than at other ages. We conclude that the model reasonably correlates ET with cell geometry and size in most cases. Our results might be relevant for the development of efficient procedures for defibrillation of pediatric patients.

Effects of electrode-myocardial separation on cardiac stimulation in conductive solution

INTRODUCTION

Effects of a conductive bath and electrode-myocardial separation on cardiac stimulation have not been elucidated. These factors may play a role in endocardial catheter stimulation or defibrillation.

METHODS AND RESULTS

We studied effects of a bath and separation on transmembrane voltage changes during stimulation (deltaVm) and excitation thresholds in rabbit hearts, cultured rat cardiac cell monolayers, and cardiac bidomain computer models. Similar to previous epicardial measurements with no bath, a dogbone pattern of deltaVm during stimulation was found in bathed epicardium and right ventricular septal endocardium and in models of bathed anisotropic myocardium. Electrode-myocardial separation altered spatial distributions of deltaVm, moved reversals of the sign of deltaVm farther from the stimulation epicenter, and decreased aspect ratio of deltaVm (i.e., length/width of dogbone contours of deltaVm). The separation increased thresholds and reduced maximal deltaVm, while deltaVm at sites away from maxima increased or decreased. Anodal thresholds in models initially were larger than those in experiments and decreased when models were altered to include nonuniform cellular coupling. Existence of nonuniformity in monolayers was indicated by irregular excitation patterns.

CONCLUSION

Electrode-myocardial separation alters spatial distributions of deltaVm, which may impact on arrhythmia induction by altering distributions of states of deltaVm-sensitive ion channels. The results also indicate that excitation thresholds may depend on tissue nonuniformities.

Ratiometry of transmembrane voltage-sensitive fluorescent dye emission in hearts

Transmembrane voltage-sensitive fluorescence measurements are limited by baseline drift that can obscure changes in resting membrane potential and by motion artifacts that can obscure repolarization. Voltage-dependent shift of emission wavelengths may allow reduction of drift and motion artifacts by emission ratiometry. We have tested this for action potentials and potassium-induced changes in resting membrane potential in rabbit hearts stained with di-4-ANEPPS [Pyridinium, 4-(2-(6-(dibutylamino)-2-naphthalenyl) ethenyl)-1-(3-sulfopropyl)-, hydroxide, inner salt] using laser excitation (488 nm) and a two-photomultiplier tube system or spectrofluorometer (resolution of 500-1,000 Hz and <1 mm). Green and red emissions produced upright and inverted action potentials, respectively. Ratios of green emission to red emission followed action potential contours and exhibited larger fractional changes than either emission alone (P < 0.001). The largest changes and signal-to-noise ratio (signal/noise) were obtained with numerator wavelengths of 525-550 nm and denominator wavelengths of 650-700 nm. Ratiometry lessened drift 56-66% (P < 0.015) and indicated decreases in resting membrane potential. Ratiometry lessened motion artifacts and increased magnitudes of deflections representing phase-zero depolarizations relative to total deflections by 123-188% in intact hearts (P < 0.02). Durations of action potentials at different pacing rates, temperatures, and potassium concentrations were independent of whether they were measured ratiometrically or with microelectrodes (P > or = 0.65). The ratiometric calibration slope was 0.017/100 mV and decreased with time. Thus emission ratiometry lessens the effects of motion and drift and indicates resting membrane potential changes and repolarization.

Evidence for roles of the activating function in electric stimulation

The hypothesis that the activating function drives transmembrane voltage changes (delta Vm) has been tested in hearts. Optical delta Vm were measured during activating functions produced with nonuniform and uniform transparent electrodes. When a nonuniform electrode was used to produce [equation: see text], the signs of delta Vm and [equation: see text] matched. The extracellular voltage gradients, often assumed important, did not predict delta Vm. When a uniform electrode was used to eliminate [equation: see text], the signs of delta Vm matched the signs of [equation: see text] estimated from variations in heart width. Demonstration of the activating function as a determinant of stimulation may improve research and therapy that use electric stimulation.

A simulation study evaluating the performance of high-density electrode arrays on myocardial tissue

Multielectrode arrays used to detect cellular activation have become so dense (electrodes per square millimeter) as to jeopardize the basic assumptions of activation mapping; namely, that electrodes are points adequately separated as to not interfere with the tissue or each other. This paper directly tests these assumptions for high-density electrode arrays. Using a finite element model with modified Fitzhugh-Nagumo kinetics, we represent electrodes as isopotential surfaces of varying widths and spacing ratio (SR) (center-to-center spacing divided by electrode width). We examine the signal strength and ability of a single electrode to detect activation due to a passing wavefront. We find that high-density arrays do not cause significant wavefront curvature or alter activation timing in the underlying tissue. Relationships between signal strength, cross talk, and array design are explained by the interaction of the propagating wavefront and induced sources on the isopotential electrodes. Sensitivity analysis shows that these results may be generalized to a wide range of physiologically relevant designs and applications. We conclude that electrode array designs in which electrode spacing greatly exceeds electrode diameter are overly conservative and that arrays with a SR of less than 2.0 may perform successfully in electrophysiological studies.

Regional differences in arrhythmogenic aftereffects of high intensity DC stimulation in the ventricles

Regional differences of the aftereffects of high intensity DC stimulation were investigated in isolated rabbit hearts stained with a voltage-sensitive dye (di-4-ANEPPS). Optical action potential signals were recorded from the epicardial surface of the right and left ventricular free wall (RVep, LVep) and from the right endocardial surface of the interventricular septum (IVS). Ten-millisecond monophasic DC stimulation (S2, 20-120 V) was applied to the signal recording spots during the early plateau phase of the action potential induced by basic stimuli (S1, 2.5 Hz). There was a linear relationship between S2 voltage and the S2 field intensity (FI). S2 caused postshock additional depolarization, giving rise to a prolongation of the shocked action potential. With S2 > or = 40 V (FI > or = approximately 20 V/cm), terminal repolarization of action potential was inhibited, and subsequent postshock S1 action potentials for 1-5 minutes were characterized by a decrease in the maximum diastolic potential and a decrease in the amplitude and a slowing of their upstroke phase. The higher the S2 voltage, the larger the aftereffects. The changes in postshock action potential configuration in RVep were significantly greater than those observed in LVep and IVS when compared at the same levels of S2 intensity. In RVep, 12 of 20 shocks of 120 V resulted in a prolonged refractoriness to S1 (> 1 s), and the arrest was often followed by oscillation of membrane potential. Ventricular tachycardia or fibrillation ensued from the oscillation in five cases. No such long arrest or serious arrhythmias were elicited in LVep and IVS. These results suggest that RVep is more susceptible than LVep and IVS for arrhythmogenic aftereffects of high intensity DC stimulation.

Virtual electrodes and deexcitation: new insights into fibrillation induction and defibrillation

Previous models of fibrillation induction and defibrillation stressed the contribution of depolarization during the response of the heart to a shock. This article reviews recent evidence suggesting that comprehending the role of negative polarization (hyperpolarization) also is crucial for understanding the response to a shock. Negative polarization can "deexcite" cardiac cells, creating regions of excitable tissue through which wavefronts can propagate. These wavefronts can result in new reentrant circuits, inducing fibrillation or causing defibrillation to fail. In addition, deexcitation can lead to rapid propagation through newly excitable regions, resulting in the elimination of excitable gaps soon after the shock and causing defibrillation to succeed.

The biphasic mystery: why a biphasic shock is more effective than a monophasic shock for defibrillation

We demonstrate that a biphasic shock is more effective than a monophasic shock at eliminating reentrant electrical activity in an ionic model of cardiac ventricular electrical activity. This effectiveness results from early hyperpolarization that enhances the recovery of sodium inactivation, thereby enabling earlier activation of recovering cells. The effect can be seen easily in a model of a single cell and also in a cable model with a ring of excitable cells. Finally, we demonstrate the phenomenon in a two-dimensional model of cardiac tissue.

Roles of electric field and fiber structure in cardiac electric stimulation

This study investigated roles of the variation of extracellular voltage gradient (VG) over space and cardiac fibers in production of transmembrane voltage changes (DeltaV(m)) during shocks. Eleven isolated rabbit hearts were arterially perfused with solution containing V(m)-sensitive fluorescent dye (di-4-ANEPPS). The epicardium received shocks from symmetrical or asymmetrical electrodes to produce nominally uniform or nonuniform VGs. Extracellular electric field and DeltaV(m) produced by shocks in the absolute refractory period were measured with electrodes and a laser scanner and were simulated with a bidomain computer model that incorporated the anterior left ventricular epicardial fiber field. Measurements and simulations showed that fibers distorted extracellular voltages and influenced the DeltaV(m). For both uniform and nonuniform shocks, DeltaV(m) depended primarily on second spatial derivatives of extracellular voltages, whereas the VGs played a smaller role. Thus, 1) fiber structure influences the extracellular electric field and the distribution of DeltaV(m); 2) the DeltaV(m) depend on second spatial derivatives of extracellular voltage.

Optical transmembrane potential recordings during intracardiac defibrillation-strength shocks

BACKGROUND

The prolongation of the action potential after defibrillation-strength shocks is believed to be a critical component of defibrillation. The response of the transmembrane potential to the shock may affect this prolongation. We studied the effects of an intracardiac shock on the transmembrane potential and action potential duration at multiple sites on the epicardium using a voltage-sensitive dye and optical mapping system.

METHODS AND RESULTS

A laser scanner recorded optical action potentials with voltage-sensitive dye at 63 spots on both the left and right ventricles of six isolated, perfused rabbit hearts. Hearts were paced with epicardial point stimulation followed by the delivery of a 2 A and 20 ms rectangular waveform shock during the relative refractory period. The shock was given between right atrial and right ventricular electrodes. Of 621 total spots analyzed, 241 spots hyperpolarized and 76 spots depolarized with a right ventricular anode, whereas 159 spots hyperpolarized and 145 spots depolarized with a right ventricular cathode (P < 0.05). Both hyperpolarized and depolarized spots exhibited prolonged action potential duration, although prolongation was greater with depolarizing responses (16.7 +/- 9 ms vs. 13.3 +/- 13.4 ms, p<0.001). Hyperpolarized and depolarized spots were not randomly distributed, but clustered into regions. The size of the hyperpolarized regions was larger than the depolarized regions with RV anodal stimulation (27 +/- 20 spots/hyperpolarized region vs. 8.5 +/- 9 spots/depolarized region, p < 0.03) but not with RV cathodal stimulation. With reversal of electrode polarity, spots hyperpolarized near the shocking electrodes frequently did not reverse polarization but remained hyperpolarized.

CONCLUSIONS

Distinct regions of either polarization occur during intracardiac defibrillation-strength shocks. Although hyperpolarizing membrane responses were observed more often than depolarizing responses, depolarizing membrane polarization resulted in greater action potential prolongation. The absence of sign change in polarization in some regions with shocks of opposite polarities suggests that nonlinear intrinsic membrane properties are operative during strong electrical stimulation.

Nonuniform responses of transmembrane potential during electric field stimulation of single cardiac cells

The response of cellular transmembrane potentials (V(m)) to applied electric fields is a critical factor during electrical pacing, cardioversion, and defibrillation, yet the coupling relationship of the cellular response to field intensity and polarity is not well documented. Isolated guinea pig ventricular myocytes were stained with a voltage-sensitive fluorescent dye, di-8-ANEPPS (10 microM). A green helium-neon laser was used to excite the fluorescent dye with a 15-micrometers-diameter focused spot, and subcellular V(m) were recorded optically during field stimulation directed along the long axis of the cell. The membrane response was measured at the cell end with the use of a 30-ms S1-S2 coupling interval and a 10-ms S2 pulse with strength of up to approximately 500-mV half-cell length potential (field strength x one-half the cell length). The general trends show that 1) the response of V(m) at the cell end occurs in two stages, the first being very rapid (<1 ms) and the second much slower in time scale, 2) the rapid response consists of hyperpolarization when the cell end faces the anode and depolarization when the cell end faces the cathode, 3) the rapid response varies nonlinearly with field strengths and polarity, being relatively larger for the hyperpolarizing responses, and 4) the slower, time-dependent response has a time course that varies in slope with field strength. Furthermore, the linearity of the dye response was confirmed over a voltage range of -280 to +140 mV by simultaneous measurements of optically and electrically recorded V(m). These experimental findings could not be reproduced by the updated, Luo-Rudy dynamic model but could be explained with the addition of two currents that activate outside the physiological range of voltages: a hypothetical outward current that activates strongly at positive potentials and a second current that represents electroporation of the cell membrane.

Panoramic optical imaging of electrical propagation in isolated heart

Optical imaging of cardiac transmembrane potential in dye-stained tissue is an emerging technique in cardiac electrophysiology. Despite its widespread application to studies of isolated hearts, it has been applied traditionally to recording only a single view that presents the potential distribution of a fraction of the cardiac surface. This poses a significant limitation in studying whole heart electrophysiology, particularly when large-scale phenomena such as fibrillation and defibrillation are of interest. We have developed a panoramic imaging system based on a high-speed charge-coupled device camera with a maximum imaging speed of 335 frames/s at 128×64 pixels/frame. Our system provides one front view and two back mirror views of isolated hearts, thus extending optical imaging capabilities to record from the entire three dimensional heart surface with only one camera. © 1999 Society of Photo-Optical Instrumentation Engineers.

Energy levels for defibrillation: what is of real clinical importance?

Today, transthoracic and intracardiac defibrillation offer a well-accepted and widely used form of therapy for patients with life-threatening ventricular arrhythmias. Despite the wide clinical use of defibrillators, the mechanisms by which an electrical shock halts fibrillation are still not completely understood. During a shock, different amounts of current flow through the different parts of the heart and the current distribution is highly uneven. This current distribution is affected by changes in the shock potential gradient through the heart, changes in fiber orientation, and changes in myocardial conductivity caused by connective tissue barriers. It would be ideal if the potential gradient distribution throughout the ventricles could be measured directly for each individual patient during defibrillator implantation and follow-up and the shock strength could be programmed based on this measurement, but so far this is not possible. A more feasible approach is to determine, by trial and error, the magnitude of the shock strength delivered through the defibrillation electrodes for successful defibrillation. There is no distinct threshold value above which all shocks succeed and below which all shocks fail to defibrillate. Rather, increasing shock strength increases the likelihood the shock will succeed. Therefore, instead of a distinct defibrillation threshold, a probability of success curve exists. However, increasing the shock strength above an optimal range can actually decrease the success rate for defibrillation. One possible explanation is that the high voltage gradients caused by such large shocks damage cells and result in postshock arrhythmias that may reinitiate fibrillation. Another problem that can affect the probability of defibrillation success for a particular programmed energy setting is that the shock strength required for defibrillation may increase over time due to (1) the growth of fibrotic tissue around the defibrillation electrode; (2) migration of the lead; (3) acute ischemia; or (4) other changes in the underlying cardiac disease (e.g., worsening of heart failure). Such possible increases in the defibrillation shock strength requirement should be compensated for before they occur by adding a margin of safety to the shock strength needed for effective defibrillation. When programming an implantable defibrillator, it is important to keep in mind that the defibrillation shock should be (1) strong enough to defibrillate at least 98% of the time with the first shock; (2) weak enough not to cause severe post-shock arrhythmias or reinitiation of fibrillation; but (3) strong enough to compensate for changes of defibrillation energy requirements over time. This usually can be accomplished by setting the defibrillator 7-10 J higher than the defibrillation threshold determined by a standard step-down protocol.

Review of mechanisms by which electrical stimulation alters the transmembrane potential

Electrical stimuli pace, cardiovert, or defibrillate the heart by changing transmembrane potential (deltaVm). Recent simulation studies provide insights into mechanisms by which stimuli establish deltaVm. This review attempts a nonmathematical description of these mechanisms. We start with the cable model in which the intracellular core conductor is bounded by a highly resistive and capacitive membrane that separates the intracellular and extracellular spaces. Intracellular and extracellular resistances are assumed to vary linearly with position. Although this model predicts anodal extracellular stimuli hyperpolarize adjacent tissue and cathodal extracellular stimuli depolarize that tissue, it fails to reproduce regions of opposite deltaVm distant from the electrodes. We then consider the sawtooth model in which microscopic discontinuities in intracellular resistance represent gap junctions. While model studies with such discontinuities demonstrate large deltaVm at cell ends, experimental validation of such deltaVm remains elusive. Extending the analysis to the two- and three-dimensional syncytium, we also consider the bidomain model in which intracellular, extracellular, and interstitial currents are explicitly characterized. Differences in resistance to these currents gives rise to virtual electrodes, which are experimentally observed regions of large deltaVm that arise distant from the stimulating electrode. Distant deltaVm regions are also evident when macroscopic discontinuities in intracellular resistance are introduced into the bidomain model. Such discontinuities are associated with clefts or scars that give rise to "secondary sources." Albeit the cable model offers remarkable insight the bidomain model and the concept of secondary sources provide a more complete understanding of membrane excitation, especially when combined into a unifying activating function.

Field stimulation of isolated chick heart cells: comparison of experimental and theoretical activation thresholds

INTRODUCTION

This study examines the accuracy of using membrane models to predict activation thresholds for chick heart cells during field stimulation.

METHODS AND RESULTS

Activation thresholds were measured experimentally in ten embryonic chick heart cells at 37 degrees C for stimulus durations 0.2 to 40 msec. Activation was assessed by observing the mechanical twitch of the cell. The heart cells ranged in diameter from 15.0 to 26.7 microm. Since the electric field required for activation depends on diameter, the thresholds were expressed as the maximum field-induced transmembrane potential, Vth = 1.5 a Eth, where a is the cell radius and Eth is the strength of the electric field at threshold. A cell model was created using a singular perturbation method and membrane models describing the ionic currents of a heart cell. The study used membrane models of Ebihara and Johnson (1980), Luo and Rudy (1991), Shrier and Clay (1994), and their combinations. The results show that for stimuli longer than 1 msec, theoretical activation thresholds were within one standard deviation of experimental thresholds. For shorter stimuli, the models failed to predict thresholds because of a premature deactivation of the sodium current. The modification of the m gates dynamics, so that they closed with a time constant of 1.4 msec, allowed to predict thresholds for all durations. The root mean square error between experimental and theoretical thresholds was 6.14%.

CONCLUSIONS

The existing membrane models can predict thresholds for field stimulation only for stimuli longer than 1 msec. For shorter stimuli, the models need a more accurate representation of the sodium tail current.

Spatiotemporal effects of syncytial heterogeneities on cardiac far-field excitations during monophasic and biphasic shocks

INTRODUCTION

It has recently been postulated that syncytial (anatomic) heterogeneities inherent within cardiac tissue might represent a significant mechanism underlying field-induced polarization of the bulk myocardium. This simulation study examines and characterizes the spatiotemporal excitatory dynamics associated with this newly hypothesized mechanism.

METHODS AND RESULTS

Two-dimensional regions of syncytially heterogeneous cardiac tissue were simulated with active membrane kinetics. Heterogeneities were manifested via random spatial variations of intracellular volume fractions over multiple length scales. Excitation thresholds were determined for uniform rectangular monophasic (M) and symmetric biphasic (B) far-field stimuli, from which strength-duration and strength-interval relationships were constructed. For regions measuring 5.4 x 5.4 mm, baseline diastolic thresholds for longitudinal (L) and transverse (T) shocks of 5-msec total duration averaged (in V/cm, n = 10) M-L = 2.87+/-0.26, M-T = 6.71+/-0.83, B-L = 3.22+/-0.25, and B-T = 7.93+/-0.51. These thresholds decreased by 15% to 25% when the region sizes were increased to 10.8 x 10.8 mm. Strength-duration relationships correlated strongly with the Weiss-Lapicque hyperbolic relationship, with rheobases and chronaxies of 2.33 V/cm and 1.15 msec for M-L stimuli, and 2.28 V/cm and 2.04 msec for B-L stimuli. Strength-interval relationships for M-L and B-L stimuli decreased monotonically with increasing coupling intervals, with similar minimum coupling intervals at absolute refractoriness. However, the B-L thresholds were substantially less sensitive to changes in coupling intervals than their M-L counterparts.

CONCLUSION

This study provides strong additional support for and understanding of the syncytial heterogeneity hypothesis and its manifested properties. Furthermore, these results predict that syncytial heterogeneities of even modest proportions could represent a significant mechanism contributing to the far-field excitation process.

Transmembrane potential changes caused by monophasic and biphasic shocks

Transmembrane potential change (DeltaVm) during shocks was recorded by a double-barrel microelectrode in 12 isolated guinea pig papillary muscles. After 10 S1 stimuli, square-wave S2 shocks of both polarities were given consisting of 10-ms monophasic and 10/10-ms and 5/5-ms biphasic waveforms that created potential gradients from 1.1 +/- 0.3 to 11.9 +/- 0.4 V/cm. S2 shocks were applied with 30, 60- to 70-, and 90- to 130-ms S1-S2 coupling intervals so that they occurred during the plateau, late portion of the plateau, and phase 3 of the action potential, respectively. Some shocks were given across as well as along the fiber orientation. The shocks caused hyperpolarization with one polarity and depolarization with the opposite polarity. The ratio of the magnitude of hyperpolarization to that of depolarization at the three S1-S2 coupling intervals was 1.5 +/- 0.3, 1.1 +/- 0.2, and 0.5 +/- 0.2, respectively. DeltaVm during the shock was significantly greater for the monophasic than for the two biphasic shocks. The prolongation of total repolarizing time (TRT) was significantly greater for monophasic (119.8 +/- 19.1%) and 10/10-ms biphasic (120.5 +/- 18.2%) than for 5/5-ms biphasic (113.0 +/- 12.9%) waveforms. The dispersion of the normalized TRT between instances of hyperpolarization and depolarization caused by the two shock polarities was 7.4 +/- 7.1% for monophasic, 3.0 +/- 4.1% for 10/10-ms biphasic, and 2.8 +/- 3.1% for 5/5-ms biphasic shocks (P < 0.05 for monophasic vs. biphasic). Shock fields along fibers produced a larger DeltaVm and prolongation of TRT than those across fibers. We conclude that 1) a change in shock polarity causes an asymmetrical change in membrane polarization depending on shock timing; 2) the 5/5-ms biphasic waveform causes the smallest DeltaVm, prolongs repolarization the least, and causes the smallest polarity-dependent dispersion; and 3) the changes in transmembrane potential and repolarization are influenced by fiber orientation.

Virtual electrode effects in defibrillation

This modeling study demonstrates that a re-entrant activity in a sheet of myocardium can be extinguished by a defibrillation shock delivered via extracellular point-source electrodes which establish spatially non-uniform applied field. The tissue is represented as a homogeneous bidomain with unequal anisotropy ratios in the cardiac conductivities. Spiral wave re-entry is initiated in the bidomain sheet following an S1-S2 stimulation protocol. The results indicate that the point-source defibrillation shock establishes large-scale changes in transmembrane potential in the tissue (virtual electrodes) that are 'superimposed' over regions of various degrees of membrane refractoriness in the myocardium. The close proximity of large-scale shock-induced regions of alternating membrane polarity is central to the ability of the shock to terminate the spiral wave. The new wavefronts generated following anode/cathode break phenomena restrict the spiral wave and render the tissue too refractory to further maintain the re-entry. In contrast, shocks delivered via line electrodes establish, in close proximity to the electrode, changes in transmembrane potential that are of same-sign polarity. These shocks are incapable of terminating the re-entrant activation.

Ability of activation recovery intervals to assess action potential duration during acute no-flow ischemia in the in situ porcine heart. Experimental Cardiology Group, University of North Carolina at Chapel Hill

INTRODUCTION

The ability to assess transmural changes in action potential duration during acute no-flow ischemia is essential to an understanding of the tachyarrhythmias that occur in this setting. The purpose of this study was to determine if activation recovery intervals determined from unipolar electrograms would provide this information.

METHODS AND RESULTS

We recorded simultaneously transmembrane action potentials and unipolar electrograms from sites located as closely together as possible in the center and at the lateral margin of the ischemic zone during acute no-flow ischemia and correlated the changes in activation recovery intervals obtained from the unipolar electrograms to the changes in action potential duration. We found that the activation recovery intervals provided an accurate measure of the changes in action potential duration during acute no-flow ischemia provided the electrograms had a well-defined, single negative component to the QRS complex with a maximum negative dV/dt > 10 V/sec and a single positive component to the T wave having a maximum positive dV/dt > 1.6 V/sec. Electrograms meeting these criteria comprised 90% of the electrograms recorded at the margin of the ischemic zone throughout 60 minutes of no-flow ischemia. In the center of the ischemic zone, 75% of the recorded electrograms met these criteria for the first 20 minutes of no-flow ischemia. Thereafter, the percentage declined and after 40 minutes of no-flow ischemia, none of the electrograms recorded in the center of the ischemic zone met these criteria.

CONCLUSION

Activation recovery intervals obtained from unipolar electrograms provide an accurate assessment of changes in action potential duration throughout the ischemic zone during acute no-flow ischemia, provided the characteristics of the electrograms meet specific predetermined criteria.

Postshock potential gradients and dispersion of repolarization in cells stimulated with monophasic and biphasic waveforms

INTRODUCTION

Even though the clinical advantage of biphasic defibrillation waveforms is well documented, the mechanisms that underlie this greater efficacy remain incompletely understood. It is established, though, that the response of relatively refractory cells to the shock is important in determining defibrillation success or failure. We used two computer models of an isolated ventricular cell to test the hypothesis that biphasic stimuli cause a more uniform response than the equivalent monophasic shocks, decreasing the likelihood that fibrillation will be reinduced.

METHODS AND RESULTS

Models of reciprocally polarized and uniformly polarized cells were used. Rapid pacing and elevated [K]o were simulated, and either 10-msec rectangular monophasic or 5-msec/5-msec symmetric biphasic stimuli were delivered in the relative refractory period. The effects of stimulus intensity and coupling interval on response duration and postshock transmembrane potential (Vm) were quantified for each waveform. With reciprocal polarization, biphasic stimuli caused a more uniform response than monophasic stimuli, resulting in fewer large gradients of Vm (only for shock strengths < or = 1.25x threshold vs < or = 2.125x threshold) and a smaller dispersion of repolarization (1611 msec2 vs 1835 msec2). The reverse was observed with uniform polarization: monophasic pulses caused a more uniform response than did biphasic stimuli.

CONCLUSION

These results show that the response of relatively refractory cardiac cells to biphasic stimuli is less dependent on the coupling interval and stimulus strength than the response to monophasic stimuli under conditions of reciprocal polarization. Because this may lead to fewer and smaller spatial gradients in Vm, these data support the hypothesis that biphasic defibrillation waveforms will be less likely to reinduce fibrillation. Further, published experimental results correlate to a greater degree with conditions of reciprocal polarization than of uniform polarization, providing indirect evidence that interactions between depolarized and hyperpolarized regions play a role in determining the effects of defibrillation shocks on cardiac tissue.

Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model

Clinical studies show that polarity reversal affects defibrillation success in transvenous monophasic defibrillators. Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In nine anesthetized, ventilated pigs, the defibrillation efficacy of biphasic shocks (14.3 ms and 10.8 ms pulse duration) with "initial polarity" (IP, distal electrode = cathode) and "reversed polarity" (RP, distal electrode = anode) delivered via a transvenous/subcutaneous lead system was compared. Voltage and current of each defibrillating pulse were recorded on an oscilloscope and impedance calculated as voltage divided by current. Cumulative defibrillation success was significantly higher for RP than for IP for both pulse durations (55% vs 44%, P = 0.019) for 14.3 ms (57% vs 45%, P < 0.05) and insignificantly higher for 10.8 ms (52% vs 42%, P = ns). Impedance was significantly lower with RP at the trailing edge of pulse 1 (IP: 44 +/- 8.4 vs RP: 37 +/- 9.3 with 14.3 ms, P < 0.001 and IP: 44 +/- 6.2 vs RP: 41 +/- 7.6 omega with 10.8 ms, P < 0.001) and the leading edge of pulse 2 (IP: 37 +/- 5 vs RP: 35 +/- 4.2 omega with 14.3 ms, P = 0.05 and IP: 37.5 +/- 3.7 vs RP: 36 +/- 5 omega with 10.8 ms, P = 0.02). In conclusion, in this animal model, internal defibrillation using the distal coil as anode results in higher defibrillation efficacy than using the distal coil as cathode. Calculated impedances show different courses throughout the shock pulses suggesting differences in current flow during the shock.

Deexcitation of cardiac cells

Excitation and deexcitation are fundamental phenomena in the electrophysiology of excitable cells. Both of them can be induced by stimulating a cell with intracellularly injected currents. With extracellular stimulation, deexcitation was never observed; only cell excitation was found. Why? A generic model with two variables (FitzHugh) predicts that an extracellular stimulus can both excite the cell and terminate the action potential (AP). Our experiments with single mouse myocytes have shown that short (2-5 ms) extracellular pulses never terminated the AP. This result agrees with our numerical experiments with the Beeler-Reuter model. To analyze the problem, we exploit the separation of time scales to derive simplified models with fewer equations. Our analysis has shown that the very specific form of the current-voltage (I-V) characteristics of the time-independent potassium current (almost no dependence on voltage for positive membrane potentials) is responsible here. When the shape of the I-V characteristics of potassium currents was modified to resemble that in ischemic tissues, or when the external potassium concentration (K0) is increased, the AP was terminated by extracellular pulses. These results may be important for understanding the mechanisms of defibrillation.

Progressive depolarization: a unified hypothesis for defibrillation and fibrillation induction by shocks

Experimental studies of defibrillation have burgeoned since the introduction of the upper limit of vulnerability (ULV) hypothesis for defibrillation. Much of this progress is due to the valuable work carried out in pursuit of this hypothesis. The ULV hypothesis presented a unified electrophysiologic scheme for linking the processes of defibrillation and shock-induced fibrillation. In addition to its scientific ramifications, this work also raised the possibility of simpler and safer means for clinical defibrillation threshold testing. Recent results from an optical mapping study of defibrillation suggest, however, that the experimental data supporting the ULV hypothesis could instead be interpreted in a manner consistent with traditional views of defibrillation such as the critical mass hypothesis. This review will describe the evidence calling for such a reinterpretation. In one regard the ULV hypothesis superseded the critical mass hypothesis by linking the defibrillation and shock-induced fibrillation processes. Therefore, this review also will discuss the rationale for developing a new defibrillation hypothesis. This new hypothesis, progressive depolarization, uses traditional defibrillation concepts to cover the same ground as the ULV hypothesis in mechanistically unifying defibrillation and shock-induced fibrillation. It does so in a manner consistent with experimental data supporting the ULV hypothesis but which also takes advantage of what has been learned from optical studies of defibrillation. This review will briefly describe how this new hypothesis relates to other contemporary viewpoints and related experimental results.

Optical mapping of cardiac electrical stimulation

Optical mapping has been used to determine changes in transmembrane voltage during electrical stimulation pulses (deltaVm) and whether deltaVm depends on fiber orientation, as predicted from bidomain models. Fiber orientation in an approximately 1 cm2 mm mapped region on the rabbit left or right ventricular epicardium was estimated optically from the fast axis of action potential (AP) propagation. Hearts were paced outside of the region to produce APs. Unipolar stimulation (S2) was then applied early in the AP, when tissue was refractory, so that deltaVm was not obscured by a new AP. Anodal S2 produced negative deltaVm near a point S2 electrode and away from it in the direction perpendicular to the fibers. Anodal S2 produced reversal of the sign of deltaVm about 1 mm from the electrode in the direction parallel to the fibers, such that a positive deltaVm existed about 1-5 mm away from the electrode. Reversal of the sign of deltaVm in the direction parallel to the fibers also occurred with cathodal S2, which produced a negative deltaVm away from the electrode parallel to the fibers. The results indicate a "dogbone" pattern of deltaVm, as predicted from bidomain models that have resistance anisotropy ratios of trabecular muscles (ie, an intracellular ratio that does not equal the extracellular ratio). Thus, optical mapping can indicate fiber orientation and deltaVm, and the deltaVm during unipolar stimulation reverses sign on the axis parallel to the fibers, which differs from one-dimensional model predictions. The deltaVm agrees with multidimensional bidomain model predictions that have unequal resistance anisotropy.