Mechanisms of vortices termination in the cardiac muscle

TL;DR

This paper introduces a method using electric field pulses to terminate multiple vortices in cardiac tissue, providing a physical basis for developing low-energy defibrillation techniques by targeting vortices underlying fibrillation.

Contribution

It presents a novel approach to terminate multiple cardiac vortices without knowing their locations, advancing understanding of fibrillation mechanisms and defibrillation strategies.

Findings

Electric pulses can guarantee vortex termination under certain conditions.

Success rate for terminating multiple vortices depends on vortex frequency differences.

Experimental evidence from pig hearts supports the role of hidden vortices in fibrillation.

Abstract

We propose a solution to a long standing problem: how to terminate multiple vortices in the heart, when the locations of their cores and their critical time windows are unknown. We scan the phases of all pinned vortices in parallel with electric field pulses (E-pulses). We specify a condition on pacing parameters that guarantees termination of one vortex. For more than one vortex with significantly different frequencies, the success of scanning depends on chance, and all vortices are terminated with a success rate of less than one. We found that a similar mechanism terminates also a free (not pinned) vortex. A series of about 500 experiments with termination of ventricular fibrillation by E-pulses in pig isolated hearts is evidence that pinned vortices, hidden from direct observation, are significant in fibrillation. These results form a physical basis needed for the creation of new effective low energy defibrillation methods based on the termination of vortices underlying fibrillation.