Excitable cells can exhibit complex patterns of oscillations, such as spiking and bursting. In cardiac cells, pathological voltage oscillations, called early afterdepolarizations (EADs), have been widely observed under disease conditions, yet their dynamical mechanisms remain unknown. Here, we show that EADs are caused by Hopf and homoclinic bifurcations. During period pacing, chaos always occurs at the transition from no EAD to EADs as the stimulation frequency decreases, providing a novel explanation for the irregular EAD behavior frequently observed in experiments.Complex oscillatory behaviors, such as spiking and bursting dynamics in pancreatic β-cells [1], neurons [1][2][3][4][5], and optical lasers [6], are common phenomena in excitable systems. These complex dynamics are generally described by systems with fast and slow time scales, where the full system behavior can be described by slow dynamics evolving the fast subsystem through a series of bifurcations [1,2]. Cardiac myocytes can exhibit pathological excitations called early afterdepolarizations (EADs), which are voltage oscillations during the repolarizing phase of the action potential (AP). They have been implicated as a cause of lethal cardiac arrhythmias [7][8][9] and have been widely investigated in experiments [8,[10][11][12] and also in simulations [13][14][15][16]. It is commonly agreed that EADs occur when inward (depolarizing) currents are increased and/or outward (repolarizing) currents are decreased. But many such changes do not produce EADs, and the general underlying dynamical mechanism still remains unknown. In single myocytes, EADs typically occur irregularly [10][11][12], which is generally attributed to random fluctuations of the underlying ion channels [13]. In a recent study [16], we presented evidence from isolated myocyte experiments and computational simulations that irregular EAD behavior is not random, but rather dynamical chaos, and gives rise to novel tissue scale dynamics.EADs have typically been studied in computational simulations using highly detailed AP models making dynamical analysis difficult [13][14][15][16] Dynamical origin of EADsThere are typically three time scales in a normal cardiac AP. The sodium (Na) current activates very rapidly, causing the fast upstroke of the AP, and then rapidly inactivates. The L-type calcium (Ca) current activates and inactivates more slowly than the Na current, playing a key role in maintaining the long AP plateau. Time-dependent potassium (K) currents activate even more slowly and eventually overcome the inward currents, repolarizing the cell back to the resting potential. EADs have typically been studied using highly detailed AP models [13][14][15][16] where C m = 1 µF/cm 2 ; I Na is the Na current; We set E si = 80 mV and E K = −77 mV. To study the effects of the time constants for the gating variables d, f, and x on the AP dynamics, we change these time constants by multiplying them by a scalar factor, i.e.,, and τ x (V) → γτ x (V). We refer to this modified LR1 model ...

Ventricular fibrillation is the leading cause of sudden cardiac death. In fibrillation, fragmented electrical waves meander erratically through the heart muscle, creating disordered and ineffective contraction. Theoretical and computer studies, as well as recent experimental evidence, have suggested that fibrillation is created and sustained by the property of restitution of the cardiac action potential duration (that is, its dependence on the previous diastolic interval). The restitution hypothesis states that steeply sloped restitution curves create unstable wave propagation that results in wave break, the event that is necessary for fibrillation. Here we present experimental evidence supporting this idea. In particular, we identify the action of the drug bretylium as a prototype for the future development of effective restitution-based antifibrillatory agents. We show that bretylium acts in accord with the restitution hypothesis: by flattening restitution curves, it prevents wave break and thus prevents fibrillation. It even converts existing fibrillation, either to a periodic state (ventricular tachycardia, which is much more easily controlled) or to quiescent healthy tissue.

Background-T-wave alternans, which is associated with the genesis of cardiac fibrillation, has recently been related to discordant action potential duration (APD) alternans. However, the cellular electrophysiological mechanisms responsible for discordant alternans are poorly understood. Methods and Results-We simulated a 2D sheet of cardiac tissue using phase 1 of the Luo-Rudy cardiac action potential model. A steep (slope Ͼ1) APD restitution curve promoted concordant APD alternans and T-wave alternans without QRS alternans. When pacing was from a single site, discordant APD alternans occurred only when the pacing rate was fast enough to engage conduction velocity (CV) restitution, producing both QRS and T-wave alternans. Tissue heterogeneity was not required for this effect. Discordant alternans markedly increases dispersion of refractoriness and increases the ability of a premature stimulus to cause localized wavebreak and induce reentry. In the absence of steep APD restitution and of CV restitution, sustained discordant alternans did not occur, but reentry could be induced if there was marked electrophysiological heterogeneity. Both discordant APD alternans and preexisting APD heterogeneity facilitate reentry by causing the waveback to propagate slowly. Conclusion-Discordant alternans arises dynamically from APD and CV restitution properties and markedly increases dispersion of refractoriness. Preexisting and dynamically induced (via restitution) dispersion of refractoriness independently increase vulnerability to reentrant arrhythmias. Reduction of dynamically induced dispersion by appropriate alteration of electrical restitution has promise as an antiarrhythmic strategy. (Circulation.

Mathematical modeling of the cardiac action potential has proven to be a powerful tool for illuminating various aspects of cardiac function, including cardiac arrhythmias. However, no currently available detailed action potential model accurately reproduces the dynamics of the cardiac action potential and intracellular calcium (Ca(i)) cycling at rapid heart rates relevant to ventricular tachycardia and fibrillation. The aim of this study was to develop such a model. Using an existing rabbit ventricular action potential model, we modified the L-type calcium (Ca) current (I(Ca,L)) and Ca(i) cycling formulations based on new experimental patch-clamp data obtained in isolated rabbit ventricular myocytes, using the perforated patch configuration at 35-37 degrees C. Incorporating a minimal seven-state Markovian model of I(Ca,L) that reproduced Ca- and voltage-dependent kinetics in combination with our previously published dynamic Ca(i) cycling model, the new model replicates experimentally observed action potential duration and Ca(i) transient alternans at rapid heart rates, and accurately reproduces experimental action potential duration restitution curves obtained by either dynamic or S1S2 pacing.

The extreme sensitivity to initial conditions that chaotic systems display makes them unstable and unpredictable. Yet that same sensitivity also makes them highly susceptible to control, provided that the developing chaos can be analyzed in real time and that analysis is then used to make small control interventions. This strategy has been used here to stabilize cardiac arrhythmias induced by the drug ouabain in rabbit ventricle. By administering electrical stimuli to the heart at irregular times determined by chaos theory, the arrhythmia was converted to periodic beating.