Spatial and temporal linking of epicardial activation directions during ventricular fibrillation in dogs. Evidence for underlying organization.

Damle, Roger S.; Kanaan, Nabil; Robinson, Nikki; Ge, Yu Zhi; Goldberger, Jeffrey J.; Kadish, Alan H.

doi:10.1161/01.cir.86.5.1547

Cited by 63 publications

(27 citation statements)

References 24 publications

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“…Although Sir Thomas Lewis stated (1) that during fibrillation, "the pauses betwixt the beats bear no relationship to one another," recent studies of fibrillation have revealed organized behavior, consisting of propagating wavefronts meandering through the myocardium in complex patterns (2,3). High-resolution mapping and other studies have detected local spatio-temporal correlations (3)(4)(5) and other evidence of determinism (6) during fibrillation, suggesting that the underlying process is not completely random. It is therefore tempting to speculate that fibrillation is deterministic chaos, especially since definitive evidence of chaos has been found in some simpler cardiac arrhythmias (7)(8)(9).…”

Section: Introductionmentioning

confidence: 75%

Quasiperiodicity and chaos in cardiac fibrillation.

et al. 1997

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In cardiac fibrillation, disorganized waves of electrical activity meander through the heart, and coherent contractile function is lost. We studied fibrillation in three stationary forms: in human chronic atrial fibrillation, in a stabilized form of canine ventricular fibrillation, and in fibrillationlike activity in thin sheets of canine and human ventricular tissue in vitro. We also created a computer model of fibrillation. In all four studies, evidence indicated that fibrillation arose through a quasiperiodic stage of period and amplitude modulation, thus exemplifying the "quasiperiodic transition to chaos" first suggested by Ruelle and Takens. This suggests that fibrillation is a form of spatio-temporal chaos, a finding that implies new therapeutic approaches. ( J. Clin. Invest. 1997. 99:305-314.)

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Section: Introductionmentioning

confidence: 75%

Quasiperiodicity and chaos in cardiac fibrillation.

et al. 1997

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“…However, other work has questioned the chaotic fibrillation hypothesis (45,46). The current prevailing theory (47), supported by a range of mathematical (48)(49)(50)(51)(52)(53)(54)(55)(56), in vitro (57)(58)(59), and in vivo (57,(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) studies, is that fibrillation is a complex nonlinear combination of stochastic and deterministic components, such as scroll waves of electrical activity meandering within the ventricular wall. Given this body of evidence, it is apparent that fibrillation is characterized by high-dimensional nonstationary spatiotemporal dynamics that are too complex for current nonlinear-dynamical control techniques.…”

Section: Discussionmentioning

confidence: 99%

Nonlinear-dynamical arrhythmia control in humans

Christini

Steín²,

Markowitz³

et al. 2001

Proc. Natl. Acad. Sci. U.S.A.

114

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Nonlinear-dynamical control techniques, also known as chaos control, have been used with great success to control a wide range of physical systems. Such techniques have been used to control the behavior of in vitro excitable biological tissue, suggesting their potential for clinical utility. However, the feasibility of using such techniques to control physiological processes has not been demonstrated in humans. Here we show that nonlinear-dynamical control can modulate human cardiac electrophysiological dynamics by rapidly stabilizing an unstable target rhythm. Specifically, in 52͞54 control attempts in five patients, we successfully terminated pacing-induced period-2 atrioventricular-nodal conduction alternans by stabilizing the underlying unstable steady-state conduction. This proof-of-concept demonstration shows that nonlinear-dynamical control techniques are clinically feasible and provides a foundation for developing such techniques for more complex forms of clinical arrhythmia.I ncreasingly, it is recognized that many cardiac arrhythmias can be characterized on the basis of the physical principles of nonlinear dynamics (1, 2). A nonlinear-dynamical system is one that changes with time and cannot be broken down into a linear sum of its individual components. For certain nonlinear systems, known as chaotic systems, behavior is aperiodic and long-term prediction is impossible, even though the dynamics are entirely deterministic (i.e., the dynamics of the system are completely determined from known inputs and the previous state of the system, with no influence from random inputs). Importantly, such determinism actually can be exploited to control the dynamics of a chaotic system. To this end, a variety of nonlineardynamical control techniques, also known as chaos control, ‡ have been developed (3, 4) and applied successfully to a wide range of physical systems (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Such techniques are modelindependent, i.e., they require no a priori knowledge of the underlying equations of a system and are therefore appropriate for systems that are essentially ''black boxes.''The success of nonlinear-dynamical control techniques in stabilizing physical systems, together with the facts that many physiological systems are nonlinear (e.g., the cardiac conduction system, because of its numerous complex nonlinear component interactions) and lack the detailed analytical system models required for model-based control techniques, have fostered widespread interest in applying these model-independent techniques to biological dynamical systems (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). In a pioneering application, Garfinkel et al. (15) stabilized drug-induced irregular cardiac rhythms by means of dynamically timed electrical stimulation in an in vitro rabbit ventricular-tissue preparation. That work was an important demonstration that the physical principles of nonlinear-dynamical control could be extended into the realm of cardiac dynamics. Although extension of that work to the control of fibrill...

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“…In experimental conditions, use of spatial analysis confirms features of a chaotic process for VT [5,18]. Theoretical and experimental workindicates that by using leads that record signals from local myocardial areas beyond the scope of ECG detection, make it possible to identify a chaotic state.…”

Section: Such An Approach May Open New Directions In Thementioning

confidence: 72%

“…Only after additional information offered by spatial analysis was taken into consideration, did it become possible to show an organized electrical activity during VF, with accompanying attributes that indicated determinism [5].…”

Section: Introductionmentioning

confidence: 99%