The dynamics of cardiac fibrillation

James N. Weiss, Zhilin Qu, Peng Sheng Chen, Shien Fong Lin, Hrayr S. Karagueuzian, Hideki Hayashi, Alan Garfinkel, Alain Karma

Research output: Contribution to journalArticle

248 Scopus citations

Abstract

Reentry occurs when the electrical wave propagating through the atria or ventricles breaks locally and forms a rotor (also called a scroll wave or functional reentry). If the waves propagating outward from a rotor develop additional wavebreaks (which may form new rotors), fibrillation results. Tissue heterogeneity, exacerbated by electrical and structural remodeling from cardiac disease, has traditionally been considered the major factor promoting wavebreak and its degeneration to fibrillation. Recently, however, dynamic factors have also been recognized to play a key role. Dynamic factors refer to cellular properties of the cardiac action potential and Ca; cycling, which dynamically generate wave instability and wavebreak, even in tissue that is initially completely homogeneous. Although the latter situation can only be created in computer simulations, its relevance to real (heterogeneous) cardiac tissue has been unequivocally demonstrated. Dynamic factors are related to membrane voltage (Vm) and Cai. Vm factors include electrical restitution of action potential duration and conduction velocity, short-term cardiac memory, and electrotonic currents. Cai factors are related to dynamic Cai cycling properties. They act synergistically, as well as with tissue heterogeneity, to promote wavebreak and fibrillation. As global properties, rather than local electrophysiological characteristics, dynamic factors represent an attractive target for novel therapies to prevent ventricular fibrillation.

Original languageEnglish (US)
Pages (from-to)1232-1240
Number of pages9
JournalCirculation
Volume112
Issue number8
DOIs
StatePublished - Aug 23 2005
Externally publishedYes

Keywords

  • Action potentials
  • Antiarrhythmia agents
  • Calcium
  • Death, sudden
  • Fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Weiss, J. N., Qu, Z., Chen, P. S., Lin, S. F., Karagueuzian, H. S., Hayashi, H., Garfinkel, A., & Karma, A. (2005). The dynamics of cardiac fibrillation. Circulation, 112(8), 1232-1240. https://doi.org/10.1161/CIRCULATIONAHA.104.529545