The following is an (more or less unedited) excerpt from my dissertation, which is in progress. It is a more in-depth version of the introduction to this paper, of which I am one of the two “first” authors.
Category Archives: Cardiac Electrophysiology
Penetration of a Re-entrant Wave From a Distant Pacing Location
The following is an (more or less unedited) excerpt from my dissertation, which is in progress. It continues where this post left off.
ATP Peeling
Progressive movement of collision location between two wave sources of different frequencies. Each horizontal line schematically represents the one-dimensional space between two wave sources. Curved lines represent wavefronts. Source B has a more rapid frequency than source A, so the location of collision moves progressively toward A with each iteration of the cycle (N).
In anti-tachycardia pacing, however, it is nearly impossible to target the core of re-entry in this fashion – pacing must be applied from a distant source. The core can therefore only be reached if stimulation is applied at a frequency more rapid than the intrinsic frequency of the re-entrant wave. This principle is illustrated schematically in the figure above. Each line between sources A and B represents the one-dimensional space in which wavefront collisions play out when the sources have different frequencies. In this example, conduction velocity is assumed to be constant, and both sources begin creating wavefronts at the same time for the sake of explanation. The concept holds even if they do not, but the position is shifted in one direction or the other depending on the difference in start time. The iterations (N) move from 1 through 6, indicating the first through sixth wavefront collisions. In this example, source B has a slightly higher frequency than source A. As such, wavefront collision proceeds as follows. On iteration 1, each source produces a wavefront at the same time. The waves travel with equal velocity toward each other, colliding in the middle of the space, and both are terminated. On iteration 2, B initiates a wave slightly before A, and so that wave has a longer period of time to travel before it encounters the wave from A. The region of collision is therefore shifted toward A a bit. On iteration 3, the head start of the wave from B in iteration 2 has been doubled, and so the region of collision is shifted twice as far toward A as it was in iteration 2. This continues in iterations 4 and 5, until in iteration 6, the wavefront reaches source A before it has an opportunity to initiate a wave. In cardiac tissue, this would result in overdrive stimulation of site A, and it would no longer initiate its own waves as long as B continued producing them and they continued to reach A.
Thus, if A is the re-entrant wave and B is the site of anti-tachycardia pacing, the core of the re-entry at A will be reached within 6 paced beats, and re-entry will be terminated. However, if the situation is reversed and B is the re-entrant wave, the site of anti-tachycardia pacing will quickly be overdriven and the therapy will be ineffective. Furthermore, if some region between A and B cannot support the higher frequency of activation produced by a sufficiently-fast anti-tachycardia pacing therapy, the therapy will be blocked from reaching the core of the re-entrant wave. These difficulties with anti-tachycardia pacing can, however, be circumvented while using an electrode distant from the site of re-entry, using the technique of far-field stimulation.
This example was inspired by a conversation with Dr.Valentin Krinsky
Resetting and Termination of Re-entry in a Ring
The following is an (more or less unedited) excerpt from my dissertation, which is in progress.
Resetting and termination in a ring
Gradients run from most recently activated (black) to recovering (grey) to recovered (white). Black dots indicate locations of stimulus application. Black lines indicate propagation of activation from the region of the applied stimulus. Flat line endings mark termination of propagation, while the black arrow represents continued propagation. A: Resetting of re-entry in a ring following stimulus application in the excitable gap. B: Termination of re-entry in a ring following stimulus application in the excitable gap.
The classic model of re-entry is the one-dimensional system of a wave propagating within a ring composed of an excitable medium (see figure above). If the ring is longer than the wavelength of the wave of excitation, there will be an excitable gap between the tail of the wave and the head (white regions in figure). A stimulus applied in that gap can either reset or terminate re-entry. Resetting occurs when the stimulus results in an orthodromic wave (that is, moving in the same direction as the original wave) and an antidromic wave (that is, moving in the opposite direction from the original wave) in the excitable gap and the following happens: the antidromic wave collides with the original wavefront and terminates it, while the orthodromic wave follows the recovering tail of the original wave and becomes the starting point of a new re-entrant wave (figure panel A). If, however, the orthodromic wave collides with the recovering tail of the original wave and terminates, then re-entry will be terminated entirely (figure panel B). Thus, if a stimulus were applied at the appropriate time and position to consume the excitable gap, it would terminate re-entry.
Interesting aside. I was at first stumped on how to make ring gradients like what you see above. I used a combination of what I found here and going back and forth from GIMP to OmniGraffle Pro. They key appears to be the use of an asymmetrical conical gradient in GIMP.
Hiatus
After a valiant attempt to keep up a regular posting schedule starting in January and lasting until about March, this blog has been on an unofficial hiatus for a while. I’m making it official today.
I am a new (as in recent) homeowner, I’m trying to graduate, I moved across the country, and I have a baby arriving in two months. This morning I had an epiphany — even though I try to keep anything that’s not immediately important in my Someday/Maybe category (in GTD), all kinds of things had crept in to my active system that were not pressing. A number of those things were blog post topics for VirtuallyShocking. After doing an aggressive move of many items to the Someday category, my active, actionable items dropped from about 80 to 35, and I can see now looking at the list that it will be much easier to retain my focus.
I’ve never been a terribly prolific blogger — this is mostly a diary blog, despite my best intentions to the contrary. In that vein, it will continue. I’ll probably keep up with the hearty Friday posts and occasional updates. Part of the reason for this is that most of the cardiac electrophysiology stuff that I’ve really wanted to blog about, I can’t, because the stuff I’m excited about is stuff I’m working on. That stuff generally needs to remain private until the related papers are published, at which point I’m generally already more excited about the next thing, and not interested in talking about the older stuff.
Hopefully once I graduate that will start to change, and I can build this blog the way I’ve really wanted to.
Hearty Friday – Ott et al.
I have a special Hearty Friday for you today. Recently, there was a very cool paper published in Nature by some people at the University of Minnesota, Harvard, and several other institutions.
The HubMed page is here, the Nature Medicine page is here.
I plan to review this article at some point, but for now, here’s a picture of their recellularized scaffold. That is, they took an animal heart, washed all of the cells out, leaving the fibrous scaffold, and put cells back in, letting them grow back into a beating “heart”. This is snapped from Figure 4 of their paper.
